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https://www.readbyqxmd.com/read/28904676/-gestational-diabetes-revealed-by-inaugural-diabetic-ketoacidosis-about-a-case
#1
Serge Irie Bi Gohi, Pete Yaich, Koffi N'guessan, Bernard Ogondon, Yapo Brouh
Ketoacidosis complicating gestational diabetes is rare and responsible for severe maternal-fetal mortality. It is an acute metabolic emergency whose management is multidisciplinary. Early diagnosis and treatment affect the vital prognosis of both the mother and the fetus. We report the case of a 27-year old pregnant woman at term, with a family history of diabetes, admitted to the emergency obstetric care with alertness problems associated with dyspnoea. The diagnosis of inaugural ketoacidosis decompensated due to severe malaria associated with gestational diabetes was retained on the basis of patient's medical history, of clinical examination and paraclinical assessment...
2017: Pan African Medical Journal
https://www.readbyqxmd.com/read/28895701/management-of-cirrhotic-ascites-in-children-review-and-recommendations-part-2-electrolyte-disturbances-nonelectrolyte-disturbances-therapeutic-options
#2
David F Bes, M Cristina Fernández, Ivone Malla, Horacio A Repetto, Daniel Buamscha, Susana López, Roxana Martinitto, Miriam Cuarterolo, Fernando Alvarez
Ascites is a major complication of cirrhosis. There are several evidence-based articles and guidelines for the management of adults, but few data have been published in relation to children. In the case of a pediatric patient with cirrhotic ascites (PPCA), the following questions are raised: How are the clinical assessment and ancillary tests performed? When is ascites considered refractory? How is it treated? Should fresh plasma and platelets be infused before abdominal paracentesis to prevent bleeding? What are the hospitalization criteria? What are the indicated treatments? What complications can patients develop? When and how should hyponatremia be treated? What are the diagnostic criteria for spontaneous bacterial peritonitis? How is it treated? What is hepatorenal syndrome? How is it treated? When should albumin be infused? When should fluid intake be restricted? The recommendations made here are based on pathophysiology and suggest the preferred approach to diagnostic and therapeutic aspects, and preventive care...
October 1, 2017: Archivos Argentinos de Pediatría
https://www.readbyqxmd.com/read/28894410/life-threatening-dyskalaemia-after-barbiturate-coma-therapy-the-strategy-of-management
#3
Yeap Boon Tat, Wan Mohd Nazaruddin Wan Hassan, Ting Yung Chuen, Abdul Rahman Izaini Ghani
Barbiturate coma therapy (BCT) is a treatment option that is used for refractory intracranial hypertension after all other options have been exhausted. Although BCT is a brain protection treatment, it also has several side effects such as hypotension, hepatic dysfunction, renal dysfunction, respiratory complications and electrolyte imbalances. One less concerning but potentially life-threatening complication of BCT is dyskalaemia. This complication could present as severe refractory hypokalaemia during the therapy with subsequent rebound hyperkalaemia after cessation of the therapy...
March 2017: Malaysian Journal of Medical Sciences: MJMS
https://www.readbyqxmd.com/read/28893450/emergency-medicine-evaluation-and-management-of-the-end-stage-renal-disease-patient
#4
REVIEW
Brit Long, Alex Koyfman, Courtney M Lee
BACKGROUND: End stage renal disease (ESRD) is increasing in the U.S., and these patients demonstrate greater all-cause mortality, cardiovascular events, and hospitalization rates when compared to those with normal renal function. These patients may experience significant complications associated with loss of renal function and dialysis. OBJECTIVE: This review evaluates complications of ESRD including cardiopulmonary, neurologic, infectious disease, vascular, and access site complications, as well as medication use in this population...
September 5, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28892994/life-threatening-severe-hypernatraemic-dehydration-in-neonates-a-report-of-two-cases
#5
Priyaja Paramasivam, Sujay Kumar Earan, Arulkumaran Arunagirinadhan, Shilpa Kantamneni
Hypernatraemic dehydration in neonates may lead to potentially lethal consequences like cerebral oedema, intracranial haemorrhage, hydrocephalus and gangrene. In the light of increase in the infants presenting with hypernatraemic dehydration, there is a definitive need to heighten the awareness and have a high degree of suspicion in diagnosis for this potentially lethal condition. We report two neonates of severe hypernatraemia with dehydration highlighting its diagnosis and management. Treatment of hypernatraemic dehydration involves correction of electrolyte imbalance by careful restoration of fluids and ensuring appropriate intake of calories...
July 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28892600/the-suspect-siadh
#6
Kristen Tee, Jerry Dang
BACKGROUND: Hyponatraemia is one of the most commonly encountered electrolyte abnormalities in general practice. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is an important but under-recognised cause. OBJECTIVE: This article explores the presentation, investigation, diagnosis and management of SIADH. DISCUSSION: SIADH can occur secondary to medications, malignancy, pulmonary disease, or any disorder involving the central nervous system...
September 2017: Australian Family Physician
https://www.readbyqxmd.com/read/28883217/safety-and-efficacy-of-long-term-use-of-tolvaptan-in-patients-with-heart-failure-and-chronic-kidney-disease
#7
Yusuke Uemura, Rei Shibata, Kenji Takemoto, Tomohiro Uchikawa, Masayoshi Koyasu, Shinji Ishikawa, Ryo Imai, Yuta Ozaki, Takashi Watanabe, Tsubasa Teraoka, Masato Watarai, Toyoaki Murohara
BACKGROUND: We assessed the long-term safety and efficacy of tolvaptan in 102 patients with heart failure (HF) and chronic kidney disease (CKD). Median follow-up duration was 1.6 years (1.0-4.4 years).Methods and Results:One patient discontinued tolvaptan because of hypernatremia. There were no changes in renal function or electrolytes during the 1-year follow-up. The cardiac-related death-free or HF-related hospitalization-free survival rate was significantly higher in patients receiving tolvaptan than in propensity score-matched patients who did not receive tolvaptan...
September 5, 2017: Circulation Journal: Official Journal of the Japanese Circulation Society
https://www.readbyqxmd.com/read/28879182/vasopressin-receptor-antagonists-in-hyponatremia-uses-and-misuses
#8
REVIEW
Helbert Rondon-Berrios, Tomas Berl
Decreases in the concentration of sodium in plasma constitute hyponatremia, the commonest electrolyte disorder in clinical medicine. It is now well established that its presence conveys an increased mortality risk even when the decrement is mild. In addition, recent evidence suggests that chronic and apparently asymptomatic hyponatremia is associated with increased morbidity including neurocognitive deficits and bone fractures. Furthermore, hyponatremia is associated with higher health care-related expenses...
2017: Frontiers in Medicine
https://www.readbyqxmd.com/read/28878933/comparison-of-a-two-bag-system-versus-conventional-treatment-protocol-one-bag-system-in-the-management-of-diabetic-ketoacidosis
#9
Iqbal Munir, Ramiz Fargo, Roger Garrison, Almira Yang, Andy Cheng, Ilho Kang, Ali Motabar, Karen Xu, Lawrence K Loo, Daniel I Kim
OBJECTIVE: We compared the conventional 'one-bag protocol' of management of diabetic ketoacidosis (DKA) with the 'two-bag protocol' which utilizes two bags of fluids, one containing saline and supplemental electrolytes and the other containing the same solution with the addition of 10% dextrose. RESEARCH DESIGN AND METHODS: A retrospective chart review and analysis was done on adult patients admitted for DKA to the Riverside University Health System Medical Center from 2008 to 2015...
2017: BMJ Open Diabetes Research & Care
https://www.readbyqxmd.com/read/28871118/durable-and-self-hydrating-tungsten-carbide-based-composite-polymer-electrolyte-membrane-fuel-cells
#10
Weiqing Zheng, Liang Wang, Fei Deng, Stephen A Giles, Ajay K Prasad, Suresh G Advani, Yushan Yan, Dionisios G Vlachos
Proton conductivity of the polymer electrolyte membranes in fuel cells dictates their performance and requires sufficient water management. Here, we report a simple, scalable method to produce well-dispersed transition metal carbide nanoparticles. We demonstrate that these, when added as an additive to the proton exchange Nafion membrane, provide significant enhancement in power density and durability over 100 hours, surpassing both the baseline Nafion and platinum-containing recast Nafion membranes. Focused ion beam/scanning electron microscope tomography reveals the key membrane degradation mechanism...
September 4, 2017: Nature Communications
https://www.readbyqxmd.com/read/28870047/-expert-consensus-for-the-diagnosis-and-treatment-of-patients-with-gitelman-syndrome
#11
(no author information available yet)
Gitelman syndrome (GS) is an autosomal recessive, salt-losing tubulopathy caused by inactivating mutations in the SLC12A3 gene that encodes the thiazide-sensitive sodium-chloride cotransporter (NCC). GS is characterized by hypokalemic metabolic alkalosis, hypomagnesemia and hypocalciuria. GS is one of the most common inherited renal tubulopathy with a prevalence estimated at about one to ten per 40 000 people. The prevalence of GS is even higher in Asia than other countries. The majority of GS patients present mild and nonspecific symptoms during adolescence or adulthood...
September 1, 2017: Zhonghua Nei Ke za Zhi [Chinese Journal of Internal Medicine]
https://www.readbyqxmd.com/read/28869702/the-prevalence-and-preventability-of-potentially-relevant-drug-drug-interactions-in-patients-admitted-for-cardiovascular-diseases-a-cross-sectional-study
#12
Milena Kovačević, Sandra Vezmar Kovačević, Branislava Miljković, Slavica Radovanović, Predrag Stevanović
AIM: The aim was to describe the type and prevalence of potentially relevant drug-drug interactions (pDDIs) in a population of patients admitted for cardiovascular diseases (CVD), and management strategies for reducing the occurrence of pDDIs. METHODS: A retrospective cross-sectional study was performed on Cardiology ward of University Clinical Hospital Center in Belgrade, Serbia. A total of 527 patients, with more than one prescription during hospital stay, were enrolled in this study...
September 4, 2017: International Journal of Clinical Practice
https://www.readbyqxmd.com/read/28866139/impact-of-caloric-intake-in-critically-ill-patients-with-and-without-refeeding-syndrome-a-retrospective-study
#13
Laura E Olthof, W A C Kristine Koekkoek, Coralien van Setten, Johannes C N Kars, Dick van Blokland, Arthur R H van Zanten
BACKGROUND & AIMS: Refeeding syndrome comprises metabolic disturbances that occur after the reintroduction of feeding after prolonged fasting. Standard care consists of correcting fluid and electrolytes imbalances. Energy intake during refeeding syndrome is heavily debated. This study addresses the effect of caloric intake on outcome during the management of refeeding syndrome. METHODS: A retrospective study among critically ill invasive mechanically ventilated patients admitted for >7 days to a medical-surgical ICU...
August 10, 2017: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/28859453/comparison-of-complications-trends-and-costs-in-endoscopic-vs-microscopic-pituitary-surgery-analysis-from-a-us-health-claims-database
#14
Anthony O Asemota, Masaru Ishii, Henry Brem, Gary L Gallia
BACKGROUND: Microsurgical and endoscopic techniques are commonly utilized surgical approaches to pituitary pathologies. There are limited data comparing these 2 procedures. OBJECTIVE: To evaluate postoperative complications, associated costs, and national and regional trends of microscopic and endoscopic techniques in the United States employing a nationwide database. METHODS: The Truven MarketScan database 2010 to 2014 was queried and Current Procedural Terminology codes identified patients that underwent microscopic and/or endoscopic transsphenoidal pituitary surgery...
September 1, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28820232/recognizing-and-managing-adrenal-disorders-in-the-emergency-department
#15
Amy Cutright, Stephen Ducey, Claudia L. Barthold
Primary and secondary adrenal insufficiency are underrecognized conditions among emergency department patients, affecting an estimated 10% to 20% of critically ill patients. The signs and symptoms of cortisol deficit can be nonspecific and wide-ranging, and identification and swift treatment with stress-dosing of hydrocortisone is vital to avoid life-threatening adrenal crisis. Laboratory evaluation focuses on identification of electrolyte abnormalities typical of adrenal insufficiency, and while additional testing may depend on the type and severity of symptoms, it should not delay corticosteroid replacement...
September 2017: Emergency Medicine Practice
https://www.readbyqxmd.com/read/28819575/therapeutic-approach-to-the-management-of-severe-asymptomatic-hyponatremia
#16
Thaofiq Ijaiya, Sandhya Manohar, Kameswari Lakshmi
Hyponatremia is an electrolyte imbalance encountered commonly in the hospital and ambulatory settings. It can be seen in isolation or present as a complication of other medical conditions. It is therefore a challenge to determine the appropriate therapeutic intervention. An understanding of the etiology is key in instituting the right treatment. Clinicians must not be too hasty to correct a random laboratory value without first understanding the physiologic principle. We present such a case of a patient who presented with sodium of 98 mmol/L, the lowest recorded in the current literature, and yet was asymptomatic...
2017: Case Reports in Nephrology
https://www.readbyqxmd.com/read/28814258/management-of-complicated-pneumonia-in-childhood-a-review-of-recent-literature
#17
John B Darby, Amrita Singh, Ricardo Quinonez
BACKGROUND: Despite declining rates of community acquired pneumonia (CAP) in children, complicated pneumonia has been on the rise in the last two decades. The management of complicated pneumonia is challenging and continues to be an area of investigation. Despite recently published guidelines, many gaps exist and recent studies attempt to answer challenging questions. OBJECTIVE: To review recently published literature to inform the clinician on the most up to date management of complicated pneumonia in children...
August 16, 2017: Reviews on Recent Clinical Trials
https://www.readbyqxmd.com/read/28814256/current-issues-in-intravenous-fluid-use-in-hospitalized-children
#18
Jennifer Fuchs, Sarah T Adams, Julie Byerley
BACKGROUND: Fluid and electrolyte therapy is an important component in the care of the hospitalized child. Previous pediatric guidelines have followed the Holliday-Segar method of calculating and delivering maintenance IV fluids, using hypotonic fluids in maintenance therapy. However, research demonstrates that hypotonic fluids can lead to iatrogenic hyponatremia and that isotonic fluid is a safer alternative. OBJECTIVE: To provide the ideal approach to intravenous (IV) fluid use in the hospitalized child and determine the safety and effectiveness of isotonic maintenance fluid therapy...
August 16, 2017: Reviews on Recent Clinical Trials
https://www.readbyqxmd.com/read/28810281/-hyponatremia-differential-diagnosis-and-treatment
#19
REVIEW
Heiner Mönig, Alexander Arlt
Hyponatremia is the most common electrolyte abnormality seen in hospitalized patients, with up to 30 % having a plasma sodium concentration below 135 mmol/l. It is now clear that the clinical problem extends beyond the neurological symptoms, which can be explained by intracerebral osmotic fluid shifts and brain edema. Instead, chronic hyponatremia is associated with impaired gait stability and an increased risk of bone fragility fractures. Moreover, hyponatremia has been demonstrated to be an indicator of poor prognosis in a variety of conditions...
August 2017: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/28806047/electrolytes-potassium-disorders
#20
Taiwona L Elliott
Hypokalemia (ie, potassium levels less than 3.5 mEq/L) occurs in fewer than 1% of healthy individuals, but is present in up to 20% of hospitalized patients, 40% of patients taking diuretics, and 17% of patients with cardiovascular conditions. Hypokalemia often is asymptomatic; symptoms are more common in older adults. Common symptoms are cardiac arrhythmias and muscle weakness or pain. Management consists of intravenous potassium replacement during cardiac monitoring for patients with marked symptoms, echocardiogram (ECG) abnormalities, or severe hypokalemia (ie, level less than 3...
August 2017: FP Essentials
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