scholarly journals Recurrent Generalized Seizures with Postictal Todd’s Paralysis Caused by Medication-Associated Severe Hypomagnesemia: A Case Report

2021 ◽  
pp. 85-90
Author(s):  
Abdalla Khalil ◽  
Jithesh Choyi ◽  
Khalil Hossenbux ◽  
Ahmed Taha
Keyword(s):  
Emergency Department ◽  
Serum Potassium ◽  
Serum Magnesium ◽  
Facial Asymmetry ◽  
Recurrent Seizure ◽  
Electrolyte Disturbances ◽  
Generalized Seizures ◽  
Prolonged Qt Interval ◽  
Ct Brain

Hypomagnesemia is one of the electrolyte disturbances that can cause seizures. It is common in the hospitalized patients and can be induced by long-term usage of many medications. A 68-year-old male known to have hypertension and gastroesophageal reflux presented to the Emergency Department with an unprovoked first seizure at home followed by a temporary right-sided hemiparesis, dysphasia, and facial asymmetry. The hemiparesis, dysphasia, and facial asymmetry resolved within less than an hour after the seizure. His serum potassium was low with prolonged QT interval in the electrocardiogram (serum magnesium was not checked in the Emergency Department). He received intravenous IV potassium chloride infusion, and his serum potassium level was corrected, but he had a recurrent seizure after 10 h. At that time, his serum magnesium was found to be very low, he received IV magnesium sulfate infusion, and his indapamide, omeprazole, and metformin medications were stopped. He had no further seizures, the rest of his blood tests were normal, and his CT brain was unremarkable. He was treated for aspiration pneumonia, and his outpatient MRI brain and EEG came to be normal too.

Hashimoto encephalopathy

2013 ◽  
Vol 154 (33) ◽  
pp. 1312-1316 ◽  
Author(s):  
Gábor Pocsay ◽  
Andrea Gazdag ◽  
József Engelhardt ◽  
István Szaniszló ◽  
Zoltán Szolnoki ◽  
...  
Keyword(s):  
Psychiatric Symptoms ◽  
Immunosuppressive Treatment ◽  
Unknown Origin ◽  
Corticosteroid Treatment ◽  
Thyroid Peroxidase ◽  
Thyroid Autoantibodies ◽  
Thyroglobulin Antibodies ◽  
Hashimoto Encephalopathy ◽  
Generalized Seizures

The authors present a case report and review the literature on Hashimoto encephalopathy. The onset of the disease may be marked by focal and then progressively generalized seizures or other neurological symptoms, but a cognitive decline or various psychiatric symptoms may also emerge. High levels of anti-thyroid peroxidase antibodies and/or anti-thyroglobulin antibodies are present in the serum. Corticosteroid treatment usually results in an improvement of symptoms. The syndrome is frequently overlooked and, therefore, the authors strongly recommend testing serum thyroid autoantibodies in cases with encephalopathy of unknown origin independently on the presence of thyroid disease in the patient or family history. The importance of long-term immunosuppressive treatment should also be stressed. Orv. Hetil., 2013, 154, 1312–1316.

scholarly journals A Rational Evaluation of the Syncope Patient: Optimizing the Emergency Department Visit

Medicina ◽  
2021 ◽  
Vol 57 (6) ◽  
pp. 514
Author(s):  
Tarek Hatoum ◽  
Robert S. Sheldon
Keyword(s):  
Emergency Department ◽  
Diagnostic Yield ◽  
Clinical Decision ◽  
Emergency Department Visits ◽  
Decision Tools ◽  
Short And Long Term ◽  
Electrocardiogram Ecg ◽  
Structured Approach

Syncope accounts for up to 2% of emergency department visits and results in the hospitalization of 12–86% of patients. There is often a low diagnostic yield, with up to 50% of hospitalized patients being discharged with no clear diagnosis. We will outline a structured approach to the syncope patient in the emergency department, highlighting the evidence supporting the role of clinical judgement and the initial electrocardiogram (ECG) in making the preliminary diagnosis and in safely identifying the patients at low risk of short- and long-term adverse events or admitting the patient if likely to benefit from urgent intervention. Clinical decision tools and additional testing may aid in further stratifying patients and may guide disposition. While hospital admission does not seem to offer additional mortality benefit, the efficient utilization of outpatient testing may provide similar diagnostic yield, preventing unnecessary hospitalizations.

scholarly journals US Emergency Department Visits for Adverse Drug Events From Antibiotics in Children, 2011–2015

2018 ◽  
Vol 8 (5) ◽  
pp. 384-391 ◽  
Author(s):  
Maribeth C Lovegrove ◽  
Andrew I Geller ◽  
Katherine E Fleming-Dutra ◽  
Nadine Shehab ◽  
Mathew R P Sapiano ◽  
...  
Keyword(s):  
Emergency Department ◽  
Adverse Drug Events ◽  
Emergency Department Visits ◽  
Drug Event ◽  
Injury Surveillance System ◽  
Adverse Event Data ◽  
Systemic Medication ◽  
Ed Visits ◽  
Pharmacy Dispensing Data

Abstract Background Antibiotics are among the most commonly prescribed medications for children; however, at least one-third of pediatric antibiotic prescriptions are unnecessary. National data on short-term antibiotic-related harms could inform efforts to reduce overprescribing and to supplement interventions that focus on the long-term benefits of reducing antibiotic resistance. Methods Frequencies and rates of emergency department (ED) visits for antibiotic adverse drug events (ADEs) in children were estimated using adverse event data from the National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance project and retail pharmacy dispensing data from QuintilesIMS (2011–2015). Results On the basis of 6542 surveillance cases, an estimated 69464 ED visits (95% confidence interval, 53488–85441) were made annually for antibiotic ADEs among children aged ≤19 years from 2011 to 2015, which accounts for 46.2% of ED visits for ADEs that results from systemic medication. Two-fifths (40.7%) of ED visits for antibiotic ADEs involved a child aged ≤2 years, and 86.1% involved an allergic reaction. Amoxicillin was the most commonly implicated antibiotic among children aged ≤9 years. When we accounted for dispensed prescriptions, the rates of ED visits for antibiotic ADEs declined with increasing age for all antibiotics except sulfamethoxazole-trimethoprim. Amoxicillin had the highest rate of ED visits for antibiotic ADEs among children aged ≤2 years, whereas sulfamethoxazole-trimethoprim resulted in the highest rate among children aged 10 to 19 years (29.9 and 24.2 ED visits per 10000 dispensed prescriptions, respectively). Conclusions Antibiotic ADEs lead to many ED visits, particularly among young children. Communicating the risks of antibiotic ADEs could help reduce unnecessary prescribing. Prevention efforts could target pediatric patients who are at the greatest risk of harm.

ENDOCRINE EFFECTS OF LITHIUM:

1978 ◽  
Vol 88 (3) ◽  
pp. 528-534 ◽  
Author(s):  
C. Christiansen ◽  
P. C. Baastrup ◽  
P. Lindgreen ◽  
I. Transbøl
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Serum Calcium ◽  
Lithium Treatment ◽  
Serum Magnesium ◽  
Endocrine Effects ◽  
Manic Depressive ◽  
Depressive Patients ◽  
Immunoreactive Parathyroid Hormone

ABSTRACT Ninety-six manic-depressive patients were studied during long-term lithium treatment. Highly significant elevations were observed respecting the levels of serum immunoreactive parathyroid hormone (P < 0.001) as well as the protein-corrected levels of serum calcium (P < 0.001) and serum magnesium (P <0.001), thus indicating a state of 'primary' hyperparathyroidism. The patients as a group had normophosphataemia and normophosphatasia supporting the impression of a rather mild state of biochemical hyperparathyroidism.

Enhancing Patient Compliance in Pediatrics

1996 ◽  
Vol 17 (4) ◽  
pp. 128-134
Author(s):  
Gregory S. Liptak
Keyword(s):  
Emergency Department ◽  
Medical Education ◽  
Rheumatic Fever ◽  
Acute Otitis Media ◽  
Streptococcal Pharyngitis ◽  
Pediatric Care ◽  
Pediatric Residency ◽  
Health Advice ◽  
Advanced Treatments

The Challenge Pediatric care has become exceedingly complex, but no matter how technologically advanced treatments become, they can be only as effective as compliance with their use. Compliance, or adherence, defined as the extent to which a person's behavior coincides with medical or health advice, is crucial for the treatment of illness, the prevention of disease, and the promotion of health. Unfortunately, noncompliance is extremely common. For example, in a study of the use of penicillin for acute otitis media and "strep" throat, Charney et al1 found that only 43% of the children complied with the regimen. Gordis and associates2 found that compliance with penicillin used for chronic rheumatic fever prophylaxis was only 36%. Eney and Goldstein3 showed that compliance with theophylline in children being evaluated in an emergency department for asthma was only 11%. Compliance decreases over the course of treatment, not only for long-term interventions, but for brief ones as well. For example, Bergman and Werner4 found that 56% of individuals being treated with penicillin for streptococcal pharyngitis had stopped taking the medication by day 3, 71% by day 6, and 82% by day 9 of the treatment course. Although compliance is so important, it is largely neglected in medical education, including pediatric residency training.

scholarly journals The Long-Term Effect of an Independent Capacity Protocol on Emergency Department Length of Stay: A before and after Study

2015 ◽  
Vol 56 (5) ◽  
pp. 1428 ◽  
Author(s):  
Won Chul Cha ◽  
Kyoung Jun Song ◽  
Jin Sung Cho ◽  
Adam J. Singer ◽  
Sang Do Shin
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Term Effect ◽  
Long Term Effect ◽  
Before And After ◽  
Before And After Study

scholarly journals Iatrogenic hypomagnesemia: an underestimated clinical problem

2015 ◽  
Vol 9 (3) ◽  
pp. 287 ◽  
Author(s):  
Antonio Villa ◽  
Paolo Zanada ◽  
Adriana Pellegrino ◽  
Gabriella Nucera ◽  
Elena Martinoli ◽  
...  
Keyword(s):  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Serum Magnesium ◽  
Concomitant Administration ◽  
Clinical Problem ◽  
Proton Pump Inhibitor Therapy ◽  
Term Therapy ◽  
Long Term Therapy ◽  
The Relationship

Hypomagnesemia is defined by having a serum magnesium level of less than 1.7 mg/dL. The magnesium balance is tightly regulated by the concerted actions of the intestine, bone and kidneys. This balance can be disturbed by a wide variety of drugs. Recently, we observed a case of severe hypomagnesemia caused by proton pump inhibitor therapy. We conducted a retrospective study of an <em>intrahospital population</em> to evaluate the prevalence of hypomagnesemia and the relationship with associated drugs. Among 181 patients with hypomagnesemia only 29 were found to have hypomagnesemia with specific causes, such as chronic diarrhea, vomiting, and so on. In the remaining patients, 120 have taken proton pump inhibitors and/or diuretics and/or metformin. Clinicians should consider proton pump inhibitors as a possible causative agent when investigating hypomagnesemia and they should be especially attentive with patients who take proton pump inhibitors, especially in cases of long-term therapy (≥1 year) and/or concomitant administration of other agents that may lower magnesium levels (<em>e.g</em>., diuretics or metformin).

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