Deutsche medizinische Wochenschrift
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The refeeding-syndrome is a potentially life-threatening metabolic complication that may occur after the initiation of a nutritional therapy in malnourished patients. The syndrome is not well known and probably frequently unrecognized and untreated. The pathophysiology is characterized by a progressive depletion in potassium, sodium and phosphate, despite mostly normal serum levels. ⋯ The refeeding-syndrome typically develops within a few days after the start of a nutritional therapy. If serum-electrolytes, including magnesium and phosphate are monitored and supplemented tightly, the syndrome can be prevented or treated at an early stage. In addition, the measurement and supplementation of thiamine and the particularly slow increase of energy intake are fundamental for the prevention and treatment of the syndrome.
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The term metabolic surgery describes the surgical therapy of metabolic diseases, which not only aims at weight reduction but more importantly on improving hyperglycemia. Following the current S3-Guidelines, metabolic surgery should be recommended to treat T2 D in patients with a BMI ≥ 40 kg/m2 and in those with BMI 35.0-39.9 kg/m2 when individual hyperglycemia treatment targets are not achieved by optimal medical therapy. Benefits of metabolic surgery. ⋯ For the majority of individuals with T2 D, metabolic surgery will not be the first treatment choice, because modern pharmacotherapies provide an effective and safe long-term treatment of diabetes. However, there are patients with T2 D which may benefit from metabolic surgery. Treatment decisions need to be based on an individual risk-benefit evaluation by a multidisciplinary team.
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Dtsch. Med. Wochenschr. · Apr 2020
[Resuscitation - practical implementation of guidelines and standards in the hospital].
Out of hospital cardiac arrest (OHCA) requiring cardio-pulmonary resuscitation (CPR) remains a mojor public health concern. OHCA affects nearly 275 000 people in Europe annualy with more than 70 000 of those in Germany alone. It represents of the major causes of death in Europe. ⋯ Thus, optimization of the initial CPR treatment with reducing overall no-flow time (time from collaps with cardiac arrest to start of CPR) and optimization and streamlining of treatment algorithms and quality in hospitals receiving patients after cardiac arrest have been a strong focus to improve overall survival. Current guidelines suggest creation of Cardiac Arrest Centers as specialized hospitals who focus on high quality of post-resuscitation care with standardized processes and interdisciplinary treatment of patients after OHCA to establish fast, secure and effective treatment that is widely available in all regions. This article will address the relevant items to be considered in daily practice of resuscitation and post-resuscitation care for cardiac arrest.
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The assessment of the QT interval has been an integral part of ECG interpretation since the first descriptions of long QT syndrome by Wolff in 1950 and by Jervell and Lange-Nielsen in 1957. The correct measurement of the QT interval as well as a correct interpretation of the causes and of the clinical consequences of a QT prolongation, however, may be difficult even for trained internists and cardiologists. In this review, we give an overview on physiological determinants of cardiac repolarization, its marker in the surface ECG - the QT interval -, methods to correctly assess QT interval duration, causes for pathologically prolonged QT intervals, and resulting clinical consequences. ⋯ The therapeutic approaches for LQTS are multimodal. Prevention is the basis of the therapy and includes avoiding known risk factors / and potentially QT-prolonging drugs, and a pharmacological treatment with non-selective beta blockers. According to the risk profile and to the patient's lifestyle the implantation of an ICD or a pacemaker should be considered.
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Dtsch. Med. Wochenschr. · Apr 2020
Practice Guideline[German S3 guideline sepsis: selected recommendations].
The German Sepsis guideline is an interdisciplinary guideline (S3 classification). It is an evidence- and consensus-based instrument for the improvement and quality assurance of prevention, diagnosis, therapy and aftercare of sepsis. It summarizes appropriate, scientifically based and up-to-date procedures for diagnosis, therapy and follow-up. The recommendations of the guideline are intended to serve as a supportive information and decision basis for the clinician in the treatment of adult patients with sepsis or septic shock.