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https://www.readbyqxmd.com/read/28320069/usefulness-of-laboratory-and-radiological-investigations-in-the-management-of-supraventricular-tachycardia
#1
Aadith Ashok, Miguel Cabalag, David McD Taylor
OBJECTIVE: Although ED patients presenting with supraventricular tachycardia (SVT) are commonly investigated, the value of these investigations has been questioned. We aimed to determine the frequency and utility of investigations in patients with SVT. METHODS: We undertook an explicit retrospective medical record audit of patients with SVT who presented to a single ED (January 2004 to June 2014). Data on demographics, presenting complaints, investigations and outcomes were extracted...
March 20, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/28316105/hypoxaemia-and-septic-shock-were-independent-risk-factors-for-mechanical-ventilation-in-bangladeshi-children-hospitalised-for-diarrhoea
#2
Mohammod Jobayer Chisti, K M Shahunja, Farzana Afroze, Abu Smsb Shahid, Sharifuzzaman, Tahmeed Ahmed
AIM: In Bangladesh approximately 6% of children under five years of age die due to diarrhoea. We evaluated the admission and hospitalisation risk factors for mechanical ventilation and outcomes in children with diarrhoea. METHODS: This retrospective case-control chart analysis was conducted in the intensive care unit of Dhaka Hospital of International Centre for Diarrhoeal Disease Research, Bangladesh. We enrolled 219 children with diarrhoea aged 0-59 months between August 2009 and July 2013...
March 17, 2017: Acta Paediatrica
https://www.readbyqxmd.com/read/28287295/-differential-diagnostic-dilemmas-after-use-of-an-out-of-date-antihypertensive-medication-case-report
#3
Péter Arányi, János Tomcsányi
Hydrochlorothiazide became one of the most commonly prescribed first-line antihypertensive medication, though its use is often complicated with serious side-effects. A 66-year-old female patient with a history of hypertension had suffered a transient loss of consciousness, and referred to our cardiology unit with an ST-segment elevation and giant negative T-waves in V1-2 ECG leads, long QT-segment and elevated serum creatine-kinase (5392 U/L) and troponin I (4,357 ng/ml) levels. Acute myocardial infarction was not proven (later coronarography revealed preserved coronary circulation), but severe hyponatraemia and hypokalaemia was detected, explaining a possible symptomatic seizure, and which could be accounted for a 25 mg daily hydrochlorothiazide antihypertensive treatment and - as a precipitating insult - a one-week history of gastroenteritis...
March 2017: Orvosi Hetilap
https://www.readbyqxmd.com/read/28263150/-rhabdomyolysis-caused-by-hyperemesis-gravidarum
#4
Lana Rashid Flachs Madsen, Marie Søgaard
Hyperemesis gravidarum (HG) is a condition of severe nausea and vomiting during pregnancy, accompanied by dehydration, electrolyte derangement and lack of nutrition. We describe a 26-year-old woman pregnant at 29 weeks of gestation, complaining about muscle pain and difficulties standing up after suffering from long-term HG followed by a weight loss of 35 kg. She had severe hypokalaemia and abnormally elevated muscle enzyme concentrations as a result of a massive catabolic process. We discuss severe HG as a rare cause of rhabdomyolysis and the importance of early aggressive resuscitation to avoid renal failure...
February 27, 2017: Ugeskrift for Laeger
https://www.readbyqxmd.com/read/28250297/multimodal-treatment-of-vasoactive-intestinal-polypeptide-producing-pancreatic-neuroendocrine-tumors-with-liver-metastases
#5
Mari Iwasaki, Kouhei Tsuchida, Hidehito Jinnai, Toshinori Komatsubara, Takahiro Arisaka, Misako Tsunemi, Masakazu Nakano, Makoto Iijima, Hideyuki Hiraishi
A 53-year-old man presented with diarrhoea and hypokalaemia and was diagnosed with a neuroendocrine tumour of unknown origin with multiple liver metastases. Somatostatin analogues led to a reduction in the size of the tumours and improvement of his symptoms. However, after several years, the tumours grew in size, and the patient's clinical symptoms recurred. The patient underwent transcatheter arterial embolization (TAE) of the hepatic artery to treat the liver metastases. Immediately after embolization, the symptoms disappeared...
2017: Internal Medicine
https://www.readbyqxmd.com/read/28224871/-a-patient-with-severe-digoxin-toxicity
#6
K P van Rhee, R van Bentum, K van Keulen, M I Kuypers, M B Haak
BACKGROUND: Digoxin is a cardiac glycoside that is frequently prescribed in atrial fibrillation and heart failure. Symptoms such as nausea, hyperkalaemia, cardiac arrhythmias and cardiac arrest are seen in digoxin toxicity. The treatment focuses on reduction of digoxin absorption, prevention of hypokalaemia and hyperkalaemia, treatment of symptoms and, in severe toxicity, administration of digoxin antibodies. CASE DESCRIPTION: A 73-year-old man with a history of extensive cardiac disease was seen 45 minutes after ingesting 20 mg of digoxin...
2017: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/28222414/urinary-steroid-metabolites-in-a-case-of-florid-ectopic-cushing-s-syndrome-and-clinical-correlations
#7
Angelos Kyriacou, Karolina M Stepien, Basil Issa
A 51-year old woman was admitted with multiple cerebral, pulmonary and intra-abdominal abscesses. The combination of apparent immunosuppression, obesity, diabetes mellitus, hypertension, hypokalaemia, osteoporotic fractures and bilateral shoulder avascular necrosis led to a clinical diagnosis of Cushing's syndrome (CS). This was biochemically confirmed as follows: midnight serum cortisol 4275 nmol/L (60-250), non-suppressed overnight dexamethasone suppression test, raised salivary cortisol 716 nmol/L (5-46) and ACTH 639 ng/L (0-46)...
October 2016: Hormones: International Journal of Endocrinology and Metabolism
https://www.readbyqxmd.com/read/28217308/demographical-and-clinicopathological-characteristics-in-heart-failure-and-outcome-predictors-a-prospective-observational-study
#8
Chakanalil Govindan Sajeev, Shreetal Rajan Nair, Biju George, Gopalan Nair Rajesh, Mangalath Narayanan Krishnan
AIMS: The aims of the study were to study the demographical and clinicopathological characteristics of patients presenting with heart failure and evaluate the 1 year outcomes and to identify risk predictors if any. METHODS AND RESULTS: A prospective observational study was conducted in consecutive patients of systolic heart failure. The study was divided into two parts-an initial 6 month enrolment phase followed up for 1 year for major adverse cardiovascular events...
February 2017: ESC Heart Failure
https://www.readbyqxmd.com/read/28210494/liquorice-a-root-cause-of-secondary-hypertension
#9
Ravi Varma, Calum N Ross
We describe a patient presenting with hypertension and hypokalaemia who was ultimately diagnosed with liquorice- induced pseudohyperaldosteronism. This rare cause of secondary hypertension illustrates the importance of a methodical approach to the assessment of hypertension.
February 2017: JRSM Open
https://www.readbyqxmd.com/read/28188436/clinical-and-molecular-aspects-of-distal-renal-tubular-acidosis-in-children
#10
Martine T P Besouw, Marc Bienias, Patrick Walsh, Robert Kleta, William G Van't Hoff, Emma Ashton, Lucy Jenkins, Detlef Bockenhauer
BACKGROUND: Distal renal tubular acidosis (dRTA) is characterized by hyperchloraemic metabolic acidosis, hypokalaemia, hypercalciuria and nephrocalcinosis. It is due to reduced urinary acidification by the α-intercalated cells in the collecting duct and can be caused by mutations in genes that encode subunits of the vacuolar H(+)-ATPase (ATP6V1B1, ATP6V0A4) or the anion exchanger 1 (SLC4A1). Treatment with alkali is the mainstay of therapy. METHODS: This study is an analysis of clinical data from a long-term follow-up of 24 children with dRTA in a single centre, including a genetic analysis...
February 10, 2017: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/28188165/indomethacin-therapy-effective-in-a-patient-with-depletion-syndrome-from-secretory-villous-adenoma
#11
Matthew David Kagan, Kara Schmidt, Gurtej Sangha
This paper details the case of a 26-year-old woman with depletion syndrome and the effectiveness of her treatment with indomethacin. Villous adenomas are benign neoplasms with a high incidence of becoming malignant. A small percentage of villous adenomas are known to cause depletion syndrome, also referred to as the McKittrick-Wheelock syndrome, a condition characterised by secretory diarrhoea, dehydration, hyponatremia, hypokalaemia, hypochloraemia, metabolic acidosis and acute renal failure. Prostaglandin-E2 mediates the hypersecretion mechanism observed in depletion syndrome, and can be inhibited by cyclo-oxygenase inhibitors...
February 10, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28155290/the-diagnosis-of-bilateral-primary-renal-paragangliomas-in-a-cat
#12
Ryan B Friedlein, Alain J Carter, Robert D Last, Sarah Clift
A 9-year-old sterilised female domestic short-hair cat was referred with a history of vomiting and anorexia of 3 months' duration. Biochemistry, full-blood counts, thoracic radiographs, feline pancreatic-specific lipase, abdominal ultrasonography and feline immunodeficiency virus/feline leukaemia virus (FIV/FeLV) SNAP tests had been performed. Mild hypochloraemia and moderate hypokalaemia were evident on initial presentation. Abdominal ultrasonography initially revealed unilateral renal nodules on the left side...
January 24, 2017: Journal of the South African Veterinary Association
https://www.readbyqxmd.com/read/28154278/near-fatal-anorexia-nervosa-in-a-middle-aged-woman
#13
Luca Foppiani, Bruno Massobrio, Christian Cascio, Giancarlo Antonucci
Anorexia nervosa (AN) is a serious psychiatric disorder which typically occurs in young women; however, more and more cases in middle-aged women are being reported. The management of this complex disease requires a team approach, and full recovery occurs only in 50% of patients. Endocrine and metabolic complications are commonly observed, the latter of which may even be life-threatening, and require prompt and proper management. Infections, albeit reported, are not usually a major clinical problem in these patients...
2017: Internal Medicine
https://www.readbyqxmd.com/read/28148579/liquorice-induced-apparent-mineralocorticoid-excess-presenting-in-the-emergency-department
#14
Stuart Declan Gallacher, Georgios Tsokolas, Ioannis Dimitropoulos
A 65-year-old woman with a background of myalgic encephalitis, who was taking alternative medicines and dietary supplements, presented with hypokalaemia and hypertension. After a thorough history it became apparent that this was most likely secondary to regular consumption of liquorice tea. The patient was advised to discontinue drinking this tea and was discharged. Follow-up showed normalising blood pressure and hypokalaemia, with a normal aldosterone:renin ratio.
February 2017: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/28148578/hypokalaemia-in-sj%C3%A3-gren-s-syndrome-the-missing-piece
#15
Umer Farooq Khan, Lee Chun Tsu, Kong-Bing Tan, Jingxiang Huang, Audrey LiAnn Wong
A 58-year-old Chinese woman with well controlled type 1 diabetes mellitus presented with acute and progressive bilateral lower limb weakness. Investigations revealed severe hypokalaemia (1.3 mmol/L) and hypophosphataemia (<0.32 mmol/L) with rhabdomyolysis and electrocardiogram changes, without other concurrent biochemical abnormalities. Immediate intravenous and oral potassium and phosphate replacement was initiated with objective improvement in weakness with replenished electrolyte levels. Urine studies confirmed renal potassium wasting...
February 2017: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/28137907/paralysis-that-easily-reverses-a-case-of-thyrotoxic-periodic-paralysis
#16
Niranjan Tachamo, Saroj Lohani, Salik Nazir, Noelle Juliano
Thyrotoxic periodic paralysis is a potentially life-threatening condition associated with recurrent episodes of muscle weakness and hypokalaemia due to hyperthyroidism. Diagnosis is often delayed or misdiagnosed due to its rarity in the western world and subtle features of hyperthyroidism on initial presentation. Here we present the case of a 25-year-old man who presented to the emergency department (ED) with sudden onset weakness of bilateral upper and lower extremities. His labs revealed hypokalaemia with elevated T4 and suppressed thyroid-stimulating hormone and he was diagnosed with thyrotoxic periodic paralysis...
January 30, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28125972/gitelman-syndrome-in-a-south-african-family-presenting-with-hypokalaemia-and-unusual-food-cravings
#17
Pieter Du Toit van der Merwe, Megan A Rensburg, William L Haylett, Soraya Bardien, M Razeen Davids
BACKGROUND: Gitelman syndrome (GS) is an autosomal recessive renal tubular disorder characterised by renal salt wasting with hypokalaemia, metabolic alkalosis, hypomagnesaemia and hypocalciuria. It is caused by mutations in SLC12A3 encoding the sodium-chloride cotransporter on the apical membrane of the distal convoluted tubule. We report a South African family with five affected individuals presenting with hypokalaemia and unusual food cravings. METHODS: The affected individuals and two unaffected first degree relatives were enrolled into the study...
January 26, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/28098079/hyperthermic-intraperitoneal-chemotherapy-for-peritoneal-surface-malignancies-a-single-institution-indian-experience
#18
S P Somashekhar, G Prasanna, Rajshekhar Jaka, Amit Rauthan, H S Murthy, Sunil Karanth
BACKGROUND: Cytoreductive surgery followed by hyper- thermic intraperitoneal chemotherapy (HIPEC) has shown better oncological outcomes in peritoneal surface malignancies (PSM). We assessed the feasibility and perioperative outcomes of this procedure in Indian patients. METHODS: In this prospective observational study from February 2013 to April 2015, we included 56 patients (41 females, 73.2%) with PSM. They had a good performance status, were either treatment-naïve or previously treated by surgery and systemic chemotherapy...
September 2016: National Medical Journal of India
https://www.readbyqxmd.com/read/28024277/qt-prolongation-caused-by-insulin-induced-hypoglycaemia-an-interventional-study-in-119-individuals
#19
Stella Kacheva, Beate Karges, Katrin Göller, Nikolaus Marx, Karl Mischke, Wolfram Karges
AIMS: Hypoglycaemia is associated with increased risk of cardiovascular events and mortality in patients with diabetes, but the extent and mechanisms of this link are ill defined. We here prospectively studied cardiac repolarization abnormalities during insulin-induced hypoglycaemia in humans. METHODS: 119 individuals (69 males, age 47.5±13.4years, range 18-82years) were assessed during hypoglycaemia after the injection of 0.1-0.25units/kg human insulin. Corrected QT intervals (QTc) and QT dispersion (QTd) were calculated from serially recorded twelve lead electrocardiograms, and plasma glucose and other endocrine markers were studied...
January 2017: Diabetes Research and Clinical Practice
https://www.readbyqxmd.com/read/28011953/hyperventilation-assists-proarrhythmia-development-during-delayed-repolarization-in-clofilium-treated-anaesthetized-mechanically-ventilated-rabbits
#20
H Papp, A Sarusi, A S Farkas, H Takacs, P Kui, D Vincze, E Ivany, A Varro, J G Papp, T Forster, A Farkas
Hyperventilation reduces partial pressure of CO2 (PCO2) in the blood, which results in hypokalaemia. Hypokalaemia helps the development of the life-threatening torsades de pointes type ventricular arrhythmia (TdP) evoked by repolarization delaying drugs. This implies that hyperventilation may assist the development of proarrhythmic events. Therefore, this study experimentally investigated the effect of hyperventilation on proarrhythmia development during delayed repolarization. Phenylephrine (an α1-adrenoceptor agonist) and clofilium (as a representative repolarization delaying agent inhibiting the rapid component of the delayed rectifier potassium current, IKr) were administered intravenously to pentobarbital-anaesthetized, mechanically ventilated, open chest rabbits...
October 2016: Journal of Physiology and Pharmacology: An Official Journal of the Polish Physiological Society
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