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At least 397 records · Page 22Linked to original sources
PubMed1950

Clinical potassium problems.

Alterations in serum potassium are common in many diseases. In a series of 390 determinations of serum potassium, the levels found were low in 24 per cent and high in 2.6 per cent. The major causes of low serum potassium are (1) decreased potassium intake due to intravenous feedings which do not contain potassium; (2) increased loss of potassium in the urine due to accelerated tissue breakdown, or renal lesions; (3) loss from the gastrointestinal tract due to diarrhea, or fistulae, and (4) shift between serum and cells, due to metabolic causes, drugs or changes in pH. The major cause of high serum potassium is uremia with renal retention.Clinical symptoms and signs of low body potassium include muscle weakness and paralysis, which may lead to death in respiratory failure if not corrected, tachycardia, gallop rhythm, dilatation of the heart. The electrocardiogram shows inverted, low amplitude, or isoelectric T waves and a prolonged QT interval. Potassium chloride orally, subcutaneously or intravenously is recommended for use in the treatment of potassium deficits. It should not be used in the presence of oliguria or anuria or dehydration. The amounts of potassium necessary to correct deficits vary widely and cannot be predicted from the serum level. Special reference is made to the prevention and therapy of potassium deficits in diabetic acidosis. High serum potassium levels are difficult to correct. Suggested measures are administration of glucose, insulin or calcium, gastric or peritoneal lavage or use of the artificial kidney.

Anuria↗
PubMed1986

Severe hyperkalemia as a complication of timolol, a topically applied beta-adrenergic antagonist.

Severe hyperkalemia occurred in a patient with radiation pneumonitis and glaucoma shortly after beginning prednisone therapy. There was no evidence of renal failure, diabetes, acidosis, increased potassium intake, or significant tissue trauma. Medications having adverse effects on potassium metabolism were considered, and the patient's use of timolol maleate eyedrops was discontinued. His serum potassium level normalized despite continuation of the prednisone therapy. He became hyperkalemic on rechallenge with timolol and normokalemic following its withdrawal. This case indicates that the potential for beta-blocker-induced hyperkalemia exists even with topical appreciation.

Aged↗
PubMed1979

Clinical use of amylase clearance and isoamylase measurements.

Isoamylase determinations and measurements of the ratio of the renal clearance of amylase relative to creatinine (CAm/CCr) were employed in an attempt to improve the diagnostic accuracy of the standard amylase measurement. An elevated CAm/CCr reflects defective proximal tubular reabsorption of amylase which occurs in virtually all patients with clear-cut acute pancreatitis. However, other conditions that apparently are associated with acute defective tubular function, such as burns and diabetic acidosis, may cause an elevated ratio. Thus, elevations of CAm/CCr cannot be considered to be specific for acute pancreatitis. Pancreatic isoamylase represents, on the average, about 33% of the normal serum amylase activity, whereas about 66% is salivary-type isoamylase. Isoamylase measurements are useful in determining whether an elevated value for serum amylase activity is of pancreatic origin. However, this measurement is not useful for determining whether patients with normal serum amylase activity have pancreatitis.

Amylases↗
PubMed1979

[Phycomycoses].

Phycomycoses are opportunistic fungal diseases as far as mucormycosis is concerned, but for basidiobolomycosis and entomophthoromycosis, the adjective 'opportunistic' should be used with caution. Mucormycosis assumes cranial, pulmonary, gastrointestinal, disseminated, cutaneous and focal forms: the infection nearly always develops in a person whose resistance is lowered by a metabolic disorder, a blood dyscrasia, corticosteroid or immunodepressive therapy. It is a frequent complication in leukemia or diabetic acidosis. Basidiobolomycosis and entomophtoromycosis are caused by fungi which belong to the order, Entomophthorales. They are characterized in tissue by broad hyphae which are surrounded by eosinophilic material. These mycoses are treated by potassium iodide.

Africa↗
PubMedDate not supplied

[Use of a temporal cardiac pacemaker in patients undergoing a major non-cardiac surgery].

This is a report of the use of transvenous temporal pacemaker in 18 patients, with an average age of 59.3 years, that under want non cardiac major surgery. They did not have cardiac simptoms but had conduction abnormalities in the preoperative electrocardiogram. A pacemaker was implanted as a prophylaxis against arrythmia during the transoperative and postoperative periods. There was no incidence of transoperative arrythmia. Three patients died in the immediate postoperative period, two due to duffuse carcinomatosis and one due to diabetic acidosis. The average duration of the implanted pacemaker was 12.7 days, and three patients required a permanent pacemaker. Case five is exemplificative of the benefits of the temporal pacemaker, he had a preoperative electrocardiogram showing trifascicular block, he was taken to the operating room and anesthesia was induced, the patient had a cardiac arrest but recovered without secuela; latter on a temporal pacemaker was inserted and the patient had surgery without cardiac problems.

Adult↗
PubMed1994

[diagnostic ultrasonography of air in the portal venous system: apropos of a case of colonic radionecrosis and literature review].

We present a case of dramatic radiation enterocolitis inducing portal venous air diagnosed by Doppler sonography only. The sonographic pattern consisted of multiple irregular hyperechoic areas into the liver, with internal repetitive noisy bidirectional peaks superimposed on the usual continuous Doppler display of the portal flow. Although portal hyperechoic moving foci alone may reflect only slow portal velocity, they do not create any Doppler distortion as do moving bubbles. Portal air may have multiple causes such as abdominopelvic abscesses, sepsis, intestinal distension, fulminant hepatitis, cholangitis, cholecystitis, diabetic acidosis..., but mesenteric infarct, necrotic enterocolitis, and radiation enteritis are life-threatening conditions that have to be diagnosed as soon as possible. Although large quantities of portal air may be demonstrated on plain film of the abdomen or by computed tomography, Doppler sonography may detect smaller quantities, allowing earlier diagnosis of intestinal pathology requiring immediate surgical treatment. Therefore, Doppler sonography of the liver should be performed in any patient with acute abdominal pain or distension, especially if being treated by abdominal radiotherapy.

Air↗
PubMed1993

Halitosis: knowing when 'bad breath' signals systemic disease.

Halitosis in older adults is a common condition that may have oral or nonoral sources, result from a number of different etiologies, and have more than just social consequences. In some cases, bad breath may reflect serious local or systemic conditions, including gingivitis, periodontal disease, diabetic acidosis, hepatic failure, or respiratory infection. Your role as the primary care physician is first to determine whether the odor has an oral or nonoral cause. Odors can be distinct in their quality and thus can help make this determination. Management of nonoral sources requires treatment of the underlying cause, whereas suspected oral sources require referral for a dental evaluation.

Aged↗
PubMed1980

[Reversible lactic acidosis in a diabetic on high dose metformin (author's transl)].

In a diabetic, who took a high dose of 5.85 g metformin daily for 75 days, urinary retention caused by a prostatic adenoma induced functional renal insufficiency and hyperlactacidemia, rapidly reversed with treatment. Plasma and urine levels of metformin were measured at the same time as lactate and pyruvate levels, until all returned to normal. Clinical and biological improvement occured at the same time. The case is discussed in the context of lactic acidosis in diabetics with functional or organic renal insufficiency, treated with metformin.

Adenoma↗
PubMedDate not supplied

[A clinical case of development of lactic acid acidosis in a diabetic patient taking metformin].

Metformin is a biguanide. Due to its effects in suppressing the hepatic production of endogenous glucose and in increasing insulin sensitivity in adipose tissue and skeletal muscle, the agent is used particularly in type 2 diabetes mellitus and metabolic syndrome, in which insulin resistance is especially pronounced. Lactic acidosis is one of the most important side effects of metformin. A male patient, born in 1923, was admitted to the emergency unit of our hospital for sudden vertigo, weakness, dyspnea, cyanosis, and lethargy. His history data showed that the patient had been suffering from type 2 diabetes mellitus for 10 years and taking Glargin (insulin), 12 U/kg, once daily and Glucophage (metformin), 850 mg thrice daily. The patient's general condition was fair; stupor, time and spatial orientation were absent. Analysis of arterial blood gases showed the presence of metabolic acidosis, hypokalemia, hypoxemia, and hypercapnia. Thereafter the patient was transferred to the intensive care unit of the hospital; intubated and connected to a T-bird ventilation apparatus. On the following day, an analysis of arterial blood gases indicated the proximity of the results to their physiological parameters. Ventilation was stopped; and monitoring of the patient continued by following the T-shape type of ventilation discontinuation. There were no X-ray signs of pneumonia or pulmonary edema. On the same day, the patient was extubated and oxygen inhalation in a dose of L/min was continued through a mask. On day 4 since therapy was initiated, the patient's vital signs, serum sugar and lactate levels became normal. By determining a new treatment regimen, the patient was discharged from the intensive care unit. Dyspnea, acidosis, and hypoxia developed in the patient resulted from lactic acidosis caused by the use of metformin. It should be remembered that dyspnea, acidosis, and hypoxia, which suddenly developed in metformin-treated patients with type 2 diabetes mellitus, may be caused by lactic acidosis.

Acidosis, Lactic↗
PubMed1976

Phenformin and lactic acidosis in a diabetic and a nondiabetic.

Two patients, each with a history of taking "diabetes pills," which proved to be phenformin, presented to the emergency department. The first, a 56-year-old female diabetic, on daily medication was symptomatic. The second, a non-diabetic 21-year-old man had attempted suicide using his grandmother's phenformin tablets. Both patients had lactic acidosis. The causal role of phenformin is discussed and the need for early recognition and aggressive treatment is stressed.

Acidosis↗