Severe Metabolic Complications Research Articles

Successful treatment of uterine torsion in a cat with severe metabolic and haemostatic complications

A peri-parturient fifteen-month-old female Maine Coon cat was presented with extreme weakness and depression, profound hypovolaemia and hypothermia. Severe hyperkalaemia, hyponatraemia and anaemia were detected. Disseminated intravascular coagulation was suspected due to marked prolongation of activated partial thromboplastin time. Uterine torsion was diagnosed at exploratory laparotomy. The cat made a full recovery following ovariohysterectomy and intensive supportive therapy.

Severe cardiac, respiratory, and metabolic complications of massive verapamil overdose

Severe cardiac, respiratory, and metabolic complications of massive verapamil overdose

The refeeding syndrome: a review

Refeeding syndrome has been used to describe those phenomena, such as severe hypophosphatemia and other metabolic complications, seen in malnourished patients receiving concentrated calories via total parenteral nutrition. The purpose of this review is to clarify and broaden this definition, as well as to make recommendations for its recognition and, more importantly, prevention.

Abdominal Burkitt's lymphoma: Role of early aggressive surgery

Current surgical teaching advocates debulking of the abdominal Burkitt's lymphoma to decrease tumor burden and improve survival. The records of 16 children who had Burkitt's lymphoma were reviewed. Eleven of these children presented with abdominal tumors. Five of these 11 patients are long-term survivors and six have died. Three of the tumors were primarily resected; two were in patients who became long-term survivors. One resection was complicated by acute renal failure, leading to the early demise of the patient. Four tumors were debulked; only one of these was in a long-term survivor. Acute renal failure also complicated the hospital course in one of these children. Finally, four patients underwent initial incisional biopsies and plans were made for subsequent resection of any residual tumor 6 weeks later. Two of these children survived and two have died. The results of this pilot study do not confirm that there is a clear advantage to aggressive operative cytoreduction. Although this approach decreases the total tumor burden, it may also impose severe metabolic complications and postpone the administration of chemotherapy. These results do suggest the need for a multi-institutional review of the surgical management of abdominal Burkitt's lymphoma.

"Inactive" Ingredients in Pharmaceutical Products

Pharmaceuticals often contain agents that have a variety of purposes including improvement of the appearance, bioavailability, stability, and palatability of the product. Excipients frequently make up the majority of the mass or volume of oral and parenteral drug products. These pharmaceutical adjuvants are usually considered to be inert and do not add to or affect the intended action of the therapeutically active ingredient. Some 773 chemical agents have been approved by the Food and Drug Administration for use as inactive ingredients in drug products.1 Inasmuch as these compounds are classified as "inactive," manufacturers are not presently required to list them on the product label. These ingredients are used for a variety of different purposes (Table 1). Because of the large number of these agents and their frequency of use, practicing physicians have recently become concerned about their possible physiologic effects. The increasing number of reports of adverse effects associated with pharmaceutical excipients2 has led to professional and consumer organizations formally requesting the FDA (Food and Drug Administration) to require complete disclosure on the product label of all substances contained in pharmaceuticals. Problems encountered with "inactive" ingredients, include the following. ADVERSE EFFECTS OF PHARMACEUTICAL EXCIPIENTS Benzyl Alcohol This antimicrobial agent is commonly used as a preservative in many injectable drugs and solutions. A number of neonatal deaths and severe respiratory and metabolic complications in infants have been associated with use of this agent.3-5 In a controlled study, intraventricular hemorrhage, metabolic acidosis, and increased mortality were positively correlated with substantial benzoic acid and benzyl alcohol levels in neonates.6

Metabolic consequences of reduced gastric acidity.

A review of the effect on metabolism of antacids, anticholinergics and histamine H2-antagonists is given. It is stated that long-term treatment with antacids by a variety of mechanisms can cause severe metabolic complications such as the milk-alkali syndrome and phosphorus depletion. The interaction with other drugs can also be marked. There is very little known of the effect of anticholinergics on metabolism. Clinical experience has not indicated that any serious consequences will occur. The authors have investigated the effect continuous treatment with cimetidine 400 mg at night or twice daily for three years on weight, haemoglobin, plasma iron, plasma folate, plasma vitamin B12, albumin and plasma calcium. The only significant difference that occurred was a slight decrease of plasma calcium within the reference values. In conclusion it is stated that there is very little indication that the moderate and inconstant reduction of acidity over 24 hours which can be achieved by anticholinergics or twice daily administration of presently available H2-antagonists will result in metabolic consequences arising from reduced acidity. Higher doses given more frequently might give a risk for bacterial overgrowth with metabolic consequences.

Severe iron poisoning treated with enteral and intravenous deferoxamine

An 18-month-old boy ingested approximately 18 g FeSO4, equivalent to 336 mg/kg elemental Fe. He rapidly developed severe gastroenteric symptoms, obtundation, and transient hypotension. The serum iron level two hours after ingestion was 6,798 micrograms/dL. He was treated with deferoxamine intravenously, enterally, and as a lavage solution. His hospital course was notable for lack of severe neurologic, hepatic, metabolic, or cardiovascular complications acutely with apparent complete recovery, although he returned six weeks after ingestion with intestinal obstruction due to a jejunal stricture.

Severe metabolic complications in a cross-country runner with sickle cell trait

Severe metabolic complications in a cross-country runner with sickle cell trait

Severe Metabolic Complications in a Cross-Country Runner With Sickle Cell Trait

A 17-year-old black male with sickle cell trait collapsed after completion of a 5,000-m cross-country race. He manifested CNS dysfunction, disseminated intravascular coagulation, rhabdomyolysis, renal insufficiency, and deep venous thrombosis. Sickle cell crisis may have been etiologic in the pathogenesis of this constellation of abnormalities. ( JAMA 1983;249:777-779)

Severe Electrolyte Abnormalities in a Pregnant Patient With a Jejunoileal Bypass

A pregnant patient with a jejunoileal bypass developed hypokalemic paralysis and severe hypocalcemia and hypomagnesemia. She also had hypokalemic myopathy with elevation of muscle enzymes, which was corrected by potassium administration. This case emphasizes the severe metabolic complications that may be encountered during pregnancy following jejunoileal bypass.

Complete heart block: Prognostic value of electrocardiographic features and clinical complications

Eighty of 98 patients with acquired complete heart block are presented and discussed with respect to the effect on prognosis of age, etiology, presence of cardiac and extracardiac complications and electrocardiographic data. In this series of 48 control and 32 paced patients, mortality was adversely affected by myocardial infarction, uremia, shock, diabetes, a ventricular rate below 30/min., and Stokes-Adams attacks. Mortality was not affected by changing block, duration of the QRS interval, or the presence of cardiac failure. The prognosis in complete heart block was improved by pacing except in the presence of severe renal or metabolic complications.