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PubMedDate not supplied

Analgesic transition after remifentanil-based anesthesia in neurosurgery. A comparison of sufentanil and tramadol.

AIM: Transition from the end of remifentanil infusion and postoperative analgesia must be planned carefully owing to remifentanil's (R) rapid offset. Intraoperative morphine has been used for the transition to postoperative analgesia following remifentanil-based anesthesia. Sufentanil (S) is a very potent opioid with high micro-receptor affinity, a much wider therapeutic index and a lower fractional receptor occupancy. These pharmacological and dynamics features make sufentanil an interesting alternative to morphine for immediate postoperative analgesia. METHODS EXPERIMENTAL DESIGN: perspective, randomized, single blinded and comparative study. Institution: neurosurgical operating theatre at University. PATIENTS: 96 patients, aging from 25 to 67 years, ASA class I-III, undergoing neurosurgical operations, were studied. INTERVENTIONS AND MEASUREMENTS: the anesthetic management was: premedication: atropine 0.01 microg kg(-1) + remifentanil 0.20 microg kg(-1) min(-1); induction: propofol 2.0 microg kg(-1) + cisatracurium 0.15 microg kg(-1); maintenance: sevoflurane 0.8% + remifentanil (titrated infusion) cisatracurium. All patients received ketorolac 30 mg i.v. 1 hour before the end of surgery and ketorolac (60-90 mg) + tramadol (200-300 mg) by elastomeric pump; patients were divided into 2 groups: group T receiving tramadol 100 mg and group S receiving a bolus dose of sufentanil 0.10 microg kg(-1), 30 and 15 minutes before the end of surgery respectively. Recovery time, postoperative analgesia evaluated by VAS, cardiocirculatory parameters and side effects like nausea, vomiting, shivering, muscle rigidity, sedation and respiratory depression were recorded. RESULTS: VAS was significantly lower in Group S. Recovery time was shorter in Group T than in Group S (8.8 +/- 3.6 vs 11.6 +/- 4.6 min), no statistically significant differences between groups as regards nausea, vomiting and shivering. Short-lasting respiratory depression was detected in 3 cases in Group S. CONCLUSION: At the emergence much better control of the transition phase in patients treated with sufentanil: smooth recovery with better tolerability of the endotracheal tube; efficacious analgesia along with cardiocirculatory stability.

Adult↗
PubMed2004

Intrathecal fentanyl in spinal anesthesia for appendectomy.

OBJECTIVE: The authors assessed the effectiveness of the administration of fentanyl in spinal anesthesia for appendectomy. MATERIAL AND METHOD: Forty patients randomized double-blind, were recruited to receive either 4 ml of 0.5% hyperbaric bupivacaine + 20 mg of fentanyl (Group F) or 4 ml of 0.5% hyperbaric bupivacaine 0.5% + 0.4 ml normal saline (Group S). RESULTS: There were no significant differences in the highest analgesic level between the groups. The number of segments regressed at 60 min in Group F was statistically less than in Group S (0 vs. 2; P 0.002). Group F showed significantly lower median VNS pain scores than Group S (0 vs. 3; P 0.004). Time to first required postoperative analgesics in Group F was significantly higher than in Group S (13.6 vs. 6.3 h, P < 0.001). The incidence of shivering in Group F was significantly lower than Group S (35% vs. 70%; P 0.023). There were no significant differences in the incidence of nausea, vomiting, hypotension and urinary retention. No patient developed respiratory depression or PDPH. The patients' satisfaction of spinal anesthesia was 100% in Group F and 80% in Group S. CONCLUSION: Intrathecal 20 microg fentanyl significantly improved the quality of analgesia, it prolonged the duration of bupivacaine in spinal anesthesia and delayed the analgesics requirement in the early postoperative period. Shivering was less frequently found in the fentanyl group.

Adjuvants, Anesthesia↗
PubMed2004

Quality of post-anesthetic care in a hospital without a Post-Anesthetic Care Unit. A clinical audit.

AIM: The majority of Italian hospitals are not equipped with a Post- Anesthetic Care Unit. The aim of this study is to evaluate whether it is possible to guarantee post-anesthetic care according to current international quality and safety standards in the absence of such a structure. METHODS: Our hospital is not equipped with a Post-Anesthetic Care Unit and post-anesthetic assistance is assured by the anesthetist and anesthetic nurse themselves. In order to evaluate the quality of the post-anesthetic care a Recovery Chart was devised and strict discharge criteria defined: Recovery Score (modified Aldrete's score) = or >7; systolic blood pressure within 20% of the preoperative values; nausea/vomiting and shivering absent; pain absent/mild. A retrospective audit was conducted in 2 orthopedic operating rooms from January 10, 2000 to January 31, 2001 in order to evaluate major complications, observance of discharge criteria, postanesthetic care time. RESULTS: Incidence of complications was 2.6%. Observance of discharge criteria was 74%. In 26% of cases (69/261 cases) discharge criteria were not completely respected: 14 cases with unstable vital parameters; 46 cases with pain not under control; 6 cases with nausea/vomiting; 3 cases with shivering. In these cases monitoring and treatment was continued on the ward according to the anesthetist's prescriptions. None of these patients died or suffered major complications because of a quick discharge to the ward. Mean post-anesthetic care time was 40+/-18 minutes (median 35 minutes). CONCLUSION: Where the Post- Anaesthetic Care Unit is not available it is virtually impossible to guarantee post-anesthetic care according to current international quality and safety standards, because production pressure can lead the anesthetist to discharge the patient to the ward before he/she is completely stabilized. In these cases the anesthetist must accurately prescribe the necessary postoperative monitoring and treatment (analgesics, antiemetics, fluids, etc.) that must be continued in the surgical ward to guarantee the patient's safety, but it must be underlined that the surgical ward is not the appropriate place to carry on immediate post-anesthetic care.

Anesthesia↗
PubMed1977

Effects of electroanesthesia and a phenothiazine tranquilizer on thermoregulation in the sheep.

The effects of giving propiopromazine alone and of electroanesthesia-propiopromazine treatment on thermoregulation (body temperature regulation) were studied in 3 sheep at ambient temperatures of 5, 25, and 35 C. Measures of thermoregulation during a 120-minute treatment and 120-treatment recovery period included rectal temperature, respiratory frequency, respiratory evaporative heat loss, metabolic heat production, multiple skin temperatures, and shivering. During cold exposure (5 C), both the propiopromazine administration and the electroanesthesia-propiopromazine treatment resulted in hypothermia which was attributed to increased peripheral and respiratory heat losses, a transient inhibition of shivering thermogenesis, and a reduction in metabolic heat production. At 35 C ambient temperature, both resulted in hyperthermia caused principally by a reduction in respiratory evaporative heat loss. The effects of electroanesthesia-propiopromazine treatment on thermoregulation appeared to be additive at both the cold (5 C) and the hot (35 C) environments, in that simultaneous administration resulted in a more profound thermoregulatory impairment. Nevertheless, shifts in body temperature during electroanesthesia are partly attributable to phenothiazine premedication.

Animals↗
PubMed2005

[Effect of rapid and slow cooling on thermoregulatory responses in hypertensive and normotensive rats after calcium administration].

The effect of iontophoretic administration of calcium ions to skin in the area of cold stimulus application on the thermal thresholds and the magnitude of cold defense responses in normotensive Wistar and hypertensive ISIAH rats was studied. In thermoneutral conditions, administration of calciumions wos without effect on the measured thermoregulatory parameters. Under the effect of calcium, the thresholds of all the thermoregulatory responses to cooling (such as heat loss, oxygen consumption, shivering) are lowered and the values of heat loss and shivering thermogenesis are considerably increased. The effects of calcium on thermoregulatory responses depend on the rate of cooling. All changes are more expressive in hypertensive rats. The increased sensitivity of hypertensives to calcium suggests that change in their calcium metabolism may be a cause of the observed shifts in the thermoregulatory response to cold.

Animals↗
PubMed1992

Fever in young lambs: hypoxemia alters the febrile response to a small dose of bacterial pyrogen.

Experiments were done on eight young lambs to investigate the effects of hypoxemia on the body temperature, metabolic and cardiovascular responses to intravenous administration of a small dose of bacterial pyrogen (0.3 micrograms lipopolysaccharide extracted from Salmonella Abortus Equi; SAE). Each lamb was anaesthetized with halothane and prepared for sleep staging and measurements of cardiac output, arterial and mixed-venous haemoglobin oxygen saturations, body-core and ear-skin temperatures. Three experiments were done on each lamb, the first being done no sooner than three days after surgery. The first experiment consisted of establishing the thermal neutral environment during normoxemia (ie, environmental temperature at which total body oxygen consumption was minimal while body temperature was maintained) for each lamb. The second and third experiments were done at the lamb's thermoneutral environment as determined on day 1. One experiment was done during normoxemia (ie, control condition, SaO2 approximately 90%) and one experiment was done during hypoxemia (ie, experimental condition, SaO2 approximately 50%). Measurements were made during a control period and during one-minute experimental periods at 10 minute intervals for 120 minutes following administration of 0.3 micrograms of bacterial pyrogen in sterile saline. Administration of SAE produced a short-lived fever of about 0.8 degrees C in the normoxemic lambs, whereas no change in body-core temperature was observed in the hypoxemic lambs. During normoxemia, the increase in body-core temperature was preceded by peripheral vasoconstriction, the onset of shivering, and a surge in total body oxygen consumption. The increase in total body oxygen consumption was met primarily by an increase in total body oxygen extraction during the development of fever. Cardiac index, heart rate, and systemic oxygen transport increased during the peak body-core temperature response. Systemic arterial blood pressure did not change significantly during the febrile response; however, pulmonic arterial blood pressure increased. During hypoxemia, peripheral vasoconstriction and shivering occurred following administration of SAE, but there was no change in total body oxygen consumption or body-core temperature. Thus, our data provide evidence that hypoxemia alters the febrile response of young lambs to bacterial pyrogen. The precise mechanism remains to be determined.

Animals↗
PubMed1991

Molecular biology of myelin basic protein: gene rearrangement and expression of anti-sense RNA in myelin-deficient mutants.

1. Myelin is an important structure for facilitating the conduction of impulses along the axons both in the central nervous system (CNS) and peripheral nervous system (PNS). 2. Myelin basic protein (MBP) is a major protein in CNS myelin. 3. MBP is expressed specifically in the nervous system. 4. The MBP gene has been cloned and characterized. 5. Two mutant mice, Shiverer (shi) and myelin-deficient (mld. shimid), are autosomal recessive mutants that show severe symptoms such as intentional tremor. They have been found to have a mutation in the MBP gene that results in poor myelination in the central nervous system. 6. It was found that rearrangement within the MBP gene results in low expression of the gene. 7. In Shiverer, the MBP gene is partially deleted (from exons 3 to 7), and in mld, the gene is duplicated tandemly and a large portion of the duplication is inverted upstream of the intact copy. 8. In mld, anti-sense RNA complementary to exons 3-7, which correspond to the inverted segment, was detected by RNase protection studies, and presumed to be responsible for the reduced expressions of MBP. 9. The mechanism of gene rearrangement in MBP was also characterized. 10. This article reviews the recent progress in the study of the MBP gene, especially the rearrangement of the gene and its expression in mutant mice.

Animals↗
PubMed2006

Acclimation to intermittent hypobaric hypoxia modifies responses to cold at sea level.

INTRODUCTION: Residence at high altitude modifies thremoregulatory responses to cold stress upon return to lower altitude. These changes are difficult to explain since several stresses related to high altitude may interact, including hypoxia, cold, solar radiation, and physical exertion. We hypothesized that adaptation to hypoxia without cold exposure would produce at least part of the observed changes. METHODS: Five men underwent acclimation to intermittent hypoxia (AIH) in a hypobaric chamber (8 h daily for 4 d, and 6 h on the last day, 4500 to 6000 m) at 24 degrees C. Cold stress responses were tested during a whole-body standard cold air test (1 degrees C, 2 h at rest at sea level) both before and after AIH. RESULTS: Increased reticulocyte counts and percentages confirmed acclimation to hypoxia after AIH. Changes in thermoregulation during the cold test included lower mean skin temperature after 60-80 min (18.8 +/- 0.7 degrees C vs. 19.4 +/- 0.7 degrees C); higher mean metabolic heat production (127 +/- 8 W x m(-2) vs. 118 +/- 6 W x m(-2)); and lower heat debt (7.7 +/- 1.3 kJ x kg(-1) vs. 10.3 +/- 1.2 kJ x kg(-1)), without significant change in rectal temperature. Time to onset for continuous shivering decreased after AIH (12 +/- 5 min vs. 21 +/- 6.3 min), and shivering activity occurred at higher mean skin but not rectal temperatures. CONCLUSION: AIH in comfortable ambient temperature leads to a normothermic-insulative-metabolic general cold adaptation. We conclude that AIH modifies the thermoregulatory responses to cold at sea level without cold exposure leading to a cross-adaptation.

Acclimatization↗
PubMed1991

Rewarming postoperative patients: lights, blankets, or forced warm air.

This study was designed to determine if the forced warm air system is more effective than warmed cotton blankets or radiant heat lamps for rewarming postoperative patients. PACU admission temperatures were taken on 370 adult patients. The study population of 90 patients with admission temperatures of 35 degrees C (95 degrees F) or less was randomly assigned to one of three intervention groups: (b) warmed cotton blankets, (L) radiant heat lamps, or (A) forced warm air. Oral or axillary temperatures were monitored every 15 minutes and the warming intervention continued until the patient reached the discharge criteria of 36 degrees C (96.8 degrees F). The three groups were comparable for sex, age, admitting temperature, OR time, and OR fluid. The mean rewarming times for patients who shivered were similar for all groups. For those patients who did not shiver, those treated with forced warm air rewarmed significantly faster than patients in the other groups. Nonshivering patients treated with forced warm air were ready for discharge somewhat sooner than those treated with either of the other two interventions.

Body Temperature Regulation↗
PubMedDate not supplied

Neonatal thermoregulation.

The human being is a homeotherm. Homeothermy is a result of thermoregulation which includes many physiological processes. Thermoregulation maintains an equilibrium between heat production (thermogenesis) and heat loss (thermolysis). There are three principal modes of heat production: 1. Voluntary muscle activity. 2. Involuntary tonic or rhythmic muscle activity known as "shivering". 3. Non-shivering thermogenesis (NST) essential for newborns. Heat loss occurs in two stages: 1. The flow of heat from the center of the body to its surface. 2. The flow of heat from the body surface to the environment by conduction, convection, radiation or water evaporation. Even in the very small premature baby, we find that metabolic and vasomotor control responses are developed. To protect the newborn from stress resulting from hypo or hyperthermia, one should take into consideration the concept of the neutral temperature range which is also called the "Thermoneutral Zone" in (TNZ) or "Thermal Neutrality". Curves, proposed in 1971 by Hey are essential for keeping newborns in the TNZ.

Body Temperature Regulation↗
PubMed1991

GABAA receptors display association of gamma 2-subunit with alpha 1- and beta 2/3-subunits.

Recombinant GABAA (gamma-aminobutyrate-Type A) receptors that are sensitive to benzodiazepine receptor ligands can be generated by coexpression of alpha-, beta-, and gamma 2-subunit cDNAs (Pritchett, D. B., Sontheimer, H., Shivers, B. D., Ymer S., Kettenmann, H., Schofield, P. R., and Seeburg, P. H. (1989) Nature 338, 582-585; Pritchett, D. B., Lüddens, H., and Seeburg, P. H. (1989) Science 245, 1389-1392; Malherbe, P., Sigel, E., Baur, R., Perssohn, E., Richards, J. G., and Mohler, H. (1990) J. Neurosci. 10, 2330-2337). However, in brain tissue, only alpha- and beta-subunit proteins have so far been detected. To identify the size and distribution of the gamma 2-subunit protein in brain tissue, polyclonal antibodies were prepared against two synthetic peptides corresponding to amino acids 1-15 and 336-350 of the cDNA-derived rat gamma 2-subunit sequence. On Western blots, both anti-gamma 2-subunit antisera selectively labeled a 43-kDa protein. gamma 2-Subunit immunoreactivity was detected immunohistochemically in various brain regions, e.g. in the olfactory bulb, cerebral cortex, islands of Calleja, hippocampus, substantia nigra, and cerebellum. Immunoprecipitation with both antisera identified the gamma 2-subunit immunoreactivity in 40 and 50% of the native GABAA receptors purified from bovine and rat brains, respectively. Monoclonal antibody bd24 selectively recognizes the alpha 1-subunit, whereas bd17 recognizes both the beta 2- and beta 3-subunits (Ewert, M., Shivers, B. D., Lüddens, H., Mohler, H., and Seeburg, P. H. (1990) J. Cell Biol. 110, 2043-2048). Since either of these monoclonal antibodies (bd17 and bd24) precipitated approximately 90% of the GABAA receptors, the gamma 2-subunit is frequently associated with the alpha 1-subunit and the beta 2- and/or beta 3-subunit in vivo.

Amino Acid Sequence↗
PubMed1990

Thermogenesis and thermoregulatory function of iron-deficient women without anemia.

Physiological responses at 16 degrees C were studied in 11 women, age 28 +/- 2(mean +/- S.E.) years and 26 +/- 2% fat, after their body iron stores were depleted by diet (5.0 mg iron x 2,000 kcal-1 x d-1), phlebotomy and menstruation for about 80 d and were repleted by diet (13.7 mg iron x 2,000 kcal-1 x d-1) for about 100 d, including daily iron supplementation (50 mg of iron as ferrous sulfate) for the last 14 d of repletion. Iron depletion was characterized by a decline (p less than 0.05) in hemoglobin (12.0 +/- 0.2 g x dl-1), ferritin (5.5 +/- 0.5 ng x ml-1) and body iron balance (-9.1 +/- 2.6 mg x 6 d-1). Iron repletion, including supplementation, increased (p less than 0.05) hemoglobin (12.6 +/- 0.1 g x dl-1), ferritin (9.5 +/- 0.4 ng x ml-1) and iron balance (+67 +/- 6.7 mg x 6 d-1). Iron depletion reduced (p less than 0.05) metabolic heat production (49.6 +/- 1.1 vs 53.6 +/- 1.2 W x m-2) during acute cold exposure. The rates of cooling of the core and periphery were greater (p less than 0.05) during iron depletion than repletion. A shift in the lower core temperature threshold for shivering was paralleled by an earlier onset of shivering (p less than 0.05) in iron depletion indicating an adaptation in cold tolerance in an attempt to maintain core temperature. Iron depletion was associated with blunted post-exposure increases in plasma thyroid hormone concentrations and greater (p less than 0.05) increases in plasma norepinephrine concentrations as compared to iron repletion. In a subsample of the women, no significant effect of calcium or ascorbic acid supplementation was found on responses to cold exposure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Physiological↗
PubMedDate not supplied

Alterations in thyroid hormone physiology induced by temperature and feeding in newly hatched chickens.

In the chicken the transition of a poikilotherm to a homeotherm reaction upon cold exposure takes place in the perinatal period between pipping and hatching. However, newly hatched chicks cannot maintain their body temperature within narrow limits after cold exposure. The fact that relatively little attention was payed on the role of thyroid hormones in the thermoregulatory reaction to cold of young chicks was probably due to the hypothetically long latention time that was thought to be necessary to bring about changes in secretory activity by cold stimulation. However, more recently, rapid changes (within hours) of thyroid hormone concentrations upon cold exposure were described in the chickens and the quail. In this study, changes in circulating T3 and T4 concentrations upon cold exposure of young chicks during the first two weeks were followed, that means during the period wherein NST (non-shivering thermogenesis), if it exists at all, should be progressively replaced by ST (shivering thermogenesis). Because of the importance of feeding condition on thyroid hormone levels, the experiments were carried out with and without a preceeding fasting period. In all experiments a short-term cold exposure of young chickens (1-11 days) fed ad lib decreased T3 but increased T4 levels while a reversed picture was found after short cold exposure of the fasted animals. However, after prolonged cold stimulus (15 degrees C) of young chickens fed ad lib, plasma T3 was also significantly elevated over that of controls whereas T4 levels returned to normal values. A prolonged warm treatment (37 degrees C) of young chickens fed ad lib resulted in significantly lower T3 and higher T4 concentrations. After a prolonged cold treatment no differences in T4 or T3 response upon TRH were found whereas the warm treatment abolished these responses upon TRH. However, a cold treatment at the stage of incubation during which the hypothalamo-hypophyseal control of thyroid function is established (dag 10-14) enhanced the T4 response to TRH with a long lasting effect extending to the posthatch period. Since T3 is thought to be the active form of thyroid hormones with regard to thermopoiesis we have studied more specifically the effect of blocking peripheral conversion of T4 on thermoregulatory abilities in young chicks and the influence of temperature treatment on monodeiodination capacity. The lower rectal temperatures following the interference with the peripheral monodeiodination of T4, the effect being more pronounced at the lower ambient temperature, are indicative for a preponderant role of T3 on thermogenesis.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1987

[Intracerebral transplantation of oligodendrocytes in mice].

We describe in this paper experiments in which oligodendrocytes (from newborn mouse, human embryonic brain, or isolated from adult rat brain) have been transplanted into the brain of the newborn mouse. Experimental conditions (Shiverer model) allowed the detection of myelin formed by transplanted oligodendrocytes into the Shiverer brain. The transplanted oligodendrocytes have been shown to survive, migrate over long distances and myelinate host axons. The maturation of transplanted oligodendrocytes depends upon the age of the brain tissue in which they differentiate.

Animals↗
PubMed1986

Effects of an insecticidal dip containing d-limonene in the cat.

A study was undertaken to determine the effects of a single dermal application of a commercial insecticidal dip containing 78.2% d-limonene in cats. At the manufacturer's recommended concentration of 1.5 oz/gal of water, no clinical signs or lesions of toxicosis were seen. At 5 times the recommended concentration, clinical signs were mild and consisted of hypersalivation of short duration, ataxia, and muscle tremors resembling shivering. At 15 times the recommended concentration, clinical signs included hypersalivation lasting 15 to 30 minutes, moderate-to-severe ataxia lasting 1 to 5 hours, muscle tremors resembling shivering lasting 1 to 4 hours, and severe hypothermia beginning soon after treatment and lasting 5 hours. Gross lesions were confined to excoriation of the scrotal and perineal areas of the treated male cats at the 15 X concentration. No deaths or other lasting effects were seen at any dosage.

Animals↗
PubMed1979

[Skeletal muscle motor unit activity in cats during cold tremors].

The electrical activity of single motor units of the cat m. sartorious during the preshivering tone and shivering tremor revealed a steady frequency 5--10/sec. The transition from preshivering tone to shivering tremor involved recruitment of motor units with similar properties: the low--threshold units. The response of motor units to local thermal stimuli applied to vascular thermoreceptors depended on the level of peripheral temperature.

Animals↗
PubMed1979

Responses of high altitude natives a standard cold test at sea level.

Studies have been conducted to evaluate the thermoregulatory, calorigenic, and peripheral vascular responses to cold of high altitude (HA) natives on their descent to sea level. Two groups of subjects (18 each), one representing high altitude (3500 m) natives and the other lowlanders, were exposed to a standard cold test at 10 degrees C wearing only shorts for 2 h. Their heart rate (HR), blood pressure (BP), oxygen consumption (VO2), oral temperature (Tor), mean weighted skin temperature (Ts) and shivering activity were recorded initially in a thermoneutral room, and 30 min intervals during the cold exposure. Afterwards, their cold-induced vasodilatation (CIVD) response was studied and the peripheral blood flow during local cold stress was calculated. The responses were statistically compared. The highlanders maintained significantly higher Tor, Tb (mean body temperature), Ts and peripheral Ts during cold stress, and they shivered much less and showed higher CIVD response and peripheral blood flow than the other group. The rise in VO2 on cold stress was identical. The observations showed better cold tolerance for high altitude natives compared to lowlanders, even at sea level.

Adult↗
PubMed1983

[Acute rhabdomyolysis in alcoholic patients].

Six episodes of acute rhabdomyolysis were observed within a two-year period in 5 male adult alcoholic patients hospitalised in a hepatology intensive care unit. Painful muscle swelling was discrete of absent in 4 of the 5 patients. Acute rhabdomyolysis was preceded by grand mal seizures in 4 patients, delirium tremens in 1 and high fever with shivers in 3. All cases were rapidly diagnosed on the finding of very high serum creatinine phosphokinase levels. One patient developed acute respiratory failure and recovered after prolonged mechanical ventilation. Three patients had acute renal failure with severe hyperkalemia in one but none required dialysis. Three patients died within 2 to 6 days of the diagnosis, but the deaths were not directly related to rhabdomyolysis. It would appear that in alcoholic patients: the prevalence of rhabdomyolysis is probably underestimated; any muscular hyperactivity as seen in seizures, delirium tremens and prolonged shivers may be a precipitating factor; the condition is easily diagnosed by measuring serum creatinine kinase activity; some cases of acute renal failure in patients with alcoholic cirrhosis might be explained by acute rhabdomyolysis with minimal symptoms.

Acute Disease↗