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What Clinical and Laboratory Parameters Distinguish Between Acute and Chronic Renal Failure?
A Sanusi, F Arogundade, T Ekwere, A Akinsola
Arab Journal of Nephrology and Transplantation , 2008,
Abstract: Introduction: In developing countries, a large number of patients presenting acutely in renal failure are indeed cases of advanced chronic renal failure. In this study, we compared clinical and laboratory parameters between patients with acute renal failure (ARF) and chronic renal failure (CRF), to identify discriminatory features. Patients and methods: The Renal Unit of Obafemi Awolowo University Teaching Hospitals Complex is a major referral center for renal disease in Nigeria. 20 patients with ARF and 22 patients with CRF (who had not had dialysis intervention) were recruited for the study at presentation. They had full evaluation including demography, history of duration of symptoms, blood pressure, volume of urine, and laboratory parameters: serum creatinine, urea, potassium, and packed cell volume (PCV). These parameters were compared using Mann Whitney U test for nonparametric data to determine statistical significance. Results: There were no significant differences between the two groups regarding their (i) ages (ii) serum creatinine and (iii) PCV. In contrast, statistically significant differences were obtained for (i) the mean duration of symptoms, which was longer in CRF patients, (ii) the mean 24 hour urine volume, which was larger in CRF patients, (iii) the mean systolic and diastolic blood pressures, both being significantly higher in CRF patients, (iv) and the mean serum urea level, which was higher in ARF patients. Conclusion: It is concluded that the duration of symptoms, quantity of urine, blood pressure, and serum urea levels are distinguishing parameters between ARF and CRF, while serum creatinine and PCV are not.
Acute lead intoxication: A rare cause of abdominal pain  [PDF]
Alempijevi? Tamara,?uranovi? Sr?an,Bogdanovi? Andrija,Kova?evi? Nada
Srpski Arhiv za Celokupno Lekarstvo , 2005, DOI: 10.2298/sarh0512514a
Abstract: Abdominal pain is a common symptom of various diseases and conditions of different aetiology. The aim of the interpretation of abdominal pain is to reach an early and accurate diagnosis, thereby enabling appropriate treatment. Acute abdominal pain may be the result of a number of abdominal, as well as extra-abdominal causes, lead poisoning being one such extraabdominal cause. Here, we report the case of a 73-year-old male patient, admitted for clinical investigation of a suspected tumour of the colon, due to the presence of acute convulsive abdominal pain, without propagation, constipation, and anaemia. A history provided by the patient’s family indicated his exposure to lead. The absence of any abdominal pathology, increased levels of lead in the blood (5.249 μmol/l), the presence of basophilically punctuated red blood cells, as well as a ring of sideroblasts, all indicated that the patient’s symptoms (abdominal pain, constipation, and anaemia) were the result of acute lead intoxication. The patient’s case history, including lead exposure, the absence of pathological findings via endoscopic and x-ray examination, laboratory findings (normocytic anaemia, an increased serum lead concentration, basophilically punctuated red blood cells, and the presence of an abundant ring of sideroblasts), all indicated that his symptoms were the result of lead intoxication. After six months of chelation therapy (EDTA), his symptoms completely disappeared, and his laboratory findings returned to normal. This presentation aims to underscore the importance of meticulous history taking, as well as of the selection of suitable laboratory and other auxiliary diagnostic methods in the correct diagnosis of this rare condition.
Dapsone hypersensitivity syndrome in an adolescent during treatment during of leprosy
Bucaretchi, Fábio;Vicente, Danielly C.;Pereira, Ricardo M.;Tresoldi, Antonia T.;
Revista do Instituto de Medicina Tropical de S?o Paulo , 2004, DOI: 10.1590/S0036-46652004000600006
Abstract: a 12 y old girl was admitted 24 days after start a who multidrug therapy scheme for multibacillary leprosy (dapsone, clofazimine and rifampicin) with intense jaundice, generalized lymphadenopathy, hepatoesplenomegaly, oral erosions, conjunctivitis, morbiliform rash and edema of face, ankles and hands. the main laboratory data on admission included: hemoglobin, 8.4 g/dl; wbc, 15,710 cells/mm3; platelet count, 100,000 cells/mm3; inr = 1.49; increased serum levels of aspartate and alanine aminotransferases, gamma-glutamyl transpeptidase, alkaline phosphatase, direct and indirect bilirubin. following, the clinical conditions had deteriorated, developing exfoliative dermatitis, shock, generalized edema, acute renal and hepatic failure, pancytopenia, intestinal bleeding, pneumonia, urinary tract infection and bacteremia, needing adrenergic drugs, replacement of fluids and blood product components, and antibiotics. ten days after admission she started to improve, and was discharged to home at day 39th, after start new supervised treatment for leprosy with clofazimine and rifampicin, without adverse effects. this presentation fulfils the criteria for the diagnosis of dapsone hypersensitivity syndrome (fever, generalized lymphadenopathy, exfoliative rash, anemia and liver involvement with mixed hepatocellular and cholestatic features). physicians, mainly in geographical areas with high prevalence rates of leprosy, should be aware to this severe, and probably not so rare, hypersensitivity reaction to dapsone.
Dapsone syndrome with acute renal failure during leprosy treatment: case report
Alves-Rodrigues, Edson Nogueira;Ribeiro, Luciano Correa;Silva, Margareth Dióz;Takiuchi, Arley;Fontes, Cor Jesus Fernandes;
Brazilian Journal of Infectious Diseases , 2005, DOI: 10.1590/S1413-86702005000100014
Abstract: dapsone syndrome is a rare hypersensitivity reaction to dapsone and is characterized by high fever, papular or exfoliative dermatitis, progressing to liver toxicity and generalized lymphadenopathy, resembling a mononucleosis infection. we report a patient who developed acute renal failure, as well as other complications characteristic of dapsone syndrome, during leprosy treatment. renal involvement had not been previously described as a dapsone syndrome feature.
What clinical and laboratory parameters determine significant intra abdominal pathology for patients assessed in hospital with acute abdominal pain?
Saleh M Abbas, Troy Smithers, Etienne Truter
World Journal of Emergency Surgery , 2007, DOI: 10.1186/1749-7922-2-26
Abstract: A prospective documentation of clinical and laboratory data was obtained on a consecutive cohort of 286 patients who were admitted to a surgical unit over a nine month period with symptoms of abdominal pain regarded severe enough for full assessment in the casualty department and admission to a surgical ward. The patients were followed until a definite diagnosis was made or the patient's condition and abdominal pain improved and the patient discharged. The hospital where the study took place is a small peripheral general hospital draining a population of 120,000 people in a rural area in New Zealand.There were 286 admissions to the emergency department. Logistic regression multivariate statistical analysis showed that guarding raised white cells count, tachycardia and vomiting were the only variables associated with significant pathology.Patients with no vomiting, no guarding, who have normal pulse rates and normal white cell counts are unlikely to have significant pathology requiring further active intervention either medical or surgical.Abdominal pain is very common presentation to emergency department. It is vital that the physician has an understanding and be familiar with the presentations of common diseases that cause abdominal pain [1,2]. Patients with acute abdominal pain are a heterogeneous group that consumes a great deal of a surgical department's resources. To streamline efficiency and provide maximum cost effectiveness it would be of benefit to identify clinical and laboratory parameters in patients admitted with acute abdominal pain that would indicate no significant intra abdominal pathology and thereby encourage early discharge back to the community [3,4].Women of childbearing age commonly present with right iliac fossa pain, most of them do not have appendicitis [4]. Those who do not have the classical features of appendicitis with no evidence of peritonism on examination can be safely managed by active observation or diagnostic laparoscopy [4,5]. T
Methemoglobinemia and dapsone levels in patients with leprosy
Vieira, Jose Luiz Fernandes;Riveira, Juan Gonzalo Bardarez;Martins, Ana de Nazaré Silva;Silva, Jorge Pereira da;Salgado, Claudio Guedes;
Brazilian Journal of Infectious Diseases , 2010, DOI: 10.1590/S1413-86702010000300022
Abstract: the objective of this work was to determine the methemoglobinemia and correlate with dapsone levels in multibacillary leprosy patients under leprosy multi-drug therapy. thirty patients with laboratory and clinical diagnosis of multibacillary leprosy were enrolled. dapsone was analyzed by high performance liquid chromatography and methemoglobinemia by spectrophotometry. the mean dapsone concentrations in male was 1.42 g/ml and in female was 2.42 g/ml. the mean methemoglobin levels in male was 3.09 μg/ml; 191%, and in female was 2.84 ± 1.67%. no correlations were seen between dapsone levels and methemoglobin in male and female patients. our results demonstrated that the dosage of dapsone in leprosy treatment does not promote a significant methemoglobinemia.
Predictors of Acute Respiratory Distress Syndrome in Patients with Paraquat Intoxication  [PDF]
Cheng-Hao Weng, Ching-Chih Hu, Ja-Liang Lin, Dan-Tzu Lin-Tan, Ching-Wei Hsu, Tzung-Hai Yen
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0082695
Abstract: Introduction Paraquat poisoning is characterized by acute lung injury, pulmonary fibrosis, respiratory failure, and multi-organ failure, resulting in a high rate of mortality and morbidity. The objectives of this study were to identify predictors of acute respiratory distress syndrome (ARDS) in cases of paraquat poisoning and determine the association between these parameters. Materials and Methods In total, 187 patients were referred for management of intentional paraquat ingestion between 2000 and 2010. Demographic, clinical, and laboratory data were recorded. Sequential organ failure assessment (SOFA) and Acute Kidney Injury Network (AKIN) scores were collected, and predictors of ARDS were analyzed. Results The overall mortality rate for the entire population was 54% (101/187). Furthermore, the mortality rate was higher in the ARDS patients than in the non-ARDS patients (80% vs. 43.80%, P<0.001). Additionally, the ARDS patients not only had higher AKIN48-h scores (P<0.009), SOFA48-h scores (P<0.001), and time to ARDS/nadir PaO2 (P=0.008) but also suffered from lower nadir PaO2 (P<0.001), nadir AaDO2 (P<0.001), and nadir eGFR (P=0.001) compared to those in the non-ARDS patients. Moreover, pneumomediastinum episodes were more frequent in the ARDS patients than in the non-ARDS patients (P<0.001). A multivariate Cox regression model revealed that blood paraquat concentrations (P<0.001), SOFA48-h scores (P=0.001), and steroid and cyclophosphamide pulse therapies (P=0.024) were significant predictors of ARDS. The cumulative survival rates differed significantly (P<0.001) between patients with SOFA48-h scores <3 and SOFA48-h scores ≥3, with a sensitivity of 95.8%, specificity of 58.4%, and overall correctness of 67.6%. Finally, the area under the receiver operating characteristic (AUROC) analysis showed that SOFA48-h scores (P<0.001) had a better discriminatory power than blood paraquat concentrations (P=0.01) for predicting ARDS. Conclusions The analytical results indicate that SOFA48-h scores, blood paraquat concentrations, and steroid and cyclophosphamide pulse therapies are significantly associated with ARDS complications after paraquat intoxication.
Acute Hydrocephaly Following Methadone Intoxication in a Child
Iranian Journal of Child Neurology , 2012,
Abstract: Infantile methadone intoxication has been on the rise since the usage of methadone in opioid detoxification programs. We report a 30-month-old child with encephalopathy and acute hydrocephaly following methadone intoxication.
Temporomandibular joint dislocation due to acute propranolol intoxication
Abbas Aghabiklooei, Homan Elahi, Babak Mostafazadeh
International Medical Case Reports Journal , 2010, DOI: http://dx.doi.org/10.2147/IMCRJ.S10352
Abstract: romandibular joint dislocation due to acute propranolol intoxication Case report (3608) Total Article Views Authors: Abbas Aghabiklooei, Homan Elahi, Babak Mostafazadeh Published Date July 2010 Volume 2010:3 Pages 59 - 61 DOI: http://dx.doi.org/10.2147/IMCRJ.S10352 Abbas Aghabiklooei1, Homan Elahi2, Babak Mostafazadeh3 1Department of Medical Toxicology and Forensic Medicine, Iran University of Medical Sciences, Tehran, Iran; 2Firouzgar Hospital, Department of ENT, Tehran, Iran; 3Department of Medical Toxicology and Forensic Medicine, Shaheed Beheshty University of Medical Sciences, Tehran, Iran Abstract: Temporomandibular joint (TMJ) dislocation has not previously been reported as a complication of beta-blocker toxicity. We are reporting two cases of TMJ dislocation resulted from acute severe intoxication with pure propranolol (PPL) for the first time. Bilateral TMJ dislocation happened in two patients who were admitted to intensive care unit with diagnosis of severe acute PPL toxicity. Clinical diagnosis of TMJ dislocation was obtained by physical examination. Successful reduction was performed for both patients without subsequent recurrence in two weeks following hospital discharge. Both of our subjects had no previous history of lower jaw dislocation. There was not any risk factor for dislocation such as convulsion during admission period, recent face trauma, or oral manipulation by the medical team. This study showed that TMJ dislocation may occur after severe acute PPL toxicity probably due to spastic contraction of the lateral pterygoid muscle. This is against previously mentioned hypothesis that stated masseteric muscles contraction as the main cause of a bilateral dislocated TMJ.
Acute lead intoxication in a pregnant mare : clinical communication  [cached]
K. Kruger,M.N. Saulez,J.A. Neser,K. Solberg
Journal of the South African Veterinary Association , 2012, DOI: 10.4102/jsava.v79i1.242
Abstract: Lead (Pb) intoxication in horses is usually a chronic phenomenon with clinical signs associated with central nervous dysfunction. This report gives details of a case of acute Pb intoxication in a 9-year-old American Saddlebred mare with severe, progressive and ultimately fatal neurological deterioration. During the 4 days of hospitalisation, clinical signs progressed from intermittent headshaking and depression to severe, continuous, uncontrollable manic behaviour. At autopsy, three grey-coloured, hard metal particles were present in the gastrointestinal tract and subsequently found to contain 2614 ppm Pb. Lead concentrations in the brain, liver, stomach and kidney were 29, 4, 6 and 2 ppm wet weight, respectively.
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