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.

Alcohol misuse

2020 ◽  
pp. 6486-6490
Author(s):  
Jonathan Wood
Keyword(s):  
Alcohol Withdrawal ◽  
Delirium Tremens ◽  
Active Management ◽  
Psychological State ◽  
Medical Setting ◽  
Medical Conditions ◽  
Korsakoff Syndrome ◽  
Life Threatening ◽  
Harmful Use ◽  
Excessive Intake

Excessive intake of alcohol is common and increases the risk of developing many medical conditions, as well as leading to psychological and social harm. Medical conditions commonly associated with harmful use include upper gastrointestinal and liver disease, hypertension, and accidents. The psychological state of alcohol dependency makes it more difficult to reduce intake and physical dependency may lead to a withdrawal syndrome after admission to hospital. Withdrawal symptoms range from mild to severe and will commonly require treatment to prevent complications of alcohol withdrawal such as seizures. Delirium tremens is a life-threatening consequence of alcohol withdrawal that requires immediate active management. The role of alcohol in the development of Wernicke–Korsakoff syndrome means patients will also need prophylaxis or treatment for this in the acute medical setting.

scholarly journals Percutaneous Mechanical Support in Cardiogenic Shock: A Review

2015 ◽  
Vol 9s2 ◽  
pp. CMC.S19707
Author(s):  
Fahad Syed Gilani ◽  
Sarah Farooqui ◽  
Rajiv Doddamani ◽  
Luis Gruberg
Keyword(s):  
Cardiogenic Shock ◽  
Pharmacological Therapy ◽  
Mechanical Support ◽  
Significant Morbidity ◽  
First Line ◽  
Life Saving ◽  
Threatening Condition ◽  
Life Threatening ◽  
Hemodynamic Improvement ◽  
Support Devices

Cardiogenic shock (CS) is a life-threatening condition associated with significant morbidity and mortality. Pharmacological therapy is often the first line of treatment but mechanical support can provide substantial hemodynamic improvement in refractory CS. Percutaneous mechanical support devices are placed in a minimally invasive manner and provide life-saving assistance to the failing myocardium. We review the percutaneous devices currently available, the evidence behind their use, and the new advances in percutaneous technology being evaluated for the treatment of CS.

Perioperative Adrenal Crisis

2017 ◽  
Author(s):  
Jing Tao ◽  
Jeffrey J. Schwartz
Keyword(s):  
Adrenal Insufficiency ◽  
Adrenal Crisis ◽  
Life Saving ◽  
Distributive Shock ◽  
Threatening Condition ◽  
Life Threatening ◽  
High Doses ◽  
Patient At Risk ◽  
Stress Dose ◽  
Timely Treatment

Perioperative adrenal insufficiency (AI) (adrenal crisis) is an uncommon life-threatening condition manifested by distributive shock that is poorly responsive to the administration of fluids and vasopressors. Timely treatment with high doses of glucocorticoids can be life saving. The difficulty is in recognizing the patient at risk, suspecting the diagnosis, and distinguishing it from other forms of shock. The incidence of adrenal crisis is rare, in large part, due to the liberal use of perioperative “stress dose” steroids in patients already receiving steroids. In this chapter we review the pathophysiology involved in both primary and secondary AI, and provide step-by-step treatment recommendations for patients as risk for this condition.

Necrotizing Enterocolitis

2018 ◽  
Author(s):  
Jared Hylton ◽  
Sarah Deverman
Keyword(s):  
Necrotizing Enterocolitis ◽  
Neonatal Intensive Care ◽  
Clinical Presentation ◽  
Pneumatosis Intestinalis ◽  
Postoperative Management ◽  
First Line ◽  
Surgical Emergencies ◽  
Threatening Condition ◽  
Life Threatening ◽  
Ventilatory Management

Necrotizing enterocolitis (NEC) is a potentially life-threatening condition that affects mainly preterm infants. It is one of the most common surgical emergencies in the neonatal intensive care unit. While medical management is the first line of treatment, if that fails, NEC becomes a surgical emergency, and the pediatric anesthesiologist must be prepared. This chapter covers the pathogenesis, risk factors, clinical presentation and diagnosis, prevention, medical and surgical management, pre- and intraoperative anesthetic assessment, and postoperative management of NEC. Topics covered include intestinal perforation, necrotizing enterocolitis, neonatal anesthesia, pneumatosis intestinalis, prematurity, and ventilatory management. The chapter ends with review questions on the chapter’s content.

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).

Sepsis and thyroid storm in a patient with methimazole-induced agranulocytosis

2020 ◽  
Vol 13 (7) ◽  
pp. e235536
Author(s):  
Vaishnavi Divya Nagarajan ◽  
Alba Morales ◽  
Lawtanya Pleasant ◽  
Asha Shenoi
Keyword(s):  
Septic Shock ◽  
Case Report ◽  
Beta Blockers ◽  
Thyroid Storm ◽  
First Line ◽  
Bridging Therapy ◽  
Definitive Therapy ◽  
Paediatric Case ◽  
Threatening Condition ◽  
Life Threatening

Paediatric hyperthyroidism cases are mostly caused by Grave’s disease. Thyroid storm is a life-threatening condition seen rarely, in severe thyrotoxicosis, occurring in about 1%–2% of patients with hyperthyroidism. Antithyroid medications and beta-blockers are typically the first-line management of thyroid storm. We report a challenging case of a 15-year-old girl who presented with thyroid storm in the setting of septic shock and methimazole-induced agranulocytosis. Since the first-line agents were contraindicated, plasmapheresis was used to control the thyroid storm and as a bridging therapy to the definitive therapy of early thyroidectomy. This is the first paediatric case report that outlines the use of plasmapheresis in the management of complicated thyrotoxicosis in a setting of septic shock.

scholarly journals Treatment of Severe Alcohol Withdrawal: A Focus on Adjunctive Agents

2017 ◽  
Vol 33 (5) ◽  
pp. 204-212 ◽  
Author(s):  
Erenie Guirguis ◽  
Jonathan Richardson ◽  
Tara Kuhn ◽  
Ashley Fahmy
Keyword(s):  
Clinical Trials ◽  
Alcohol Withdrawal ◽  
English Language ◽  
Case Reports ◽  
Treatment Options ◽  
Delirium Tremens ◽  
Adjunctive Treatment ◽  
Current Evidence ◽  
High Dose ◽  
Keywords Alcohol

Objective:To review adjunctive treatment options for severe alcohol withdrawal. Data Sources: The search strategy included a search of Ovid MEDLINE using keywords alcohol withdrawal, severe alcohol withdrawal, AWS, delirium tremens, delirium, dexmedetomidine, propofol, anticonvulsants, clonidine, and phenobarbital and included articles dated from January 1990 to March 2017. Study Selection and Data Extraction: All English-language clinical trials and case reports assessing the efficacy of adjunctive agents in severe alcohol withdrawal were evaluated. Data Synthesis: Although first-line pharmacotherapy for alcohol withdrawal continues to be benzodiazepines, literature does not clearly define adjunctive treatment options for severe alcohol withdrawal. During severe alcohol withdrawal patients may become unable to tolerate or may become unresponsive to high-dose benzodiazepines. Large doses of benzodiazepines may also result in oversedation, respiratory insufficiency, and worsening delirium. Conclusions: Phenobarbital and dexmedetomidine are both viable adjunctive treatment options for severe alcohol withdrawal. Current evidence has shown these agents decrease the dose requirements of benzodiazepines with limited incidence of adverse reactions. Propofol may also be a viable option in mechanically ventilated patients, but its lack of clear safety and efficacy advantages over current treatment options may limit its use in practice. Clonidine, oral anticonvulsants, and ketamine require further controlled clinical trials to clearly define their role in the treatment of severe alcohol withdrawal.

May-Thurner syndrome – Are we aware enough?

VASA ◽  
2019 ◽  
Vol 48 (5) ◽  
pp. 381-388 ◽  
Author(s):  
Katalin Mako ◽  
Attila Puskas
Keyword(s):  
Contraceptive Use ◽  
Iliac Vein ◽  
Common Iliac Vein ◽  
Vein Thrombosis ◽  
Compression Syndrome ◽  
Threatening Condition ◽  
Life Threatening ◽  
Iliac Vein Compression ◽  
Iliac Vein Compression Syndrome ◽  
The Right

Summary. Iliac vein compression syndrome (May-Thurner syndrome – MTS) is an anatomically variable clinical condition in which the left common iliac vein is compressed between the right common iliac artery and the underlying spine. This anatomic variant results in an increased incidence of left iliac or iliofemoral vein thrombosis. It predominantly affects young women in the second or third decades of life with preponderance during pregnancy or oral contraceptive use. Although MTS is rare, its true prevalence is underestimated but it can be a life-threatening condition due to development of pulmonary embolism (PE). In this case based review the authors present three cases of MTS. All patients had been previously confirmed with PE, but despite they were admitted to hospital, diagnosed and correctly treated for PE and investigated for thrombophilia, the iliac vein compression syndrome was not suspected or investigated. With this presentation the authors would like to emphasize that MTS is mostly underdiagnosed, and it needs to be ruled out in left iliofemoral vein thrombosis in young individuals.

Severe Alveolar Hemorrhage – What’s in it for the Gastroenterologist?

2016 ◽  
Vol 25 (4) ◽  
pp. 555-558
Author(s):  
Alina Popp
Keyword(s):  
Celiac Disease ◽  
International Normalized Ratio ◽  
Gluten Free Diet ◽  
Alveolar Hemorrhage ◽  
Severe Anemia ◽  
Gluten Free ◽  
Pulmonary Infiltrates ◽  
Pulmonary Hemosiderosis ◽  
Threatening Condition ◽  
Life Threatening

Background: Alveolar hemorrhage is a potentially life-threatening condition which is usually managed by the pulmonologist. When considering its etiology, there is a rare association that sets the disease into the hands of the gastroenterologist. Case presentation: We report the case of a 48 year-old female who was admitted to the intensive care unit for severe anemia and hemoptysis. On imaging, diffuse pulmonary infiltrates suggestive of alveolar hemorrhage were detected and a diagnosis of pulmonary hemosiderosis was made. She received cortisone therapy and hematologic correction of anemia, with slow recovery. In search of an etiology for the pulmonary hemosiderosis, an extensive workup was done, and celiac disease specific serology was found positive. After confirmation of celiac disease by biopsy, a diagnosis of Lane-Hamilton syndrome was established. The patient was recommended a gluten-free diet and at 6 months follow-up, resolution of anemia and pulmonary infiltrates were observed. Conclusion: Although the association is rare, celiac disease should be considered in a patient with idiopathic pulmonary hemosiderosis. In our case, severe anemia and alveolar infiltrates markedly improved with glucocorticoids and gluten-free diet. Abbreviations: APTT: activated partial thromboplastin time; BAL: bronchoalveolar lavage; CD: celiac disease; Cd: crypt depth; GFD: gluten-free diet; GI: gastrointestinal; IEL: intraepithelial lymphocyte; INR: international normalized ratio; IPH: idiopathic pu

Proposal for the administration of metformin in patients with chronic kidney disease

2012 ◽  
Vol 153 (39) ◽  
pp. 1527-1535 ◽  
Author(s):  
Zoltán Balogh ◽  
János Mátyus
Keyword(s):  
Lactic Acidosis ◽  
Chronic Renal Disease ◽  
Antidiabetic Agent ◽  
First Line ◽  
Oral Antidiabetic Agent ◽  
Oral Antidiabetic ◽  
Cardiovascular Morbidity And Mortality ◽  
Glomerular Filtrate ◽  
Life Threatening

Metformin is the first-line, widely used oral antidiabetic agent for the management of type 2 diabetes. There is increasing evidence that metformin use results in a reduction in cardiovascular morbidity and mortality, and might have anticancer activity. An extremely rare, but potentially life-threatening adverse effect of metformin is lactic acidosis, therefore, its use is traditionally contraindicated if the glomerular filtrate rate is below 60 mL/min. However, lactic acidosis is always associated with acute events, such as hypovolemia, acute cardiorespiratory illness, severe sepsis and acute renal or hepatic failure. Furthermore, administration of insulins and conventional antihyperglycemic agents increases the risk of severe hypoglycemic events when renal function is reduced. Therefore, the magnitude of the benefit of metformin use would outweigh potential risk of lactic acidosis in moderate chronic renal disease. After reviewing the literature, the authors give a proposal for the administration of metformin, according to the calculated glomerular filtrate rate. Orv.Hetil., 2012, 153, 1527–1535.

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