scholarly journals Refeeding syndrome : physiological background and practical management

2019 ◽  
Vol 11 (5) ◽  
pp. 404-409
Author(s):  
Aminda De Silva ◽  
Jeremy M D Nightingale
Keyword(s):  
Plasma Insulin ◽  
Water Retention ◽  
Clinical Suspicion ◽  
Calorie Intake ◽  
Refeeding Syndrome ◽  
High Clinical Suspicion ◽  
Patients At Risk ◽  
Malnourished Patient ◽  
Clinical Problems ◽  
Physiological Background

Refeeding problems have been recognised since the the liberation of starved communities under siege. The main clinical problems may relate to hypophosphataemia, hypomagnesaemia and hypokalaemia with a risk of sudden death; thiamine deficiency with the risk of Wernike’s encephalopathy/Korsakoff psychosis and sodium/water retention. The problems are greatest with oral/enteral feeding and especially with carbohydrate due to it increasing plasma insulin and thus glucose entry into cells. It is difficult to predict patients at risk of refeeding problems so there must be a high clinical suspicion on refeeding any malnourished patient (including any who have had no or very little nutrition for over 5days). Generous vitamin and electrolyte supplementation may be given while monitoring closely and increasing the calorie intake reasonably rapidly from 10 to 20 kcal/kg/24 hours. Often patients in this category are not hungry, but over the course of a few days, the restoration of their appetite is an indication that the risks of refeeding have been managed and it is now safe to increase the feed aiming for repletion. If problems do occur, the feed should be slowed to the previous day’s amount, reduced further or rarely stopped while fluid and electrolyte issues are corrected.

scholarly journals Physiology of Starvation and Refeeding Syndrome

1970 ◽  
Vol 5 (2) ◽  
pp. 101-110
Author(s):  
Raghuveer Choudhary ◽  
Vinode Kumar Chawala ◽  
Jayant Kumar ◽  
Raj Kumar Rathore
Keyword(s):  
Key Words ◽  
Fluid Retention ◽  
Nutrition Support ◽  
Refeeding Syndrome ◽  
Metabolic Complications ◽  
Vitamin Deficiencies ◽  
Neuromuscular Dysfunction ◽  
Patients At Risk ◽  
Malnourished Patient ◽  
Key Words Starvation

Refeeding syndrome represents a series of metabolic complications that sometimes results by provision of nutrients, primarily carbohydrate, to a patient in a nutritionally compromised state. Refeeding syndrome is associated with hypophosphatemia, hypokalemia and hypomagnesaemia, fluid retention and vitamin deficiencies including thiamin are also of concern. If severe, refeeding syndrome may result in respiratory, cardiac, and neuromuscular dysfunction, especially in the stressed, elderly, or severely malnourished patient. This article discuss the physiology of starvation and the pathophysiology behind refeeding syndrome, identify the patients at greatest risk, and provide practical tips for prevention. As increased awareness and understanding of refeeding syndrome may help, prevent further such incidents and clinicians learn to recognize patients at risk and avoid overaggressive nutrition support regimes. Key words: Starvation; Refeeding Syndrome DOI: 10.3329/jbsp.v5i2.6785J Bangladesh Soc Physiol. 2010 December; 5(2): 101-110

A Rare Case of Tuberculous Prostatitis

2016 ◽  
Vol 1 (2) ◽  
pp. 33
Author(s):  
Nurul Yaqeen Mohd Esa ◽  
Mohammad Hanafiah ◽  
Marymol Koshy ◽  
Hilmi Abdullah ◽  
Ahmad Izuanuddin Ismail ◽  
...  
Keyword(s):  
Rare Case ◽  
Correct Diagnosis ◽  
Immunocompetent Patient ◽  
Clinical Suspicion ◽  
Tuberculosis Infection ◽  
Advanced Age ◽  
Immunocompromised Patients ◽  
Prostatic Biopsy ◽  
High Clinical Suspicion

Tuberculous prostatitis is an uncommon form of tuberculosis infection. It is commonly seen in immunocompromised patients and in those of middle or advanced age. The diagnosis is often not straight forward due to the nature of its presentation. We report a case of tuberculous prostatitis in a young, healthy and immunocompetent patient, who initially presented with respiratory features, followed by episodes of seizures and testicular swelling. He was finally diagnosed with tuberculous prostatitis after prostatic biopsy. This case illustrates that in a high TB prevalence environment, when symptoms warrant, there should be a high clinical suspicion coupled with a thorough approach in order to arrive at a correct diagnosis of TB prostatitis.

Haemolytic Anaemia: A Diagnostic Dilemma

2018 ◽  
Vol 2 (01) ◽  
pp. 29-31
Author(s):  
Md. Rezaul Karim Chowdhury ◽  
Mohammad Quamrul Hasan ◽  
Md. Haroon Ur Rashid
Keyword(s):  
Haemolytic Anaemia ◽  
Clinical Suspicion ◽  
Diagnostic Dilemma ◽  
High Clinical Suspicion ◽  
Immune Haemolytic Anaemia

It is sometime difficult to find out the cause of haemolysis in haemolytic anaemia due to inconclusive results of investigation. Diagnosis of immune haemolytic anaemia is often difficult when Coomb’s test is negative. Here we present such a case of fourteen years old girl who presented with haemolytic anaemia with negative Coomb’s test. Due to high clinical suspicion we labelled her as a case of Coomb’s negative immune haemolytic anaemia and she responded well to steroid.

scholarly journals Advantages of 18F-FDG PET/CT Imaging over Modified Duke Criteria and Clinical Presumption in Patients with Challenging Suspicion of Infective Endocarditis

Diagnostics ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 720
Author(s):  
Valentin Pretet ◽  
Cyrille Blondet ◽  
Yvon Ruch ◽  
Matias Martinez ◽  
Soraya El Ghannudi ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Predictive Value ◽  
Fdg Pet ◽  
Clinical Suspicion ◽  
Duke Criteria ◽  
High Clinical Suspicion ◽  
Pet Ct ◽  
18F Fdg ◽  
Sensitivity Specificity ◽  
Fdg Pet Ct

According to European Society of Cardiology guidelines (ESC2015) for infective endocarditis (IE) management, modified Duke criteria (mDC) are implemented with a degree of clinical suspicion degree, leading to grades such as “possible” or “rejected” IE despite a persisting high level of clinical suspicion. Herein, we evaluate the 18F-FDG PET/CT diagnostic and therapeutic impact in IE suspicion, with emphasis on possible/rejected IE with a high clinical suspicion. Excluding cases of definite IE diagnosis, 53 patients who underwent 18F-FDG PET/CT for IE suspicion were selected and afterwards classified according to both mDC (possible IE/Duke 1, rejected IE/Duke 0) and clinical suspicion degree (high and low IE suspicion). The final status regarding IE diagnosis (gold standard) was based on the multidisciplinary decision of the Endocarditis Team, including the ‘imaging specialist’. PET/CT images of the cardiac area were qualitatively interpreted and the intensity of each focus of extra-physiologic 18F-FDG uptake was evaluated by a maximum standardized uptake value (SUVmax) measurement. Extra-cardiac 18F-FDG PET/CT pathological findings were considered to be a possible embolic event, a possible source of IE, or even a concomitant infection. Based on the Endocarditis Team consensus, final diagnosis of IE was retained in 19 (36%) patients and excluded in 34 (64%). With a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and global accuracy of 79%, 100%, 100%, 89%, and 92%, respectively, PET/CT performed significantly better than mDC (p = 0.003), clinical suspicion degree (p = 0.001), and a combination of both (p = 0.001) for IE diagnosis. In 41 patients with possible/rejected IE but high clinical suspicion, sensitivity, specificity, PPV, NPV, and global accuracies were 78%, 100%, 100%, 85%, and 90%, respectively. Moreover, PET/CT contributed to patient management in 24 out of 53 (45%) cases. 18F-FDG PET/CT represents a valuable diagnostic tool that could be proposed for challenging IE cases with significant differences between mDC and clinical suspicion degree. 18F-FDG PET/CT allows a binary diagnosis (definite or rejected IE) by removing uncertain diagnostic situations, thus improving patient therapeutic management.

scholarly journals Ovarian Torsion in a 5-Year Old: A Case Report and Review

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Matthew F. Ryan ◽  
Bobby K. Desai
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Case Report ◽  
Urinary Tract ◽  
Clinical Suspicion ◽  
Ovarian Torsion ◽  
Surgical Emergencies ◽  
High Clinical Suspicion ◽  
Tract Infections ◽  
Prompt Diagnosis

Ovarian torsion represents a true surgical emergency. Prompt diagnosis is essential to ovarian salvage, and high clinical suspicion is important in this regard. Confounding the diagnosis in general are more commonly encountered abdominal complaints in the Emergency Department (ED) such as constipation, diarrhea, and urinary tract infections and more common surgical emergencies such as appendicitis. Prompt diagnosis can be further complicated in low-risk populations such as young children. Herein, we describe the case of a 5-year-old girl with a seemingly benign presentation of abdominal pain who was diagnosed in the ED and treated for acute ovarian torsion after two prior clinic visits. A brief discussion of evaluation, treatment, and management of ovarian torsion follows.

scholarly journals Symptomatic Patent Foramen Ovale with Hemidiaphragm Paralysis

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Hussain Ibrahim ◽  
Adnan Khan ◽  
Shawn P. Nishi ◽  
Ken Fujise ◽  
Syed Gilani
Keyword(s):  
Right Atrium ◽  
Chronic Conditions ◽  
Patent Foramen Ovale ◽  
Hospital Admissions ◽  
Clinical Suspicion ◽  
Chronic Obstructive ◽  
Foramen Ovale ◽  
Obstructive Pulmonary Disease ◽  
Benign Condition ◽  
High Clinical Suspicion

Dyspnea accounts for more than one-fourth of the hospital admissions from Emergency Department. Chronic conditions such as Chronic Obstructive Pulmonary Disease, Congestive Heart Failure, and Asthma are being common etiologies. Less common etiologies include conditions such as valvular heart disease, pulmonary embolism, and right-to-left shunt (RLS) from patent foramen ovale (PFO). PFO is present in estimated 20–30% of the population, mostly a benign condition. RLS via PFO usually occurs when right atrium pressure exceeds left atrium pressure. RLS can also occur in absence of higher right atrium pressure. We report one such case that highlights the importance of high clinical suspicion, thorough evaluation, and percutaneous closure of the PFO leading to significant improvement in the symptoms.

scholarly journals Hematospermia in a returned traveler

2017 ◽  
Vol 11 (1-2) ◽  
pp. 41 ◽  
Author(s):  
Raynell Lang ◽  
Jessica Minion ◽  
Alexander Wong
Keyword(s):  
Schistosoma Haematobium ◽  
Microscopic Analysis ◽  
Lake Malawi ◽  
Clinical Suspicion ◽  
Eastern Africa ◽  
Rare Presentation ◽  
Sexually Transmitted ◽  
Common Complaint ◽  
High Clinical Suspicion ◽  
Global Travel

Hematospermia is a common complaint among patients seen in outpatient urology clinics. The differential diagnosis is broad and includes inflammatory, infectious, neoplastic, structural, systemic, and traumatic causes. The most common infectious causes are uropathogens and sexually transmitted infections. However, with increasing global travel, physicians must maintain a high clinical suspicion for pathogens not endemic to their region, including Echinococcus, Mycobacterium tuberculosis, and Schistosoma.1 We present a case of hematospermia in a traveler returning from Eastern Africa with exposure to Lake Malawi. The patient’s microscopic analysis of semen was positive for Schistosoma haematobium, revealing a rare presentation of S. haematobium infection.

scholarly journals Gastrointestinal Tuberculosis Presenting as Malnutrition and Distal Colonic Bowel Obstruction

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Raja Chandra Chakinala ◽  
Zahava C. Farkas ◽  
Benjamin Barbash ◽  
Khwaja F. Haq ◽  
Shantanu Solanki ◽  
...  
Keyword(s):  
Pulmonary Disease ◽  
Primary Infection ◽  
Clinical Suspicion ◽  
Left Colon ◽  
Severe Malnutrition ◽  
Gi Tract ◽  
Ileocecal Region ◽  
Abdominal Symptoms ◽  
High Clinical Suspicion ◽  
Segmental Colitis

Gastrointestinal (GI) tuberculosis (TB) is rare and can occur in the context of active pulmonary disease or as a primary infection with no pulmonary symptoms. It typically presents with vague abdominal symptoms, making it difficult to discern from alternative disease processes. Although the ileocecal region is the most commonly affected site, tuberculous enteritis can involve any aspect of the GI tract. To demonstrate the importance of maintaining a high clinical suspicion for the disease, we present a case of GI TB presenting as severe malnutrition and segmental colitis of the left colon.

scholarly journals Giant dermoid cyst mimicking posterior fossa tumors in a child: A Case Report and Review of the Literature

2020 ◽  
Vol 2 (2(May-August)) ◽  
pp. e452020
Author(s):  
Leopoldo Mandic Ferreira Furtado ◽  
José Aloysio da Costa Val Filho ◽  
Bruno Lacerda Sandes ◽  
Plínio Duarte Mendes ◽  
Patrícia Salomé Gouvea Braga
Keyword(s):  
Case Report ◽  
Dermoid Cyst ◽  
Clinical Suspicion ◽  
Review Of The Literature ◽  
Benign Lesions ◽  
Posterior Fossa Tumors ◽  
Case Presentation ◽  
High Clinical Suspicion ◽  
Neuroimaging Data ◽  
Epidemiological Characteristics

Introduction: Intracranial dermoid cysts are rare, congenital and, benign lesions. The etiology of these lesions is related to an embryonic defect during neurulation. Case presentation: The present study describes a case of a 3-year-old girl with a giant cerebellar dermoid cyst, which initially manifested as hydrocephalus. Discussion: We discuss its epidemiological characteristics as well as diagnostic and therapeutic management. The combination of high clinical suspicion, anamnesis, thorough physical examination, and adequate interpretation of neuroimaging data is crucial for the early diagnosis and timely therapeutic intervention for such cysts. Conclusion: Surgical approach involving complete lesion resection considerably improves prognosis.

Platypnoea-orthodeoxia syndrome: the importance of the patient’s posture for diagnosis

2021 ◽  
Vol 14 (6) ◽  
pp. e243210
Author(s):  
Carla Pereira Fontes ◽  
Samuel Barbosa Fonseca ◽  
Mário Santos
Keyword(s):  
Transthoracic Echocardiography ◽  
Rare Condition ◽  
Definitive Diagnosis ◽  
Clinical Suspicion ◽  
Oxygen Desaturation ◽  
Arterial Oxygen ◽  
Common Cause ◽  
Intracardiac Shunt ◽  
High Clinical Suspicion ◽  
Functional Components

Platypnoea-orthodeoxia syndrome (POS) is a rare condition characterised by the association of dyspnoea and arterial oxygen desaturation induced by standing and relieved by recumbency. The precise mechanism remains poorly understood, but it appears to involve both anatomical and functional components producing a significant right-to-left shunting under certain postural conditions. This syndrome is associated with either intracardiac or extracardiac aetiologies, and the diagnosis depends on high clinical suspicion. Intracardiac shunt is the most common cause of POS and can be identified through echocardiography with bubble study. We report the case of a patient with POS secondary to a paradoxical shunt through the patent foramen oval, whose definitive diagnosis was only possible with contrasted transthoracic echocardiography in the sitting and standing positions.

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