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Biomedical subjects

N S Lichtenstein

Publications and source records attributed to N S Lichtenstein.

14 recordsLinked to original sources

Halothane-induced nephrotoxicity.

Two cases are reported of combined renal and hepatic failure following exposure to halothane anesthesia. Both patients presented with postoperative fever and rapidly deteriorating liver and kidney function. Both required peritoneal dialysis. Both patients died, and in both cases this was the second exposure to halothane. The pathologic features of the 2 cases were similar in that the liver changes were typical of those seen with halothane hepatitis and the renal lesion was similar to that of methoxyflurane nephritis. This is, to our knowledge, the third report of renal failure occurring after halothane anesthesia. Possible mechanisms regarding its toxicity are discussed.

Aged

The myth of the low anion gap.

Sixty-seven thousand seven hundred forty consecutive sets of electrolyte levels measured at the Massachusetts General Hospital were reviewed, and their anion gaps were calculated. A low anion gap (less than 8 mEq/L) was found in 304 patients (0.8%). Repeatedly low anion gaps were found in only 19 patients. Eight patients were hypoalbuminemic, and eight were hyponatremic. For the entire population, there was a positive correlation between sodium concentration and anion gap. The average anion gap was 16.25 mEq/L. The most common cause of a low anion gap was presumptive laboratory error.

Anions

Low fractional excretion of sodium with contrast media-induced acute renal failure.

Risk factors, clinical courses, and urinary indices were examined in 12 consecutive patients with contrast media-induced acute renal failure. A high prevalence of preexisting renal disease, diabetes, vascular disease, and compromised cardiac output was observed. All patients had transient oliguria one to four days in duration, and all patients had return of renal function to their baseline values within five to ten days. Consistently low urinary sodium concentration and fractional excretion of sodium (FENa) were seen during the oliguric phase of the acute renal failure. Fractional excretion of sodium of less than 1% persisted for up to five days despite unequivocal renal function deterioration. The findings raise the possibility that acute renal failure secondary to contrast media may be mediated either by decreases in renal perfusion or by acute tubular obstruction.

Acute Kidney Injury