A&A practice
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Severe and life-threatening cases of metformin-associated lactic acidosis (MALA) are treated with renal replacement therapy. Intermittent hemodialysis is recommended, as it achieves rapid more elimination of metformin compared to continuous renal replacement therapy (CRRT). ⋯ Three of the 4 patients survived to hospital discharge. Dual CRRT may be an effective alternative when dialysis is not readily available.
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Intrathecal drug delivery systems (IDDS) are a treatment option for patients with chronic nonmalignant pain and cancer pain. In this case report, we describe a patient in whom an intrathecal catheter was implanted into a blood vessel rather than into the subarachnoid cavity. ⋯ The anterior spinal arteries and veins were verified on the ventral side of the spinal cord without interruption. To our knowledge, this is the first report of implantation of an IDDS catheter into a blood vessel.
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Case Reports
Scrambler Therapy for the Treatment of Multiple System Atrophy-Parkinsonian Subtype Pain: A Case Report.
The management of pain in patients with multiple system atrophy (MSA) is often inadequate, and treatments commonly result in adverse effects. A 63-year-old man with the parkinsonian subtype of MSA presented with bilateral neck, shoulder, upper extremity, lower extremity, and low back pain of 6 years' duration. His baseline pain was 5 of 10 with flares to 10 of 10. ⋯ His pain relief after 4 ST sessions lasted for 6 weeks. No complications or adverse effects occurred. ST deserves further study for patients with atypical parkinsonism.