Acta Medica Port
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Review Case Reports
Lithium Intoxication after Bariatric Surgery: A Case Report.
Bariatric surgery is a therapeutic option to treat obesity in (carefully selected) patients with psychiatric disorders. About half of the patients referred for bariatric surgery have a diagnosis of (at least one) mental disorder and most of them are treated with psychotropic drugs. This procedure may modify the bioavailability of drugs and lithium is no exception. ⋯ We conducted a review of the published clinical cases in the scientific literature about lithium toxicity after bariatric surgery, and we propose potential preventive clinical solutions. It is essential to increase awareness of changes to the absorption of psychotropic drugs in the post-surgery period, particularly in the case of lithium. Regular postoperative clinical and laboratory monitoring of lithium serum levels is strongly recommended.
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Monoclonal gammopathy of renal significance (MGRS) is described as a hematologic condition characterized by nephrotoxicmonoclonal proteins produced by a non-malignant B-cell or plasma cell clone. Nevertheless, MGRS can cause serious renal lesions, leading to high morbidity. In C3 glomerulonephritis, a monoclonal protein can cause renal damage indirectly. Acting as an autoantibody, the protein cannot be detected in the kidney biopsy, promoting the dysregulation of the alternative pathway of the complement system. ⋯ With the increasing understanding of the complex interaction between monoclonal gammopathy and renal damage, such as C3 glomerulonephritis, it becomes clear that an early recognition is crucial, as Ig-directed therapy might improve outcomes. In this context, and in order to maximize the chance of a correct diagnosis, renal biopsy is mandatory to determine the exact nature of the lesion, and the severity of renal disease. Conclusion: It is important to make an early diagnosis of MGRS-associated C3 glomerulonephritis in order to prevent not only the progression to a hematological malignancy, but also end-stage renal disease.
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Determination of renal function is particularly important when prescribing antibiotics to elderly patients. This study aims to determine the correlation between estimated creatinine clearance and the estimated glomerular filtration rate, for a hospitalized population of very elderly patients, and to audit antibiotic prescribing errors. ⋯ This study supports the maintenance of the Cockcroft-Gault equation for drug dosing in the very elderly population. Further studies are needed to investigate underlying causes of prescribing errors.