scholarly journals Nafcillin-Associated Hypokalemia

2021 ◽  
Vol 96 (2) ◽  
pp. 139-142
Author(s):  
Do Hyun Lee ◽  
Eun Kyoung Lee ◽  
So Mi Kim ◽  
Jong Tae Cho ◽  
Seok Weon Kim ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Staphylococcus Epidermidis ◽  
Relevant Literature ◽  
Common Finding ◽  
Clinical Settings ◽  
Common Causes ◽  
Gastrointestinal Side Effects ◽  
High Doses ◽  
Renal Tubular ◽  
Staphylococcal Aureus

Hypokalemia is a common finding in various clinical settings; it is associated with diuretic use and loss of potassium via the gastrointestinal tract. Less common causes are renal tubular acidosis, diabetic ketoacidosis, excess insulin, primary hyperaldosteronism, and medications, such as amphotericin B. Nafcillin, a narrow-spectrum penicillin class antibiotic, which is selectively prescribed for methicillin-susceptible Staphylococcal aureus infections, and is commonly associated with gastrointestinal side effects, such as nausea, vomiting, and abdominal pain. However, in rare cases it can cause hypokalemia, which is usually overlooked. Severe hypokalemia was detected in a 59-year-old male patient hospitalized due to traumatic cerebral hemorrhage who received 12 g of nafcillin per day for more than 2 weeks for sepsis caused by methicillin-sensitive <i>Staphylococcus epidermidis</i>. We confirmed the association between nafcillin and hypokalemia through further evaluation and a review of the relevant literature. Clinicians should be aware of hypokalemia as a complication when using high doses of nafcillin.

scholarly journals Assessment of Gastrointestinal Autonomic Dysfunction: Present and Future Perspectives

2021 ◽  
Vol 10 (7) ◽  
pp. 1392
Author(s):  
Ditte S. Kornum ◽  
Astrid J. Terkelsen ◽  
Davide Bertoli ◽  
Mette W. Klinge ◽  
Katrine L. Høyer ◽  
...  
Keyword(s):  
Gastrointestinal Tract ◽  
Autonomic Dysfunction ◽  
Physiological Function ◽  
Clinical Performance ◽  
Data Interpretation ◽  
Assessment Methods ◽  
Common Finding ◽  
Colonic Manometry ◽  
Target Organs ◽  
Common Causes

The autonomic nervous system delicately regulates the function of several target organs, including the gastrointestinal tract. Thus, nerve lesions or other nerve pathologies may cause autonomic dysfunction (AD). Some of the most common causes of AD are diabetes mellitus and α-synucleinopathies such as Parkinson’s disease. Widespread dysmotility throughout the gastrointestinal tract is a common finding in AD, but no commercially available method exists for direct verification of enteric dysfunction. Thus, assessing segmental enteric physiological function is recommended to aid diagnostics and guide treatment. Several established assessment methods exist, but disadvantages such as lack of standardization, exposure to radiation, advanced data interpretation, or high cost, limit their utility. Emerging methods, including high-resolution colonic manometry, 3D-transit, advanced imaging methods, analysis of gut biopsies, and microbiota, may all assist in the evaluation of gastroenteropathy related to AD. This review provides an overview of established and emerging assessment methods of physiological function within the gut and assessment methods of autonomic neuropathy outside the gut, especially in regards to clinical performance, strengths, and limitations for each method.

Benzocaine-Induced Methemoglobinemia: Report of a Severe Reaction and Review of the Literature

1994 ◽  
Vol 28 (5) ◽  
pp. 643-649 ◽  
Author(s):  
Luis F. Rodriguez ◽  
Lynn M. Smolik ◽  
Alicia J. Zbehlik
Keyword(s):  
Methylene Blue ◽  
Ventilatory Support ◽  
The Elderly ◽  
Severe Reaction ◽  
Oxygen Administration ◽  
Arterial Blood ◽  
Laboratory Confirmation ◽  
Common Causes ◽  
High Doses ◽  
Special Risk

OBJECTIVE: To report a case of benzocaine-induced inethemoglobinemia and present a review of the related literature. CASE REPORT: An 83-year-old man received benzocaine topical anesthesia 600 mg prior to intubation for resection of a thyroid adenoma. The patient became severely cyanotic after induction of anesthesia. After a negative workup for common causes of cyanosis, blood co-oximetry analysis revealed a methemoglobin concentration of 54.1 percent. Intravenous methylene blue reversed the methemoglobinemia, although delayed recurrence 20 h later necessitated readministration of intravenous methylene blue. The patient developed cardiovascular instability and severe neurologic depression requiring prolonged ventilatory support. DISCUSSION: Methemoglobinemia can result from exposure to a number of drugs including benzocaine. Cyanosis, neurological and cardiac dysfunction may result when methemoglobin concentrations exceed 30 percent. Clinical diagnosis is made on the presentation of cyanosis unresponsive to oxygen administration and a distinctive arterial blood brown color; laboratory confirmation is by co-oximetry. Treatment of symptomatic methemoglobinemia is by intravenous methylene blue (1–2 mg/kg) administration. Fifty-four cases of benzocaine-induced methemoglobinemia have been reported in the literature. Intubation, endoscopy/bronchoscopy, and ingestion were the most common procedures in which benzocaine administration produced methemoglobinemia. Infants and the elderly were more likely to develop toxic methemoglobinemia after benzocaine exposure. Other risk factors included genetic reductase deficiencies, exposure to high doses of anesthetic, and presence of denuded skin and mucous membranes. CONCLUSIONS: Because of the potential for severe complications, methemoglobinemia should be corrected promptly in compromised patients and those with toxic benzocaine concentrations. The possibility of masking symptoms during general anesthesia carries special risk of use of this agent in the preanesthesia setting.

Diagnostic Evaluation of Patients Presenting with Rectal Bleeding by Colonoscopy

2020 ◽  
Vol 42 (1) ◽  
pp. 36-39
Author(s):  
Bala R Malla ◽  
Suyog Simkhada
Keyword(s):  
Rectal Bleeding ◽  
Diagnostic Yield ◽  
Adult Population ◽  
Common Finding ◽  
Common Causes ◽  
Optic Colonoscopy ◽  
The Common ◽  
Gastro Intestinal Tract ◽  
Histopathologic Findings ◽  
Malignant Mass

Introduction Rectal bleeding indicates the bleeding from lower gastro-intestinal tract occurring distal to ligaments of Treitz. Annual incidence of per rectal bleeding has been estimated to be 20% . Colonoscopy is the examination of choice for investigation. The objective of this study is to know the diagnostic yield of colonoscopy in cases with per rectal bleeding and to know the common causes of per rectal bleeding in adults MethodsOne hundred and twenty-nine adult patients, age more than 18years, who presented to Surgical OPD and ward of Dhulikhel Hospital during the year 2018 and 2019 were taken for the study irrespective of their sex. All the patients were subjected to fibre-optic colonoscopy after necessary preparation and the findings were recorded. Diagnosis was based on colonoscopic and histopathologic findings. ResultsA total of 129 (77 male and 52 female )patients with per rectal bleeding were evaluated with colonoscopy. The age ranged from 18 years to 79 years with the mean age 42.25 (SD+/- 15.29). Colonoscopy showed abnormalities in 102 patients (79.06%). The most common finding was hemorrhoids in 36 patients (27.90%) followed by colorectal malignant mass in 20 patients (15.50%). Polyps were diagnosed as the cause of rectal bleeding in 14 patients (10.84%). ConclusionColonoscopy has good diagnostic yield at evaluating cases with per rectal bleeding. Hemorrhoids, colorectal malignant mass and polyps are the common causes producing PR bleeding in Nepalese adult population.

scholarly journals Taking Screenshots of the Invisible: A Study on Bacterial Contamination of Mobile Phones from University Students of Healthcare Professions in Rome, Italy

2020 ◽  
Vol 8 (7) ◽  
pp. 1075 ◽  
Author(s):  
Domenico Cicciarella Modica ◽  
Massimo Maurici ◽  
Gian Loreto D’Alò ◽  
Cinzia Mozzetti ◽  
Alessandra Messina ◽  
...  
Keyword(s):  
Mobile Phones ◽  
Staphylococcus Epidermidis ◽  
Univariate Analysis ◽  
Clinical Settings ◽  
Linear Regression Models ◽  
Biochemical Tests ◽  
E Coli ◽  
Plate Counts ◽  
Healthcare Professions ◽  
Heterotrophic Plate Counts

Mobile phones (MPs) are commonly used both in the personal and professional life. We assessed microbiological contamination of MPs from 108 students in healthcare professions (HPs), in relation to their demographic characteristics and MPs handling habits, collected by means of a questionnaire. Cultural and biochemical tests were performed, and statistical analyses were carried out. Staphylococci were present in 85% of MPs, Enterococci in 37%, Coliforms in 6.5%; E. coli was never detected. Staphylococcus epidermidis was the most frequently isolated staphylococcal species (72% of MPs), followed by S. capitis (14%), S. saprophyticus, S. warneri, S. xylosus (6%), and by S. aureus (4%). Heterotrophic Plate Counts (HPC) at 37 °C, ranged from 0 to 1.2 × 104 CFU/dm2 (mean = 362 CFU/dm2). In univariate analysis, the male gender only was significantly associated with higher HPCs and enterococcal contamination. Multiple linear regression models explained only 17% and 16% of the HPC 37 °C and staphylococcal load variability, respectively. Developing specific guidelines for a hygienic use of MPs in clinical settings, for preventing cross-infection risks, is advisable, as well as introducing specific training programs to HP students. MPs decontamination procedures could also be implemented in the community.

Gastrointestinal side effects associated with high doses of acetaminophen

2000 ◽  
Vol 95 (9) ◽  
pp. 2639-2639
Author(s):  
Elham Rahme ◽  
Dan Pettitt ◽  
Jacques LaLorier
Keyword(s):  
Side Effects ◽  
Gastrointestinal Side Effects ◽  
High Doses

AUDIT OF PARACETAMOL PRESCRIPTIONS IN PAEDIATRIC SURGICAL PATIENTS

2016 ◽  
Vol 101 (9) ◽  
pp. e2.33-e2 ◽  
Author(s):  
Rowena McArtney ◽  
Angharad Atkinson
Keyword(s):  
Ideal Body Weight ◽  
Oral Route ◽  
Surgical Patients ◽  
Growth Charts ◽  
Obese Children ◽  
Ideal Weight ◽  
High Doses ◽  
And Gender ◽  
Renal Tubular ◽  
The Uk

AimLocal Guidelines for peri-operative pain management in children published in 2012 recommended that paracetamol dosing was calculated using ideal body weight (IBW) to prevent inadvertent overdosing in overweight and obese children.1 The purpose of this audit was to establish compliance with these guidelines. The oral paracetamol dose recommended was 20–30 mg/kg as a single dose then 15–20 mg/kg every 4–6 hrs with a maximum of 90 mg/kg/day. IV paracetamol doses were as recommended in BNF for Children (BNFC).2 BNFC states that paracetamol doses totalling 150 mg/kg may cause severe hepatocellular necrosis and renal tubular necrosis but the potential for adverse effects in some children can be seen with doses as little as 75 mg/kg in 24 hrs.MethodPaediatric Surgical patients prescribed paracetamol as an inpatient or on discharge over a 10 week period were included in the audit. For this audit patients were assessed as overweight or obese using age and gender specific UK growth charts endorsed by the Department of Health.Audit standards100% compliance with the following:1. inpatient charts and discharge prescriptions document patient weight and height.2. paracetamol prescriptions based on ideal weight for height in overweight and obese paediatric patients.3. prescriptions have IV route prescribed independently to oral (PO) or rectal route.4. patients prescribed IV paracetamol reviewed after 48 hrs for an oral switch.Results100 inpatient prescriptions (71 elective and 29 non-elective) and 35 discharge prescriptions were analysed.1. Weight was annotated for 84% of inpatient prescriptions and 94% of discharge prescriptions; height was not documented for any patient. Therefore data was analysed basing IBW on 50th centile of the UK growth charts.2. The following results are based on IBW: ▸ Six inpatients prescribed oral paracetamol were classified as overweight or obese; doses ranged from 17.4–30 mg/kg/dose. ▸ Four patients prescribed IV paracetamol were classified as overweight or obese; doses ranged from 20–23 mg/kg/dose. ▸ Four patients prescribed the combined route of PO/IV paracetamol were classified as overweight or obese; doses ranged from 18–24 mg/kg/dose. ▸ Six patients prescribed oral paracetamol on discharge were classified as overweight or obese; doses ranged from 13–33 mg/kg/dose.3. Paracetamol was prescribed as IV/PO in 32 inpatients.4. IV paracetamol was prescribed in 52 patients; 20 were not reviewed at 48 hrs for a switch to oral route. Of these, only 3 were appropriate prolonged IV prescriptions.Conclusion Audit findings showed inadequate compliance with local prescribing guidelines posing a risk of inappropriately high doses of paracetamol being prescribed to overweight and obese children. In addition, unnecessarily prolonged IV use was observed. Following feedback local guidelines were amended in 2015 to recommend that in obese children, dosing should reflect lean body mass and ideal weight for height. The maximum daily dose was also reduced to 75 mg/kg/day. Prescribers require education regarding this important issue.

scholarly journals Long-Term Intravenous Ketamine for Analgesia in a Child with Severe Chronic Intestinal Graft versus Host Disease

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Jennifer Busse ◽  
Leroy Phillips ◽  
William Schechter
Keyword(s):  
Abdominal Pain ◽  
Adverse Effects ◽  
Cancer Pain ◽  
Pediatric Patients ◽  
Hemorrhagic Cystitis ◽  
Graft Versus Host ◽  
Intestinal Gvhd ◽  
High Doses ◽  
Intravenous Ketamine

Ketamine is reported to be an effective adjuvant to opioids in the treatment of refractory cancer pain; however, the use of high doses of ketamine for extended periods in pediatric patients has not been described. We present a five-year-old male with grade IV intestinal GVHD whose abdominal pain required both hydromorphone and ketamine for a period of over four months. There was no evidence of hepatotoxicity, hemorrhagic cystitis, or other adverse effects. Possible withdrawal symptoms were mild and were readily mitigated by gradually weaning ketamine.

scholarly journals Future-proofing pathology: the case for clinical adoption of digital pathology

2017 ◽  
Vol 70 (12) ◽  
pp. 1010-1018 ◽  
Author(s):  
Bethany Jill Williams ◽  
David Bottoms ◽  
Darren Treanor
Keyword(s):  
Relevant Literature ◽  
Healthcare Providers ◽  
Digital Pathology ◽  
Business Case ◽  
Clinical Settings ◽  
Illustrative Case ◽  
Business Cases ◽  
Potential Benefits ◽  
Strategic Context ◽  
Clinical Adoption

This document clarifies the strategic context of digital pathology adoption, defines the different use cases a healthcare provider may wish to consider as part of a digital adoption and summarises existing reasons for digital adoption and its potential benefits. The reader is provided with references to the relevant literature, and illustrative case studies. The authors hope this report will be of interest to healthcare providers, pathology managers, departmental heads, pathologists and biomedical scientists that are considering digital pathology, deployments or preparing business cases for digital pathology adoption in clinical settings. The information contained in this document can be shared and used in any documentation the reader wishes to present for their own institutional case for adoption report or business case.

scholarly journals A Rare and Challenging Case of Pulmonary Mycobacterium genavense in an Immunocompetent Adult

2018 ◽  
Vol 3 (1) ◽  
pp. 47
Author(s):  
Nur ‘Aini Eddy Warman ◽  
Nurul Yaqeen Mohd Esa
Keyword(s):  
Human Immunodeficiency Virus ◽  
Relevant Literature ◽  
Immunocompetent Adult ◽  
Drug Induced ◽  
Drug Induced Liver Injury ◽  
Immunodeficiency Virus ◽  
Mycobacterium Genavense ◽  
Night Sweats ◽  
Gastrointestinal Side Effects ◽  
History Of

Mycobacterium genavense, a non-tuberculous mycobacterium (NTM), usually affects patients severely immunodeficient from human immunodeficiency virus (HIV) infection or any other immunocompromised states. We reported a case in a 70-year-old female with well-controlled diabetes and history of proximal cystic bronchiectasis. She presented with 2 months history of cough, haemoptysis, and night sweats of which serial sputa were positive for acid-fast bacilli and the culture repeatedly grew M. genavense. Treatment with rifampicin, ofloxacin, and clarithromycin was complicated with drug-induced liver injury and intractable gastrointestinal side effects. We also presented a brief review of relevant literature.

scholarly journals Causes of Acute Abdominal Pain in Geriatrics: A Review

2021 ◽  
pp. 20-28
Author(s):  
Abdullah Saed Albalawi ◽  
Mohammed Omar Amer ◽  
Mohammed Ghannam Alharbi ◽  
Etizaz Ayed Alshaleikhi
Keyword(s):  
Abdominal Pain ◽  
Elderly Population ◽  
Renal Colic ◽  
Acute Abdominal Pain ◽  
The Elderly ◽  
Current Evidence ◽  
Biliary Disease ◽  
Timely Manner ◽  
Cross Sectional ◽  
Common Causes

Background: Aging affects all functions of the gastrointestinal system (GIS). The elderly commonly has atypical presentation of a disease with more subtle symptoms; hence physicians who are not familiar with these might miss the opportunity to make a diagnosis of abdominal pain in timely manner. The main objective of our study is to summarize the current evidence regarding causes and management of acute abdominal pain in elderly.                      Methodology: MEDLINE, Embolic, CINAHL, PsycInfo, and ASSIA were searched from 2000 until April 2021, and reference lists of included studies were searched. Studies were included that described causes and management of abdominal pain in elderly. No software has been utilized to analyze the data. The data was extracted based on specific form that contains (Author’s name, publication year, country, methodology and results). Results: The study included 7 papers. 2 cross sectional, 2 prospective and 3 retrospective studies all reporting causes and management of acute abdominal pain in elderly. Conclusion: The most common causes of abdominal pain in elderly population were biliary disease, appendicitis and bowel obstruction. Renal colic, hernia and ischemia were also reported in different rates. Diagnosis and management of abdominal pain especially in elderly should be immediate to avoid potential complications.

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