Transdermal glyceryl trinitrate.
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Administration, Topical↗
Biomedical subjects
P Charters
Publications and source records attributed to P Charters.
Mannitol, osmolality and steroids during renal transplantation. Real and theoretical influences on plasma potassium.
Mannitol did not have an exaggerated effect on plasma potassium when administered to twelve patients undergoing renal transplantation. Unexpected rises in plasma osmolality, greater than those recorded after mannitol, were observed in two of the patients. In these two patients the osmolality changes were due to sudden hyperglycaemia and followed methylprednisolone therapy (given for immunosuppression). It is suggested that under certain circumstances, such changes in osmolality may lead to a rise in plasma potassium comparable to the effect of mannitol. One of the two patients with the rise in glucose and osmolality did have a rise in plasma potassium.
Blood Glucose↗
Renal transplantation in diabetes mellitus.
Renal failure is common in patients with diabetes mellitus, and renal transplantation has been used in its treatment. There are indications that the operation may be hazardous in these circumstances, and a report is presented in which careful biochemical monitoring of a diabetic patient undergoing transplantation revealed two episodes of hyperkalaemia which might go some way to explain the hazards of this operation. The relevance of the concept of glucose-induced hyperkalaemia is discussed and it is suggested that intravenous infusion of insulin during and after operation might have decreased the rises in serum potassium. The report emphasises the need for careful biochemical monitoring of diabetics undergoing renal transplantation.
Adult↗
Airway intervention in adult supraglottitis.
BACKGROUND: The timing of aggressive airway intervention in adult epiglottitis is controversial. AIMS: To correlate Friedman's staging of epiglottitis on admission with the airway interventions undertaken. METHODS: A retrospective study of 23 adult patients, mean age 51 years (range 29-81 years), who had been admitted with acute supraglottitis between March 1988 and December 2000 was undertaken. RESULTS: Three patients (13%) had airway interventions; two with tracheostomy and one with tracheal intubation. All were Friedman stage III and had rapid symptom progression during the 24 hours prior to admission. Three other stage III patients with symptom progression longer than 24 hours and all the remaining patients (stage II or less) were managed with observation and intravenous therapy. CONCLUSIONS: Friedman originally advocated airway intervention in any patient stage II or worse, but this intubation threshold should probably be lowered to those patients with rapid-onset stage Ill (moderate respiratory distress, stridor, respiratory rate > 30 per minute, pCO2 > 45mmHg) disease.
Acute Disease↗