Clin Nephrol
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The occurrence of hepatotoxicity and acute renal dysfunction following an acute paracetamol overdose has been well documented. Acute pancreatitis, however, has been rarely described. ⋯ To our knowledge, this represents the first description in a dialysis patient of paracetamol induced pancreatitis. Given the frequency of paracetamol usage in these patients, we believe that it is important to consider this diagnosis in patients with unexplained acute pancreatitis, particularly if there is associated hepatic dysfunction.
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Much progress has been made in recent years in the management of anemia associated with chronic and renal failure with recombinant human erythropoietin (r-Hu EPO). However, there remains much debate surrounding the diagnosis and treatment of iron deficiency. To ensure that full benefit from erythropoietin therapy is received, most patients require iron supplement during treatment. ⋯ Thus, intravenous iron supplementation should be administered only in patients who do not tolerate available intravenous iron preparations or who are on continuous ambulatory peritoneal dialysis with no evidence of functional iron deficiency. This article provides guidelines for the diagnosis of absolute or functional iron deficiency in patients with renal anemia and suggests treatment schedules for intravenous iron supplementation. We hope that all dialysis patients will be able on this basis to achieve a satisfactory iron status and benefit fully from r-Hu EPO therapy.
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Letter Randomized Controlled Trial Clinical Trial
Maintenance therapy with intravenous iron in hemodialysis patients receiving erythropoietin.
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Severe metabolic acidosis in the setting of alcoholism raises diagnostic and therapeutic problems [Levinsky 1994]. Alcoholic ketoacidosis and toxic alcohol ingestion can be difficult to distinguish on initial presentation [Litovitz 1986]. ⋯ Invasive therapeutic manoeuvers as for toxic alcohol poisoning have been recommended empirically before toxicological confirmation when very high osmolarity gaps are reached. Herein, we report two cases of high anion gap metabolic acidosis with very high osmolal gap due to alcoholic ketoacidosis without any evidence of toxic alcohol ingestion.
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Hyaluronan (HA) is a high molecular weight polysaccharide present in the extracellular matrix of most tissues. It is a major component of loose connective tissues such as skin, synovial fluid and the vitreous body, and during embryonic development, tissue repair, tumor growth and at inflammatory sites. Increased serum concentrations have been reported in association with tissue damage, certain inflammatory diseases, notably rheumatoid arthritis and scleroderma, liver malfunction and in some malignancies. ⋯ One patient, with equivocal clinical relapse after transplantation, exhibited high p-ANCA (404 IU) but serum HA remained normal (ten readings over six months 0-163 micrograms/l). Little change was seen in symptoms, or HA and ANCA serology, following plasma exchange. These preliminary data indicate that serum HA is raised in active vasculitis and may be a useful adjunctive marker of disease activity and extent of tissue damage.