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Biomedical subjects

C H Barton

Publications and source records attributed to C H Barton.

88 records · Page 5Linked to original sources
PubMed1981

Phencyclidine intoxication: clinical experience in 27 cases confirmed by urine assay.

Medical records of 107 consecutive patients with a diagnosis of phencyclidine (PCP) intoxication were reviewed and in 27 of these the diagnosis was confirmed by positive urine assay. In the 27 confirmed cases, the most common abnormalities present on physical examination were mental/behavioral (89%) and nystagmus (85%). Elevations in blood pressure, temperature, and heart rate that were statistically significant when compared with an age-matched control group also were noted. Review of available medical records disclosed that 13 of these patients had been evaluated previously at our institution for PCP intoxication. Toxicological screening tests including blood alcohol level, hypnotic screen, and urine test for alkaloids, were performed on 11 patients and found positive in four. The most common serious medical complication requiring hospitalization was rhabdomyolysis which occurred on three patients, two of whom developed acute renal failure. This complication may occur more frequently than previously recognized and should be excluded in patients with PCP intoxication.

Adolescent↗
PubMed1981

Femoral neuropathy: a complication of renal transplantation.

Femoral neuropathy occurred in 3 patients after renal transplantation. This appeared to be due to compression of the femoral nerve by medial and inferior blades of the self-retaining retractors used during renal transplantation surgery. The condition resulted in weakness of quadriceps muscles, loss of patellar reflex, and sensory deficit on the side of transplantation surgery. The rate of recovery from neurologic deficits appeared to depend on the level of transplant renal function.

Adult↗
PubMed1981

Ineffectiveness of intravenous ascorbic acid as an acidifying agent in man.

The acidifying effect of intravenous (IV) ascorbic acid was studied in seven healthy adult volunteers. After obtaining baseline urine and blood samples, 2-g IV doses of ascorbic acid were administered to each subject during a 20-minute period. Venous blood samples were obtained at times 0.5, 1, and 2 hours, and urine was collected at times 0.5, 1, 2, and 3 hours. Our results show that venous blood pH, plasma bicarbonate concentration, urine PCO2, and urine bicarbonate excretion did not change significantly during the study period. Urinary titratable acidity, ammonium excretion, and net hydrogen ion excretion decreased, and urinary pH actually showed a significant rise at two hours. We therefore conclude that IV ascorbic acid administered in recommended doses does not effectively acidify urine.

Acid-Base Equilibrium↗
PubMed1980

Nephrotic syndrome associated with adenocarcinoma of the breast.

Although the nephrotic syndrome has been reported in association with a wide variety of neoplastic diseases, it has only rarely been noted as a complication of breast carcinoma. We describe a patient who presented with the nephrotic syndrome and who was subsequently found to have carcinoma of the breast. The findings on renal biopsy were indicative of membranous nephropathy with positive immunofluorescent staining for immunoglobulin G (IgG) and the third component of complement (C3). The nephrotic syndrome completely resolved following successful treatment of the cancer. We have now followed this patient for over two years and there has been no recurrence of tumor or the nephrotic syndrome.

Biopsy↗
PubMed1980

Hemodialyzability of acetazolamide.

Because the dialyzability of acetazolamide is not known, we undertook a study to determine the in vivo dialysance of this drug and found it to average 22 ml per minute. The quantity of the drug removed by four hours of dialysis was approximately 30% of the dose administered intravenously one half hour before dialysis. Accordingly, considerable amounts of the drug are removed by dialysis, despite its high intraerythrocytic distribution and plasma protein binding properties. Therefore, hemodialysis may be effective in the management of acetazolamide overdose, particularly when complicated by the presence of renal failure. The dialysance can vary under different dialyzing conditions. An acetazolamide/urea nitrogen extraction ratio of 0.16 established in this study can be used to predict the acetazolamide dialysance in various dialyzing conditions.

Acetazolamide↗
PubMed1980

Hemodialysis clearance of arsenic.

We studied the clearance of arsenic by hemodialysis in two patients with acute sodium arsenite intoxication and acute renal failure. Blood arsenic concentration fell considerably with dialysis. The dialysance of arsenic ranged between 76 and 87 mL/min. Total arsenic removal by 4 h of hemodialysis exceeded its 24 hr urinary excretion while renal function was impaired. With improvement of renal function, urinary arsenic excretion increased remarkably and dialysis treatments were discontinued. Based on these result, hemodialysis is a useful adjunct in the treatment of acute arsenic poisoning with concomitant renal failure.

Adult↗
PubMed1980

Rhabdomyolysis and acute renal failure associated with phencyclidine intoxication.

Rhabdomyolysis can occur with phencyclidine hydrochloride (PCP) intoxication. However, to our knowledge acute renal failure with phencyclidine-induced rhabdomyolysis has not been reported previously. Therefore, we describe two patients with this condition. The modern treatment of phencyclidine intoxication, namely aggressive acidification and diuretic therapy, can enhance the risk of acute renal failure in patients with rhabdomyolysis. Therefore, exclusion of rhabdomyolysis is essential before acidification measures are undertaken.

Acute Kidney Injury↗
PubMed1979

Cimetidine in the management of metabolic alkalosis induced by nasogastric drainage.

Metabolic alkalosis resulting from nasogastric drainage is a well recognized and potentially serious clinical problem. In the postoperative patient with acute renal failure, the management of the metabolic alkalosis is particularly difficult, and established modalities of therapy are sometimes ineffective and can be hazardous to the patient. In this article, we report on the successful use of cimetidine (an H2-receptor antagonist) as an adjunct in the treatment of severe metabolic alkalosis in a postsurgical renal failure patient. To our knowledge, this is the first reported successful use of cimetidine in the treatment of metabolic alkalosis due to gastric acid loss.

Acute Kidney Injury↗
PubMed1979

Renal tubular dysfunction in transplanted kidneys.

We studied 15 renal transplant recipients for evidence of tubular dysfunction. Eight patients were hypophosphatemic, and two had systemic acidosis with a urinary acidification defect. Mild aminoaciduria and bicarbonaturia were present in four and 14 patients, respectively. Elevated parathyroid hormone level was found in only one patient. Tubular reabsorption of phosphorus was depressed in all eight hypophosphatemic patients, while no such abnormalities were observed in 14 control subjects. Defective tubular reabsorption of phosphorus was the most striking abnormality. None of the parameters studied, including immunosuppressant therapy, parathyroid hormone levels, creatinine clearance, or acid-base balance, clearly account for the pathogenesis of this abnormality.

Acidosis↗
PubMed1979

Thyroid function studies in the nephrotic syndrome.

Total serum and urinary thyroxine (T4), triiodothyronine (T3), and thyroxine-binding globulin (TBG) as well as serum free T4, thyroid-stimulating hormone (TSH), and T3 resin uptake (T3RU) were measured in seven patients with the nephrotic syndrome. The nephrotic syndrome was defined by proteinuria exceeding 3 g/24 h. All patients were clinically euthyroid. Most values for total serum T4, free T4, T3, T3RU, TBG, and TSH were within normal limits. However, the mean serum T3 and TBG values were significantly lower in patients compared with the control group. The values (mean +/- 2 SD) for urinary T4 were 24.3 +/- 20.3 in the patient group and 1.5 +/- 0.7 microgram/24 h in the control group. Urinary T3 values for patients and the control group were 2100 +/- 856 and 848 +/- 253 ng/24 h respectively. Urinary TBG was 2.1 +/- 1.8 mg/24 h in the patients and undetectable in the control group. There was no correlation between daily urinary T3 and T4 and urinary TBG. There was a weak correlation between daily urinary protein excretion and urinary T4 (r = 0.5).

Adult↗
PubMed1979

Peritoneal dialysis clearance of cimetidine.

Peritoneal dialysis clearance of cimetidine was determined in two patients undergoing peritoneal dialysis treatment. The peritoneal dialysis clearance of cimetidine was approximately 10 ml./min. under optimal dialyzing conditions. The average cimetidine to creatinine extraction ratio was 0.45, which represents significant peritoneal dialyzability. The amount of cimetidine removed, however, constituted only a small fraction of the total administered dose. Therefore, only minor dose adjustments may be necessary during peritoneal dialysis treatment.

Adult↗
PubMed1978

Dialysability of theophylline.

We have shown that theophylline is highly dialysable with an average dialysis clearance of 76 ml/min approaching 63% of urea clearance with hemodialysis. Implications include dose adjustment during dialysis and efficacy of dialytic technique in the treatment of theophylline intoxication.

Blood Glucose↗
PubMed1978

Hemodialysis clearance of cimetidine.

Hemodialysis clearance of cimetidine was determined in three patients and was found to range between 41.34 to 75.91 ml/min. Notwithstanding its substantial dialyzability, the amount of cimetidine removed by four hours of hemodialysis constituted only 8% to 14% of the administered dose. Accordingly, major dose adjustment on the days of dialysis treatment, as suggested in the available literature, may not be necessary.

Adult↗
PubMedDate not supplied

Central retinal vein occlusion associated with hemodialysis.

Central retinal vein occlusion (CRVO) occurred in 3 of 15 maintenance hemodialysis patients over a two-week period. There have been no previous reports of this ophthalmologic catastrophe observed in the dialysis setting. Lupus nephritis, Henoch-Schönlein purpura and nephrosclerosis constituted the patients' major underlying diseases. Moderate hypertension was also present. Impaired vision of the left eye noted 24 to 36 hours following dialysis was the presenting symptom in all cases. Findings included decreased visual acuity, retinal vein engorgement, hemorrhage, and disc edema. All three patients subsequently lost the vision in their left eye (two received anticoagulation therapy). With the exception of hypertension, there were no known underlying predisposing conditions present. Although we are unable to offer a definite explanation for these unusual cases of CRVO, we feel a hypercoagulable state may have been responsible. Because our three cases occurred during a two-week period, some transient unidentified procoagulant factor associated with hemodialysis could have been present.

Adolescent↗
PubMedDate not supplied

Erythropoiesis associated with viral hepatitis in end stage renal disease.

We describe an end stage renal disease (ESRD) patient on maintenance hemodialysis who developed a spontaneous increase in erythropoiesis associated with an episode of viral hepatitis. Resolution of the hepatitis was accompanied by a reduction in erythropoiesis with the hemoglobin and hematocrit falling back toward the patient's low baseline levels. Plasma erythropoietin (Ep) titers were measured during the period of active erythropoiesis and were found to be low to low normal. The unusual phenomenon of increased erythropoiesis in ESRD following liver injury has been previously described and is thought to be mediated through increased hepatitic Ep production. The low Ep titers measured in our patient, however, suggest that the liver may be capable of stimulating erythropoiesis by another mechanism.

Aged↗