1/16. neuroleptic malignant syndrome due to promethazine.A 42-year-old man came to our emergency room hyperthermic (oral temperature, 42.4 degrees C), diaphoretic, and delirious. Other findings included labile blood pressure, sinus tachycardia (heart rate, 138/min), tachypnea (respiratory rate 34/min), muscle rigidity, and incontinence. Two days earlier, he had gone to a local clinic with complaints of abdominal pain, nausea, and vomiting. promethazine was prescribed, and this was the patient's only medication on admission. Laboratory studies showed leukocytosis, hypernatremia, metabolic acidosis, elevated creatinine phosphokinase level, elevated transaminase levels, azotemia, hyperkalemia, hyperphosphatemia, hypocalcemia, and myoglobulinuria. The clinical and laboratory findings were characteristic of the neuroleptic malignant syndrome, with promethazine as the offending agent.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/16. Hyponatremic hypertensive syndrome.We report on a 4-year-old girl with hyponatremic-hypertensive syndrome (HHS), a rare entity in childhood. The girl was referred to us from a local hospital with a history of recurrent fever, vomiting, and seizures. On admission she was markedly dehydrated. Initial investigations revealed severe hyponatremia (serum Na 120 mmol/l), hypochloremia (serum Cl 68 mmol/l), and mild hypokalemia (serum K 3.3 mmol/l), while serum calcium and magnesium were normal. serum urea was 5 mmol/l and serum creatinine was 62 mumol/l. Despite hyponatremic dehydration, her urine output was high (2050 ml/24 h), as was her urinary sodium (168 mmol/24 h). She had massive transient proteinuria (maximal 1642 mg/24 h) while being severely hypertensive (blood pressure 210/160 mmHg). Further investigations revealed right kidney scarring, hyper-reflexive bladder dysfunction, massive brain infarcts, and myocardial left ventricular hypertrophy. Renal arteries were normal on arteriography. blood pressure control resulted in normalization of serum and urinary electrolytes and decrease of proteinuria. hyponatremia and transient massive proteinuria in this patient seem to be caused by high-pressure-forced diuresis due to malignant renoparenchymal hypertension.- - - - - - - - - - ranking = 3keywords = pressure (Clic here for more details about this article) |
3/16. Two cases of hyperkalemia after administration of hypertonic mannitol during craniotomy.mannitol is used commonly as an osmotic diuretic to reduce intracranial pressure during the perioperative period of craniotomy. The rapid administration of mannitol solution can cause an imbalance of electrolytes such as sodium and potassium. Here, we report two cases of mannitol-induced hyperkalemia. We demonstrate that administration of mannitol during craniotomy increases potassium iron concentration, and in some cases it may cause disturbance of cardiac function.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
4/16. Posterior reversible encephalopathy syndrome on computed tomography perfusion in a patient on "Triple H" therapy.INTRODUCTION: This article reports a case of posterior reversible encephalopathy syndrome on compyted tomography (CT) perfusion in a patient on "Triple H" (hypertension, hypervolemia, and hemodilution) therapy following aneurysmal rupture repair. CASE REPORT: "Triple H" therapy is used in the postoperative course for treatment of vasospasm to prevent stroke and hemorrhage by maintaining cerebral perfusion pressure. DISCUSSION: A potential complication includes vasogenic edema from dysfunction of cerebral blood vessel autoregulation. CT perfusion can detect alterations in cerebral blood flow and volume caused by these hemodynamic changes.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/16. Regression of long standing anorexia nervosa following acute renal failure caused by gentamicin intoxication.A female patient aged 22 with fully developed symptoms of anorexia nervosa presented the following metabolic disturbances: persistent hyperuricemia, hyponatruria, (sometimes with sodium lack in urine) as well as frequent hyponatremia and hyper-uricosuria. The patient's low arterial blood pressure (70/40 mm Hg on average) was not improved by pharmacological treatment, and only high oral doses of table salt (20-70 g/24 h) did prove effective in the therapy. The subject passed seven renal calculi composed of sodium urate and uric acid. Numerous urinalyses did not reveal any changes, and bacterial cultures of the urine were also negative. After 14 years of anorexia nervosa, the patient was treated for pneumonia with gentamicin at doses of 2 x 80 mg/24 h. Following third dose of the antibiotic, the patient developed acute renal failure and was treated by haemodialysis for six weeks. The renal function came gradually to the norm. Simultaneously, all the anorexia nervosa symptoms subsided along with sodium metabolism disturbances, while purine metabolism disorders got considerably alleviated. The patient started to have her menstrual cycles again, gained 12 kg in body weight, and one year afterwards bore a son. A further 10-year follow-up period was free of any pathological changes except for a slight hyperuricemia. To the best of our knowledge, the similar case has not been reported in the medical literature and electronic data bases.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/16. Reversible changes in osmoregulation of vasopressin release due to impaired water excretion.Studies of renal water handling and the effects of altered hydration and posture on the osmoregulation of vasopressin release were performed on a chronically hyponatremic patient with complete cervical spinal cord transection at the C-5 level. Acute oral water loading studies showed marked reduction in free water clearance and urine diluting ability, despite appropriate suppression of plasma vasopressin concentrations. Orthostatic reductions in arterial blood pressure during head-up tilting and following the assumption of sitting posture were also demonstrable, and may have contributed to, but could not fully account for, the defect in renal water excretion, which persisted in supine posture. Hypertonic sodium chloride infusion studies performed before fluid restriction showed that low preinfusion plasma osmolality was associated with a reduced osmotic threshold for vasopressin release, which was subsequently corrected by a period of fluid restriction that restored the patient's plasma osmolality to a normal level. This shift in osmotic threshold can be inferred from both linear regression and log-linear regression analysis of the data. These studies show that marked impairment of renal water excretion coupled with unrestricted water intake can result in altered osmoregulation of vasopressin release in association with persistent plasma hypo-osmolality, which can be corrected by fluid restriction.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/16. Renovascular hypertension: a rare cause of neonatal salt loss.We report a case of severe hypertension in the newborn period due to obstruction of the right renal artery. The baby presented with polyuria leading to dehydration and was found to have hyponatraemia and severe renal salt loss. When sudden malignant hypertension is induced in experimental conditions, a high pressure diuresis and increased angiotensin ii production are found. These findings could explain the renal salt loss, notwithstanding the effects of secondary hyperaldosteronism and hyper-reninaemia.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
8/16. The interstitial fluid pressure monitor: a device to aid in the determination of patient fluid requirements.Assessment of patient fluid requirements is often difficult. Previous basic as well as clinical studies have suggested that interstitial fluid pressure (IFP) correlates with interstitial fluid volume and can be measured with a catheter placed in the subcutaneous space. We constructed a simple device to monitor IFP. The mean IFP for 7 healthy volunteers was -1.19 mmHg. IFP was measured in 25 patients at presentation and as clinical status evolved. patients were classified as hypervolemic, normovolemic, or hypovolemic on the basis of their clinical status, the evolution of their condition, and laboratory and radiographic data. IFP correlation with assigned classification was statistically significant. The results suggest IFP can be measured readily and reliably in humans and is sensitive for reflecting the hydration of the interstitial compartment. This measure can assist in the determination of patient fluid requirements.- - - - - - - - - - ranking = 5keywords = pressure (Clic here for more details about this article) |
9/16. Orthostatic hypotension occurring after discontinuation of long-term minoxidil therapy.minoxidil (Loniten), a potent predominant arteriolar vasodilator, provides prompt and effective reduction of blood pressure in many patients with severe hypertension. minoxidil results, however, in profound reflex tachycardia and increased plasma volume almost always necessitating concomitant use of beta-adrenergic blocking agents and diuretics. hypertrichosis and massive fluid retention are troublesome adverse reactions that may require discontinuation of minoxidil and initiation of an alternative antihypertensive agent. When minoxidil is discontinued, diuretic dosage requires re-evaluation and possible tapering to prevent volume depletion. Volume depletion is a risk factor in patients with persistent peripheral edema, sodium deprivation or dehydration; these states may interfere with physiologic mechanisms that maintain adequate cerebral perfusion upon standing, triggering orthostatic hypotension and potential syncope. hypertension clinic visits should routinely include supine followed by sitting and standing blood pressure determinations to ensure detection of orthostatic hypotension. Described in the article is a case study in which a patient developed severe orthostatic hypotension one month after minoxidil was discontinued. Pathophysiologic mechanisms are discussed.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
10/16. The management of acute quinidine intoxication.A 16-year-old patient survived severe intoxication with quinidine. hypotension, rapidly progressing to oliguria and shock, was resistant to the usual therapeutic interventions but responded favorably to the use of an intra-aortic balloon pump. Some hemodynamic implications are discussed. pulmonary edema occurred and was treated with positive end-expiratory pressure. Electrocardiographic disturbances in conduction, transient bradycardia and recurrent ventricular arrhythmias characterized the initial 36-hour critical period. Unexplained electrolyte abnormalities occurred and further complicated management.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
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