Agitation

2018 ◽  
pp. 244-248
Author(s):  
Christopher J. M. Green
Keyword(s):  
Differential Diagnosis ◽  
Alcohol Withdrawal ◽  
Signs And Symptoms ◽  
Seizure Threshold ◽  
Life Threatening ◽  
Acute Agitation ◽  
Key Aspects ◽  
Possible Cause

Acute agitation is a common issue encountered among patients admitted to inpatient wards, and it has a broad differential diagnosis. When confronted with an agitated inpatient, it is important to consider the underlying etiology before administering any sedatives so that patients receive appropriate management. This case illustrates a possible cause of agitation, alcohol withdrawal, which is potentially life-threatening if not recognized. Discussion focuses on the signs and symptoms that allow alcohol withdrawal to be distinguished from other causes of inpatient agitation, as well as key aspects of management including administration of benzodiazepines and thiamine, and avoidance of medications that lower seizure threshold (e.g., antipsychotics).

Toxic levels of glycosides in herbal medication: a potential cause of hyperkalaemia

2011 ◽  
Vol 56 (4) ◽  
pp. 1-3 ◽  
Author(s):  
M Haden ◽  
D A S Marshall ◽  
B Murphy
Keyword(s):  
Heart Failure ◽  
Differential Diagnosis ◽  
Cardiac Glycosides ◽  
Digoxin Toxicity ◽  
Herbal Medication ◽  
Healthy Man ◽  
Herbal Medications ◽  
Drug History ◽  
Life Threatening ◽  
Possible Cause

We report a previously healthy man presenting with life-threatening hyperkalaemia and heart failure. The only possible cause was thought to be the long list of herbal medications he was taking, several of which contained significant amounts of cardiac glycosides. Hyperkalaemia is known to be associated with digoxin toxicity and we present this as the likely cause in this case, and emphasize the importance of a thorough drug history in forming a differential diagnosis.

scholarly journals Dexmedetomidine infusions and phenobarbital in the treatment of an unusual presentation of benzodiazepine-resistant alcohol withdrawal

2019 ◽  
Author(s):  
Neil Shah
Keyword(s):  
Alcohol Withdrawal ◽  
Critical Role ◽  
Delirium Tremens ◽  
Seizure Threshold ◽  
First Line ◽  
Keywords Alcohol ◽  
Threatening Condition ◽  
Life Threatening ◽  
Hospital Stays ◽  
High Doses

Background: Alcohol withdrawal is a life-threatening condition characterized by a myriad of physiologic changes including tachycardia, hypertension, lowered seizure threshold, hallucinations, and potential for delirium tremens. Benzodiazepines remain the gold standard for treatment of alcohol withdrawal, although few studies have compared barbiturates to benzodiazepines as first-line treatment. Methods: This study is a single patient chart review. Results: Over the course of his hospital stay, in addition to receiving a continuous infusion of dexmedetomidine, the patient received a total of 389 mg lorazepam, 650 mg phenobarbital, 40 mg haloperidol, 25 mg quetiapine, 5 mg midazolam, and 75 mg diphenhydramine. Conclusion: Phenobarbital is an effective first line agent for management of alcohol withdrawal and may be a safer and more effective treatment with lower rates of intubation and shorter hospital stays than benzodiazepines. It is particularly successful in patients who require high doses of benzodiazepines or ICU admission. Furthermore, the role of dexmedetomidine infusions in alcohol withdrawal remains unclear but may play a critical role in mitigating tachycardia and hypertension though it poses a risk of bradycardia and hypotension. Keywords: Alcohol withdrawal, Dexmedetomidine, Precedex, Phenobarbital, Ativan, Lorazepam, CIWA, GABA channel.

scholarly journals Evaluation of Transfusion Pyrexia: A Review of Differential Diagnosis and Management

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Oladimeji P. Arewa
Keyword(s):  
Differential Diagnosis ◽  
Blood Transfusion ◽  
Electronic Materials ◽  
Signs And Symptoms ◽  
Continuous Medical Education ◽  
Management Measures ◽  
Study Selection ◽  
Life Threatening ◽  
Important Sign ◽  
Adequate Evaluation

Background/purpose. Transfusion pyrexia (fever) is an important clinical sign/symptom occurring either as an isolated event or as part of a constellation of signs and symptoms in relation to blood transfusion. It is an important cause of morbidity and may be an important sign of life-threatening complications of blood transfusion. Pyrexia is often a reason for the discontinuation of a blood transfusion episode, and adequate evaluation remains a challenge for clinicians. The decision to stop a blood transfusion episode on account of fever is often a difficult one. This paper reviews the differential diagnosis of transfusion pyrexia (TP), the pathogenesis as well as current management measures. Study selection and data source. Literature sources include medical texts, journals, dissertations, and internet-based electronic materials Results and conclusion. Adequate evaluation of pyrexia accompanying blood transfusion remains a challenge for clinicians. An algorithm to assist the clinician in the evaluation of fever occurring in a blood transfusion recipient is developed and presented. Continuous medical education is necessary for clinicians towards improved patient care in transfusion medicine.

Serotonin toxicity

2011 ◽  
Vol 28 (2) ◽  
pp. i-iv ◽  
Author(s):  
Sobia Nasim ◽  
Faraz Jabbar ◽  
Asfar Afridi ◽  
Brendan D Kelly
Keyword(s):  
Differential Diagnosis ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Causal Agent ◽  
Vital Functions ◽  
Threatening Condition ◽  
Life Threatening ◽  
Clinical Signs And Symptoms ◽  
High Index Of Suspicion ◽  
Serotonin Toxicity

Serotonin toxicity is a potentially life-threatening condition associated with a range of psychotropic medications, co-administration of specific combinations of agents and overdose of certain drugs. It is associated with a wide diversity of clinical signs and symptoms, including cognitive, autonomic and somatic effects, as well as serious complications, including possible death. Diagnosis is often challenging and requires a high index of suspicion. Differential diagnosis includes syndromes such as neuroleptic malignant syndrome. Management depends on the causal agent and urgency of clinical presentation. Treatment may involve discontinuing the causal agent and providing supportive measures, or emergency intervention to preserve vital functions (airway, breathing, circulation), amongst other measures. Further research is needed to clarify the incidence of serotonin toxicity, issues related to differential diagnosis, optimal management of the condition, and treatment of mood problems following serotonin toxicity.

scholarly journals Side effects of antipsychotic agents: Neuroleptic malignant syndrome

2010 ◽  
Vol 63 (9-10) ◽  
pp. 705-708 ◽  
Author(s):  
Mina Cvjetkovic-Bosnjak ◽  
Branislava Soldatovic-Stajic
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Atypical Antipsychotics ◽  
Signs And Symptoms ◽  
Antipsychotic Agents ◽  
Psychotic Symptoms ◽  
Symptomatic Therapy ◽  
Idiosyncratic Reaction ◽  
Hypothalamic Nuclei ◽  
Life Threatening ◽  
Possible Cause

Neuroleptic malignant syndrome is a rare, potentially life-threatening complication which is an unpredictable, idiosyncratic reaction to antipsychotics. In patients receiving traditional antipsychotics, neuroleptic malignant syndrome occurs with an incidence of 0.2-3.3%. However, neuroleptic malignant syndrome also appears in patients treated with atypical antipsychotics, especially Clozapine. A possible cause of neuroleptic malignant syndrome is blockade of dopamine receptors in the nigrostriatal tracts or hypothalamic nuclei. If signs and symptoms of the Neuroleptic malignant syndrome are identified in time, full recovery is possible. This is a report of a female patient with neuroleptic malignant syndrome treated by traditional antipsychotics. As soon as neuroleptic malignant syndrome symptoms were recognized, the antipsychotic drugs were discontinued, symptomatic therapy was initiated and symptoms of neuroleptic malignant syndrome disappeared. However, the patient's psychotic symptoms persisted and an atypical antipsychotic was administered. During the next few days the psychotic symptoms gradually disappeared and the patient accomplished good recovery.

A Serological Storm

1970 ◽  
Vol 9 (2) ◽  
Author(s):  
Bertha Wong MD ◽  
Maria Bagovich MD ◽  
Ivan Blasutig PhD ◽  
Simon Carette MD MPhil
Keyword(s):  
Differential Diagnosis ◽  
Hepatitis C Virus ◽  
Immune System ◽  
Hepatitis C ◽  
Hcv Infection ◽  
Clinical Context ◽  
Autoantibody Profile ◽  
Life Threatening ◽  
Clinically Significant ◽  
Sensory Polyneuropathy

This article describes a patient presenting with a sensory polyneuropathy and multiple autoantibodies, leading to the diagnosis of hepatitis C virus (HCV) infection. His widely positive autoantibody profile in the absence of clinically significant rheumatic disease illustrates the importance of interpreting autoimmune serology in the appropriate clinical context and the concept of HCV being a non-specific activator of the immune system. In addition, it highlights the importance of considering untreated HCV infection in the differential diagnosis of rheumatic complaints, particularly if the workup reveals multiple autoantibodies, as HCV is a potentially severe and life-threatening disease, which can be appropriately managed with effective antiviral therapy.

Ultrasound diagnosis of dissecting thoracic aortic aneurysms: procedure with a handheld device and a video-illustrated case

2021 ◽  
Vol 51 (1) ◽  
pp. 10-15
Author(s):  
Kenneth V Iserson ◽  
Sri Devi Jagjit ◽  
Balram Doodnauth
Keyword(s):  
Aortic Dissection ◽  
Correct Diagnosis ◽  
Signs And Symptoms ◽  
Aortic Aneurysms ◽  
Thoracic Aortic Aneurysms ◽  
Handheld Device ◽  
Thoracic Aortic Dissection ◽  
Threatening Condition ◽  
Life Threatening ◽  
Handheld Ultrasound

Acute thoracic aortic dissection is an uncommon, although not rare, life-threatening condition. With protean signs and symptoms that often suggest more common cardiac or pulmonary conditions, it can be difficult to diagnose. Ultrasound has proven useful in making the correct diagnosis. This case demonstrates that training gained using standard ultrasound machines can be easily and successfully adapted to newer handheld ultrasound devices. The examination technique using the handheld device is illustrated with photos and a video.

scholarly journals Pathophysiology of Atherosclerotic Plaque Development-Contemporary Experience and New Directions in Research

2021 ◽  
Vol 22 (7) ◽  
pp. 3513
Author(s):  
Michal Kowara ◽  
Agnieszka Cudnoch-Jedrzejewska
Keyword(s):  
Atherosclerotic Plaque ◽  
Molecular Mechanisms ◽  
Cellular Heterogeneity ◽  
Ldl Oxidation ◽  
Plaque Development ◽  
New Directions ◽  
Life Threatening ◽  
Non Coding Rnas ◽  
Cellular Pathways ◽  
Key Aspects

Atherosclerotic plaque is the pathophysiological basis of important and life-threatening diseases such as myocardial infarction. Although key aspects of the process of atherosclerotic plaque development and progression such as local inflammation, LDL oxidation, macrophage activation, and necrotic core formation have already been discovered, many molecular mechanisms affecting this process are still to be revealed. This minireview aims to describe the current directions in research on atherogenesis and to summarize selected studies published in recent years—in particular, studies on novel cellular pathways, epigenetic regulations, the influence of hemodynamic parameters, as well as tissue and microorganism (microbiome) influence on atherosclerotic plaque development. Finally, some new and interesting ideas are proposed (immune cellular heterogeneity, non-coding RNAs, and immunometabolism) which will hopefully bring new discoveries in this area of investigation.

scholarly journals A rare case of fat embolism syndrome secondary to abdominal liposuction and gluteal fat infiltration

2020 ◽  
Vol 2020 (12) ◽  
Author(s):  
Salvador Recinos ◽  
Sabrina Barillas ◽  
Alejandra Rodas ◽  
Javier Ardebol
Keyword(s):  
Right Ventricular Dysfunction ◽  
Signs And Symptoms ◽  
Fat Embolism ◽  
Fat Infiltration ◽  
Fat Embolism Syndrome ◽  
Embolism Syndrome ◽  
Threatening Condition ◽  
Life Threatening ◽  
Bone Marrow Harvesting ◽  
Dermatologic Manifestations

Abstract Fat embolism syndrome (FES) is a rare, life-threatening condition habitually associated with traumatic events such as fractures and, less commonly, burns, liposuction and bone marrow harvesting and transplant [ 1]. The biochemical theory for this condition suggests that fat droplets embolize and convert into fatty acids, eventually leading to toxic injury and inflammation, which results in increased vascular permeability, edema and hemorrhage [ 2]. FES may have an asymptomatic interval lasting 12–72 hours after the insult; however, in some cases, signs have also been seen intraoperatively. Pulmonary signs and symptoms are customarily the earliest and manifest in 75% of patients. Nevertheless, neurologic and dermatologic manifestations are also characteristic, and most severe cases could perhaps present with disseminated intravascular coagulation, right ventricular dysfunction, shock or death. The following case consists of a 37-year-old patient that presented with fat embolism syndrome during liposuction and gluteal fat infiltration.

scholarly journals Ultrasound evaluation of dialysis access-related distal ischaemia

2021 ◽  
pp. 112972982093242
Author(s):  
N Pirozzi ◽  
L De Alexandris ◽  
J Scrivano ◽  
L Fazzari ◽  
J Malik
Keyword(s):  
Differential Diagnosis ◽  
Ultrasound Examination ◽  
Preoperative Evaluation ◽  
Signs And Symptoms ◽  
Central Vein ◽  
Dialysis Access ◽  
Needed Information ◽  
Vein Catheter ◽  
Ultrasound Evaluation ◽  
Central Vein Catheter

Dialysis access-related distal ischaemia is a rare yet potentially rather risky complication of haemodialysis angioaccess. Timely diagnosis is crucial to target both the goals of the access team: first of all to preserve the function of the hand ideally along with angioaccess patency. Unfortunately for some patients, urgent access ligation and central vein catheter insertion would be needed to save the hand. After a first clinical examination to determine the diagnostic suspicion, the ultrasound evaluation would provide nearly all the needed information to confirm the diagnosis and to determine the most appropriate procedure to rescue the patient from distal ischaemia. In some cases, photoplethysmography would help in the differential diagnosis of other non-ischaemic causes of similar signs and symptoms. Angiography would complete the preoperative evaluation for some. Dialysis access-related distal ischaemia would be briefly reviewed, and a deep description of the ultrasound examination tools and findings would be provided for a tailored therapeutic approach.

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