Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Mar 1990
Case Reports[Fulminant venous and arterial thromboses under heparin therapy].
A deep-vein thrombosis developed in a 71-year-old patient on the eleventh day of heparin treatment (25,000 U intravenously over 24 hours) given because of a nontransmural anterior-wall infarct. Subsequently there occurred a unilateral and then bilateral thrombotic occlusion of the femoral arteries and thrombosis of the infrarenal artery with occlusion of the right renal artery which necessitated operative thrombectomy. Platelet count, initially 370,000/microliters, fell to 34,000/microliters. ⋯ Rapidly progressing demarcation necessitated amputation of both legs. The patient died on the 23rd hospital day. The reported findings indicate a heparin-induced thrombosis-thrombocytopenia syndrome.
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Dtsch. Med. Wochenschr. · Feb 1990
Case Reports[Life-threatening lactic acidosis during total parenteral nutrition. Successful therapy with thiamine].
Two patients, 37 and 44 years old, respectively, developed severe metabolic acidosis after abdominal surgery which was followed by three weeks of total parenteral nutrition. Septicaemia, peritonitis or hypoxia were excluded as possible causes. Both patients had very high serum lactate concentrations (24.3 and 22.8 mmol/l, respectively). ⋯ Because vitamin B1 deficiency was suspected, two doses of 400 mg thiamine were administered. In both patients the extreme lactic acidosis disappeared immediately after the injections. Both patients were later discharged without any symptoms.