Læknablađiđ
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Review
[SGLT2 inhibitors - A novel treatment for congestive heart failure and chronic kidney disease].
SGLT2 inhibitors increase renal excretion of sodium and glucose by blocking the SGLT2 transporters in the proximal tubule. Not only do they lower blood sugars levels but also have positive effects on blood pressure and weight. They lead to more efficient energy metabolism in the heart and kidneys, increase the production of red blood cells and decrease fibrosis and inflammation in the heart and the kidneys. ⋯ SGLT2 inhibitors are shown to decrease risk of chronic kidney disease stage 5 and dialysis, death due of cardiovascular events and doubling of serum creatinine in patients with chronic kidney disease both with and without diabetes type 2. They are now recommended for treatment of heart failure and chronic kidney disease with the highest evidence grade. SGLT2 inhibitors do not increase risk of hypoglycemia or acute kidney injury but do have a serious uncommon adverse effect that are normoglycemic ketoacidosis and Fournier's gangrene that physicians need to be alert to.
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Eosinophilic esophagitis (EoE) is a common cause of swallowing difficulties in both children and adults. The incidence of EoE has been increasing over the past decades, which cannot be solely attributed to improved diagnostic techniques. ⋯ Many patients respond to treatment with proton pump inhibitors, but those with severe EoE may require dietary modifications, topical steroids, and/or dilation of esophageal strictures. This review covers the incidence, risk factors, natural course, diagnosis, and treatment options for EoE, both within the Icelandic healthcare system andi n a broader context.
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A 71-year-old man came to the emergency department (ED) at Landspitali University Hospital after collapsing at his home. He had a severely decreased serum potassium concentration of 2.1 mmol/L (ref. 3,5-4,8 mmol/L), along with an influenza A infection and thigh muscle weakness. Further investigations revealed atrial fibrillation, new-onset hypertension and increased urinary excretion of potassium. ⋯ The patient had consumed a significant amount of liquorice with marzipan, over 250g per day, in the days preceding his visit to the ED. He was subsequently diagnosed with liquorice-induced hypertension and syndome of apparent mineralocordicoid excess (pseudohyperaldosteronism). This case emphasizes the need for clinicians to be aware of the dangers of liquorice consumption.