American journal of therapeutics
-
Comparative Study
Comparison of Arginine Hydrochloride and Acetazolamide for the Correction of Metabolic Alkalosis in Pediatric Patients.
Metabolic alkalosis is a common acid-base disturbance occurring in critically ill pediatric patients. Acetazolamide and arginine hydrochloride are pharmacologic agents used at our institution for patients refractory to first-line therapy or those unable to tolerate fluid replacement. The objective of this retrospective review was to determine if a course of arginine hydrochloride or acetazolamide was more effective at correcting metabolic alkalosis within a 24-hour period. ⋯ Both groups had a similar increase in mean serum chloride concentration (5.7 ± 5.3 vs. 4.4 ± 4.4 mmol/L, P = 0.458). Mean decrease in serum bicarbonate concentration was equivalent between groups (5.6 ± 5.2 vs. 2.8 ± 4.7, mmol/L, P = 0.110). Acetazolamide and arginine hydrochloride appear to be equally effective in correcting metabolic alkalosis in critically ill pediatric patients.
-
The Coflex is one of the representatives of posterior dynamic interspinous process device, but no study with the application of Coflex interlaminar stabilization in L5/S1 level has been performed. The aim of this study was to evaluate the feasibility and validity of the Coflex interlaminar stabilization in the treatment of degenerative lumbar diseases on L5/S1 level. A retrospective study was conducted for a consecutive series of 33 patients with degenerative lumbar spinal stenosis or lumbar disc herniation located in L5/S1 between November 2007 and September 2010. ⋯ Radiological evaluation revealed that dorsal intervertebral space height and intervertebral foramen height of target level increased significantly in all cases postoperatively and maintained well to final follow-up. In addition, the sagittal range of motion of operated level was restricted (P < 0.05), and the range of motion of adjacent segment did not change much (P > 0.05). The Coflex is an efficacious dynamic interspinous process device for the treatment of degenerative lumbar diseases that can apply to L5/S1.
-
Vitamin D deficiency is known to be common in the general population and has been linked to all-cause mortality. The classically recognized role of vitamin D is its involvement in calcium and phosphorous homeostasis and bone health. ⋯ Many of these studies have indicated that there is an association between vitamin D deficiency and clinical outcomes such as mortality, sepsis, duration of mechanical ventilation, and length of stay. This review article provides an overview of vitamin D physiology in adults, a summary of observational studies on vitamin D deficiency in critical illness, and an examination of the few clinical trials on vitamin D supplementation in intensive care patients.
-
One of the most fascinating drugs in the anesthesiologist's armament is ketamine, an N-methyl-D-aspartate receptor antagonist with a myriad of uses. The drug is a dissociative anesthetic and has been used more often as an analgesic in numerous hospital units, outpatient pain clinics, and in the prehospital realm. It has been used to treat postoperative pain, chronic pain, complex regional pain syndrome, phantom limb pain, and other neuropathic conditions requiring analgesia. ⋯ Such effects make it necessary for the clinician to use the drug only in situations where it will provide the greatest benefit with the fewest adverse effects. To the best of our knowledge, none of the reviews regarding ketamine have taken a comprehensive look at the drug's uses in all territories of medicine. This review will serve to touch on its chemical data, pharmacokinetics and pharmacodynamics, medical uses, and adverse effects while focusing specifically on the drugs usage in anesthesia and analgesia.
-
Case Reports
Rhabdomyolysis Secondary to Therapeutic Hypothermia After Cardiopulmonary Resuscitation: A Rare Complication.
Patient maintenance after successful cardiopulmonary resuscitation starts with decreasing the neurological damage despite serious difficulties such as hypoxic ischemic infarcts and reperfusion infarcts. Therapeutic hypothermia is the most rejoicing method in use to prevent neurological damage. Here, we discuss about a 35-year-old woman resuscitated for 20 minutes in hospital who was followed because of postpartum cardiomyopathy. ⋯ Although we were successful to prevent neurological damage, rhabdomyolysis arose secondary to therapeutic hypothermia. As a result, the intubation process was prolonged, and acute tubular necrosis due to myoglobinuria was occurred. Despite all complications patient faced, she was discharged on her 31th day; without sequela and with no need for hemodialysis; under medical therapy.