American journal of therapeutics
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Review Case Reports
Neuroleptic Malignant Syndrome Associated With Metoclopramide Use in a Boy: Case Report and Review of the Literature.
Neuroleptic malignant syndrome (NMS), an idiosyncratic reaction comprising muscular rigidity, altered level of consciousness, and autonomic dysfunction, is a rare but serious medical condition. It is most commonly precipitated by major tranquilizers such as butyrophenones, phenothiazines, and thioxanthines. Metoclopramide, a chlorbenzamide derivative with antidopaminergic properties, is widely used to treat nausea and emesis. ⋯ He subsequently recovered fully and was discharged home with pediatric follow-up. This case represents the first description of NMS in association with metoclopramide in a healthy boy. It demonstrates the importance of considering this diagnosis early in the course of disease in patients with muscular rigidity, altered level of consciousness and autonomic dysfunction, and the need to rapidly respond to the physiological aberrations.
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The macrolide antibiotic erythromycin has been known to be associated with increased gastrointestinal motility since its introduction more than 35 years ago. Investigators have, thus, sought to take advantage of this side effect in patients with gastric stasis secondary to long-standing insulin-dependent diabetes mellitus (IDDM). The hormone motilin induces phase 3 contractions of the migrating motor complex (MMC) to induce peristalsis and facilitate gastric emptying in normal subjects. ⋯ Erythromycin appears to be both effective and well tolerated in clinical studies. At this time it should be reserved for the treatment of patients with diabetic gastroparesis who are resistant to or intolerant of other prokinetic agents. Future research on erythromycin's long-term safety and comparative efficacy will further define its role.
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Syncope is defined as a transient loss of consciousness due to cerebral hypoperfusion followed by spontaneous recovery. Common causes of syncope include vasovagal syncope, situational syncope, orthostatic hypotension, carotid sinus hypersensitivity, left- and right-sided obstructive cardiac lesions, and cardiac arrhythmias. History and physical examination often provide valuable clues about the underlying etiology of syncope. ⋯ Evaluation of a patient with syncope involves a large battery of diagnostic tests that include a 12-lead electrocardiogram, Holter monitoring, echocardiogram, tilt table testing, ischemia evaluation, electrophysiologic studies, and other imaging tests. Despite the availability of these advanced diagnostic tests, a significant proportion of patients with syncope remain undiagnosed. Therapy should be tailored based on the underlying etiology of syncope.
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Review Case Reports
Systemic Intravenous Lidocaine for the Treatment of Complex Regional Pain Syndrome: A Case Report and Literature Review.
Complex regional pain syndrome (CRPS) was described in 1864 by Mitchell et al as a condition characterized by many unique symptoms. Although symptoms may differ from patient to patient, the most common complaints are painful swelling in upper or lower extremities or changes in the skin. CRPS has been given many different names since it was first mentioned in the literature in 1851. ⋯ Intravenous lidocaine is used to block the sodium channels in neuronal membranes, thus stopping initiation and conduction of impulses associated with neuropathic and inflammatory pain. The use of regional intravenous lidocaine (by applying a tourniquet on the affected extremity) has been well-documented in the literature with a successful decrease in pain symptoms. A unique case of the use of systemic intravenous lidocaine will be presented.
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Opioid misuse is a growing epidemic among the civilian and military communities. Five hundred prospective, anonymous surveys were collected in the emergency department waiting room of a military tertiary care hospital over 3 weeks. Demographics, medical and military characteristics were investigated for association with opioid use. ⋯ Chronic opioid use among young soldiers maybe viewed as a weakness that could influence opioid misuse. Younger cohorts of active duty service members could be at higher risk for misuse. Efforts to enhance close monitoring of misuse should address these at-risk populations.