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https://www.readbyqxmd.com/read/28076917/multi-organ-dysfunction-due-to-bath-salts-are-we-aware-of-this-entity
#1
Rohith Valsalan, Benoj Varghese, Diya Soman, Jonathan Buckmaster, Steven Yew, David Cooper
Methylenedioxypyrovalerone (MDPV) is a synthetic, cathinone-derivative, central nervous system stimulant taken to produce a cocaine- or methamphetamine-like high. Physical manifestations include tachycardia, hypertension, arrhythmias, hyperthermia, sweating, rhabdomyolysis, hyperkalaemia, disseminated intravascular coagulation, oliguria and seizures. We report a patient who presented with severe metabolic acidosis, multi-organ dysfunction, rhabdomyolysis, hyperkalaemia and seizures. This case highlights that even though a urine drug screen for routine psychostimulant drugs is negative, clinicians need to be vigilant about the adverse effects of MDPV as a possible cause of multi-organ dysfunction...
January 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28004486/pharmacological-interventions-for-the-management-of-acute-hyperkalaemia-in-adults
#2
Emmanuel Effa, Angela Webster
No abstract text is available yet for this article.
January 2017: Nephrology
https://www.readbyqxmd.com/read/27905476/heart-failure-neprilysin-inhibition-attenuates-risk-of-hyperkalaemia-in-hfref
#3
Karina Huynh
No abstract text is available yet for this article.
January 2017: Nature Reviews. Cardiology
https://www.readbyqxmd.com/read/27903702/cold-acclimation-improves-chill-tolerance-in-the-migratory-locust-through-preservation-of-ion-balance-and-membrane-potential
#4
Mads Kuhlmann Andersen, Rasmus Folkersen, Heath A MacMillan, Johannes Overgaard
Most insects have the ability to alter their cold tolerance in response to temporal temperature fluctuations, and recent studies have shown that insect cold tolerance is closely tied to the ability to maintain transmembrane ion-gradients that are important for the maintenance of cell membrane potential (Vm). Accordingly, several studies have suggested a link between preservation of Vm and cellular survival after cold stress, but none have measured Vm in this context. We tested this hypothesis by acclimating locusts (Locusta migratoria) to high (31°C) and low temperature (11°C) for four days before exposing them to cold stress (0°C) for up to 48 hours and subsequently measuring ion balance, cell survival, muscle Vm, and whole animal performance...
November 30, 2016: Journal of Experimental Biology
https://www.readbyqxmd.com/read/27856806/comparative-effectiveness-of-fourth-line-anti-hypertensive-agents-in-resistant-hypertension-a-systematic-review-and-meta-analysis
#5
REVIEW
Sarah-Jo Sinnott, Laurie A Tomlinson, Adrian A Root, Rohini Mathur, Kathryn E Mansfield, Liam Smeeth, Ian J Douglas
AIM: We assessed the effectiveness of fourth-line mineralocorticoid receptor antagonists in comparison with other fourth-line anti-hypertensive agents in resistant hypertension. METHODS AND RESULTS: We systematically searched Medline, EMBASE and the Cochrane library from database inception until January 2016. We included randomised and non-randomised studies that compared mineralocorticoid receptor antagonists with other fourth-line anti-hypertensive agents in patients with resistant hypertension...
November 17, 2016: European Journal of Preventive Cardiology
https://www.readbyqxmd.com/read/27825591/optimized-management-of-heart-failure-patients-aged-80-years-or-more-improves-outcomes-versus-usual-care-the-hf80-randomized-trial
#6
Charles Vorilhon, Frédéric Jean, Aurélien Mulliez, Guillaume Clerfond, Bruno Pereira, Vincent Sapin, Géraud Souteyrand, Bernard Citron, Pascal Motreff, Jean-René Lusson, Romain Eschalier
BACKGROUND: The prevalence and incidence of heart failure (HF) in elderly patients are increasing worldwide. Management of HF with reduced ejection fraction (HF-REF) in patients aged 80 years or more follows international guidelines, despite the lack of a dedicated study in this frail population. AIMS: To determine whether optimized management of HF-REF in patients aged 80 years or more can improve quality of life at 6 months. METHODS: Patients aged 80 years or more hospitalized for acute HF-REF were randomized prospectively into an optimized group or a control group (usual care)...
December 2016: Archives of Cardiovascular Diseases
https://www.readbyqxmd.com/read/27807020/miliary-tuberculosis-in-an-immunocompetent-male-with-a-fatal-outcome
#7
Louise Dunphy, Elizabeth Keating, T Parke
A man aged 33 years, born in Nepal, but resident in the UK for 7 years presented to the emergency department with a 4-day history of general malaise, fever (temperature 38.6°C) and a non-productive cough. His medical history was unremarkable and no high-risk behaviour was identified. Clinical examination confirmed decreased air entry bilaterally with bibasal crackles. He was tachycardic, with a heart rate of 120 bpm. Further investigation with a 12-lead ECG confirmed supraventricular tachycardia (SVT) which was terminated with vagal manoeuvres...
November 2, 2016: BMJ Case Reports
https://www.readbyqxmd.com/read/27756978/medicinal-mishap-trimethoprim-induced-critical-hyperkalaemia
#8
REVIEW
Alice Kennard, Darren M Roberts
No abstract text is available yet for this article.
August 2016: Australian Prescriber
https://www.readbyqxmd.com/read/27754166/sy-12-2-ace-inhibitors-and-arbs-similarities-and-differences-in-cv-risk-reduction
#9
Alexander Danser
Blockade of the renin-angiotensin-aldosterone system (RAAS) can be accomplished at the level of the angiotensin-generating enzymes renin and angiotensin-converting enzyme (ACE; using renin inhibitors or ACE inhibitors), the type 1 angiotensin II (AT1) receptor or mineralocorticoid receptor (MR; using angiotensin receptor blockers [ARBs] or MR blockers) and/or renin release (using beta-blockers). Several of these drugs are often combined-for example in heart failure-but such approaches may ultimately lead to RAAS annihilation with adverse consequences such as hypotension, renal dysfunction and hyperkalaemia...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27754015/br-04-1management-of-treatment-resistant-hypertension
#10
David John Webb
Treatment-resistant hypertension (TRH) is defined as the failure to achieve an office BP target of <140/90 mmHg (<130/80 mmHg in patients with chronic kidney disease (CKD) or diabetes) in patients with hypertension (HT), despite adherence to at least 3 antihypertensive medications at optimal tolerated doses, ideally including a diuretic (Calhoun et al., Circulation 2008). TRH identifies patients with hard-to-treat HT, who might benefit from specialist investigation and treatment. Although some studies put the prevalence of TRH as >10%, these levels may be inflated by white-coat hypertension and poor adherence...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27750339/-the-silent-killer-hyper-and-hypokalaemia
#11
Mark Dominik Alscher
The estimation of potassium in the serum is basis for the diagnosis of potassium disturbances. The value is a result of intake, excretion and internal distribution of potassium between intra- and extracellular compartments of the body. Clinically, we often see disturbances of potassium. The causes are explained by an aging population with morbidities that warrant diuretic treatment on the one side, and chronic kidney diseases on the other. In the first cases, we see hypokalaemia, in the latter hyperkalaemia...
October 2016: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/27729353/development-of-guidance-on-the-timeliness-in-response-to-acute-kidney-injury-warning-stage-test-results-for-adults-in-primary-care-an-appropriateness-ratings-evaluation
#12
Tom Blakeman, Kathryn Griffith, Dan Lasserson, Berenice Lopez, Jung Y Tsang, Stephen Campbell, Charles Tomson
OBJECTIVES: Tackling the harm associated with acute kidney injury (AKI) is a global priority. In England, a national computerised AKI algorithm is being introduced across the National Health Service (NHS) to drive this change. The study sought to maximise its clinical utility and minimise the potential for burden on clinicians and patients in primary care. DESIGN: An appropriateness ratings evaluation using the RAND/UCLA Appropriateness Method. SETTING: Clinical scenarios were developed to test the timeliness in (1) communication of AKI warning stage test results from clinical pathology services to primary care, and (2) primary care clinician response to an AKI warning stage test result...
October 11, 2016: BMJ Open
https://www.readbyqxmd.com/read/27659366/pseudohyperkalaemia-a-rare-complication-of-splenectomy
#13
R Wilson, P Skelly
Pseudohyperkalaemia is an uncommon and frequently unrecognised biochemical abnormality. It occurs as a consequence of aggregation and lysis of platelets in vitro. As a result, potassium is released, which causes an elevated serum concentration. We present the case of a 21-year-old man with a traumatic splenic injury necessitating laparotomy and splenectomy. Following surgery he developed hyperkalaemia. Further investigations diagnosed pseudohyperkalaemia, one of the causes of which is thrombocytosis secondary to splenectomy...
September 23, 2016: Annals of the Royal College of Surgeons of England
https://www.readbyqxmd.com/read/27643121/sy-12-2-ace-inhibitors-and-arbs-similarities-and-differences-in-cv-risk-reduction
#14
Alexander Danser
Blockade of the renin-angiotensin-aldosterone system (RAAS) can be accomplished at the level of the angiotensin-generating enzymes renin and angiotensin-converting enzyme (ACE; using renin inhibitors or ACE inhibitors), the type 1 angiotensin II (AT1) receptor or mineralocorticoid receptor (MR; using angiotensin receptor blockers [ARBs] or MR blockers) and/or renin release (using beta-blockers). Several of these drugs are often combined-for example in heart failure-but such approaches may ultimately lead to RAAS annihilation with adverse consequences such as hypotension, renal dysfunction and hyperkalaemia...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27642926/br-04-1management-of-treatment-resistant-hypertension
#15
David John Webb
Treatment-resistant hypertension (TRH) is defined as the failure to achieve an office BP target of <140/90 mmHg (<130/80 mmHg in patients with chronic kidney disease (CKD) or diabetes) in patients with hypertension (HT), despite adherence to at least 3 antihypertensive medications at optimal tolerated doses, ideally including a diuretic (Calhoun et al., Circulation 2008). TRH identifies patients with hard-to-treat HT, who might benefit from specialist investigation and treatment. Although some studies put the prevalence of TRH as >10%, these levels may be inflated by white-coat hypertension and poor adherence...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27617753/intractable-bradycardia-associated-with-hyperkalaemia-in-a-patient-with-end-stage-renal-disease-a-case-report-and-review-of-literature
#16
W Hwang, K Lee, J Joo
A 75-year-old male was diagnosed with diabetic foot syndrome and scheduled for amputation of the right second toe under general anaesthesia. He had suffered from Type 2 diabetes mellitus (DM); he had received maintenance haemodialysis (HD) three times a week for end-stage renal disease (ESRD) due to DM. At 30 minutes after induction, the heart rate decreased below 50 beats per minute (bpm); the arterial blood gas analysis (ABGA) showed a potassium concentration of 6.7 mEq/L without any other abnormal findings...
September 18, 2015: West Indian Medical Journal
https://www.readbyqxmd.com/read/27609359/effect-of-mineralocorticoid-receptor-antagonists-on-proteinuria-and-progression-of-chronic-kidney-disease-a-systematic-review-and-meta-analysis
#17
Gemma Currie, Alison H M Taylor, Toshiro Fujita, Hiroshi Ohtsu, Morten Lindhardt, Peter Rossing, Lene Boesby, Nicola C Edwards, Charles J Ferro, Jonathan N Townend, Anton H van den Meiracker, Mohammad G Saklayen, Sonia Oveisi, Alan G Jardine, Christian Delles, David J Preiss, Patrick B Mark
BACKGROUND: Hypertension and proteinuria are critically involved in the progression of chronic kidney disease. Despite treatment with renin angiotensin system inhibition, kidney function declines in many patients. Aldosterone excess is a risk factor for progression of kidney disease. Hyperkalaemia is a concern with the use of mineralocorticoid receptor antagonists. We aimed to determine whether the renal protective benefits of mineralocorticoid antagonists outweigh the risk of hyperkalaemia associated with this treatment in patients with chronic kidney disease...
September 8, 2016: BMC Nephrology
https://www.readbyqxmd.com/read/27581233/acute-peritoneal-dialysis-in-a-jehovah-s-witness-post-laparotomy
#18
Usha Devi Appalsawmy, Habib Akbani
A 56-year-old man who was a Jehovah's Witness with an advanced directive against autologous procedures developed acute kidney injury needing renal replacement therapy while he was intubated and ventilated on the intensive care unit. He was being treated for hyperosmolar hyperglycaemic state. He also had a healing laparotomy wound, having undergone a splenectomy less than a month ago following a road traffic accident. His hyperkalaemia and metabolic acidosis were refractory to medical treatment. As he became oligoanuric, decision was taken to carry out acute peritoneal dialysis (PD) by inserting a Tenckhoff catheter in his abdomen using peritoneoscopic technique...
August 31, 2016: BMJ Case Reports
https://www.readbyqxmd.com/read/27506441/mineralocorticoid-receptor-antagonists-in-elderly-patients-with-heart-failure-a-systematic-review-and-meta-analysis
#19
Deepa Japp, Anoop Shah, Sheila Fisken, Martin Denvir, Susan Shenkin, Alan Japp
BACKGROUND: mineralocorticoid receptor antagonists (MRAs) improve outcomes in several populations of patients with heart failure (HF), but there has been no systematic review of MRAs in older patients. OBJECTIVES: systematic review and meta-analysis of the efficacy and safety of MRA treatment in elderly HF patients. DATA SOURCES: trials were identified through a literature search until 24 January 2015. STUDY SELECTION: randomised controlled trials (RCTs) of MRAs in patients with HF and/or left ventricular systolic dysfunction aged ≥65 years, with subgroup analysis of patients ≥65 years or with mean participant age ≥70 years...
August 9, 2016: Age and Ageing
https://www.readbyqxmd.com/read/27502170/normal-saline-versus-lower-chloride-solutions-for-kidney-transplantation
#20
REVIEW
Susan Wan, Matthew A Roberts, Peter Mount
BACKGROUND: The ideal intravenous fluid for kidney transplantation has not been defined, despite the common use of normal saline during the peri-operative period. The high chloride content of normal saline is associated with an increased risk of hyperchloraemic metabolic acidosis, which may in turn increase the risk of hyperkalaemia and delayed graft function. Balanced electrolyte solutions have a lower chloride content which may decrease this risk and avoid the need for dialysis due to hyperkalaemia in the immediate post-transplant period...
August 9, 2016: Cochrane Database of Systematic Reviews
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