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Ravi S Tripathi, Sarah B Russell, Michael R Lyaker, Stanislaw Pa Stawicki, Thomas J Papadimos
Here we posit for discussion the example of a reversible metabolic encephalopthy in a very elderly male that was missed clinically. A metabolic encephalopathy in extrememly elderly patients may be confused with delerium or inattention. A reversible cause of cognative dysfunction in the aged may be missed by practitioners because the aged may be assumed to have some level of impaired cognition; this may lead to a "social dismissal" of mental status changes. We highlight the need for engaged physicians in the care of the aged and vigilance against a professional bias toward the elderly patient that is dismissive...
October 2013: International Journal of Critical Illness and Injury Science
John T Street, Brian J Lenehan, Christian P DiPaola, Michael D Boyd, Brian K Kwon, Scott J Paquette, Marcel F S Dvorak, Y Raja Rampersaud, Charles G Fisher
BACKGROUND CONTEXT: To date, most reports on the incidence of adverse events (AEs) in spine surgery have been retrospective and dependent on data abstraction from hospital-based administrative databases. To our knowledge, there have been no previous rigorously performed prospective analysis of all AEs occurring in the entire population of patients presenting to an academic quaternary referral center. PURPOSE: To determine the mortality and true incidence and severity of morbidity (major and minor, medical and surgical) in adults undergoing complex spinal surgery, both trauma and elective, in a quaternary referral center...
January 2012: Spine Journal: Official Journal of the North American Spine Society
Kim Bezzant
This article describes the ways in which practice development can aid Nurse Managers to enhance both efficiency and effectiveness, focussing particularly on the care of older people with delerium and dementia. Practitioners caring for this group of patients in acute general hospitals need specialist skills, particularly skills in working with the unusual ('challenging') behaviours that these patients often exhibit. These skills are rarely present at the point of registration but practice development techniques can facilitate the acquisition of appropriate skills with resultant benefits for both patients and organization...
March 2008: Journal of Nursing Management
Leigh J Beglinger, Kevin Duff, Sara Van Der Heiden, Karen Parrott, Douglas Langbehn, Roger Gingrich
Delirium has been associated with a high risk of mortality in medical patients. Despite the high incidence of delirium in patients who undergo hemapoietic stem cell transplantation (HSCT), delirium as a risk factor for death has not been examined in this population. Thirty adult patients undergoing HSCT who were admitted to the University of Iowa Blood and Marrow Transplantation Program inpatient unit were assessed prospectively from 1 to 2 weeks before transplantation, throughout their inpatient stay, and at 100 days after transplantation...
September 2006: Biology of Blood and Marrow Transplantation
S B Baker, L I G Worthley
OBJECTIVE: To review the components of calcium, phosphate and magnesium metabolism that are relevant to the critically ill patient, in a two-part presentation. DATA SOURCES: A review of articles reported on calcium, phosphate and magnesium disorders in the critically ill patient. SUMMARY OF REVIEW: Abnormal calcium metabolism in the critically ill patient often presents with an alteration in plasma ionised calcium. The characteristic clinical features of an acute reduction in ionised plasma calcium include tetany, laryngospasm, paraesthesia, confusion, hallucinations, seizures and, rarely, hypotension all of which resolve with intravenous calcium administration...
December 2002: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
Chantal Ski, Bev O'Connell
OBJECTIVE: This paper discusses the problem of delirium and the challenges of accurately assessing, preventing and managing patients with delirium in an acute care setting. PRIMARY ARGUMENT: Acute confusion, also known as delirium, is misdiagnosed and under-treated in up to 94% of older patients in hospitals. With the ageing population, this problem will increase dramatically in the Australian setting. Managing patients with delirium is challenging not only for the management of their basic nursing care needs but also because they are prone to adverse events such as falls and medication problems...
March 2006: Australian Journal of Advanced Nursing: a Quarterly Publication of the Royal Australian Nursing Federation
Kenneth R. Alper, John J. Barry, Antoaneta J. Balabanov
Psychosis, irritability, and aggression in persons with epilepsy are frequently the focus of clinical intervention. These neuropsychiatric symptoms may occur due to the bidirectional relationship between psychosis and epilepsy, in which the potential etiopathogenic mechanisms are believed to be closely related to the seizure disorder itself and also may result from underlying brain injury or behavioral intolerance of antiepileptic or other medication. Epileptic patients are at heightened risk for mood disorders, psychotic disorders, and delerium...
October 2002: Epilepsy & Behavior: E&B
P B Dews, C P O'Brien, J Bergman
Acquired tolerance to some behavioral effects of caffeine in humans is widely assumed to occur but is poorly documented and appears, at most, to be of low magnitude. Withdrawal from regular consumption of caffeine has been reported to result in a variety of symptoms, including: irritability, sleepiness, dysphoria, delerium, nausea, vomiting, rhinorrhea, nervousness, restlessness, anxiety, muscle tension, muscle pains and flushed face. Some of these same symptoms have been reported following excess intake of caffeine...
September 2002: Food and Chemical Toxicology
P Pfitzenmeyer, A Musat, L Lenfant, A Turcu, A Musat
TWO DISTINCT CATEGORIES: Postoperative cognitive disorders include delirium and long-term cognitive dysfunction. DELERIUM: Delirium is an acute state occurring early during the postoperative period. It may be considered as an acute cerebral insufficiency which may be consecutive both to the negative effects of aging and chronic illness on cognitive function, and to the cerebral impact of operative stress. In addition, precipitating postoperative medical factors may facilitate cerebral failure. Only a few studies have been devoted to prevention programs aimed at reducing the risk of postoperative delirium...
April 7, 2001: La Presse Médicale
G Tsai, J T Coyle
Recent evidence suggests that ethanol abuse produces its diverse effects on the brain to a substantial degree by disrupting the function of the major excitatory neurotransmitter, glutamate. Ethanol, at concentrations associated with behavioral effects in humans, inhibits the N-methyl-D-aspartate (NMDA) receptor, which mediates the post-synaptic excitatory effects of glutamate. Tolerance to ethanol results in up-regulation of the NMDA receptor so that abrupt withdrawal produces a hyperexcitable state that leads to seizures, delerium tremens, and excitotoxic neuronal death...
1998: Annual Review of Medicine
D Barcia, R Muñóz
No abstract text is available yet for this article.
September 1980: Actas Luso-españolas de Neurología, Psiquiatría y Ciencias Afines
D Cottin
No abstract text is available yet for this article.
February 1984: Soins; la Revue de Référence Infirmière
K Barton, P W Auld, M G Scott, D P Nicholls
Chlordiazepoxide 40mg daily was used to prevent delerium tremens in a 64-year-old female with alcoholic liver disease. After 20 days, the drug was stopped because of the onset of progressive drowsiness. The kinetics of chloridazepoxide were within the predicted range for patients with liver disease, but the elimination half-lives of desmethylchlordiazepoxide and demoxepam were greatly prolonged at 346 hours and 150 hours, respectively. It is suggested that metabolite accumulation may have contributed to the coma, which is an unusual reaction to chlordiazepoxide...
January 1989: Medical Toxicology and Adverse Drug Experience
G A Taler, M H Waymack
The elderly are most often the focus of ethical dilemmas, not only because of the increased frequency of illness, but also because of the reality that death is an impending inevitability. Of all the health care professionals, it is the primary care physician who is best situated to assist the elderly patient in exercising his or her own autonomy in matters concerning health care decisions. Both intrinsic factors, such as the presence of dementia and delerium associated with acute illness, and extrinsic factors, including the family's wishes, the settings of care, and financial consideration, may influence decision making...
June 1989: Primary Care
J C Gribbin, C J Cox
A 44-year-old man was admitted with acute abdominal pain, anorexia, nausea and dry retching, with tenderness and rigidity of the abdominal wall. Exploratory laparotomy revealed generalized peritonitis. He developed delerium tremens soon after operation and dehiscence of the abdominal wound 36 hours postoperatively. When the wound was closed and reinforced his recovery was uneventful. This case was unusual because he did not have ascites or cirrhosis, which are commonly associated with the disease.
September 1990: Australian and New Zealand Journal of Surgery
D W Nave
Systematic assessment of cognition, mood, and function in geriatric psychiatry using simple psychological tests provides vital data for diagnosis, management, and treatment outcome. Use of such tests can assist in differentiating depressive pseudodementia and delerium from true dementia. This article presents a computer database program using serial administration of basic psychological tests which are readily obtainable and easily administered. Case histories describe how this testing format provides graphic data documenting treatment course and outcome...
October 1992: Journal of the Louisiana State Medical Society: Official Organ of the Louisiana State Medical Society
B Blumenthal
No abstract text is available yet for this article.
October 1975: Therapie der Gegenwart
L T Iseri, J Freed, A R Bures
Magnesium deficiency can occur in congestive heart failure, after diuresis with furoxemide, ethacrynic acid and mercurials, and with digitalis intoxication, diabetic acidosis, acute and chronic alcoholism, delerium tremens, cirrhosis, malabsorption syndromes, protracted postoperative cases, open heart surgery, the diuretic phase of acute tubular necrosis, and with hypoparathyroidism, primary aldosteronism, juxta-glomerular hyperplasia and pancreatitis. Two cases of serious ventricular arrhythmias associated with magnesium depletion are described...
June 1975: American Journal of Medicine
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