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Stimulants: cocaine, amphetamines and party drugs
Published in Berry Beaumont, David Haslam, Care of Drug Users in General Practice, 2021
A small number of deaths have been reported in recreational users, about 90 in 15 years in the UK. This figure should be taken in the context of the estimated three million doses of the drug which are taken annually. A form of disseminated intravascular coagulation may occur as a result of heat stroke caused by a direct effect on thermoregulation and vigorous dancing in hot conditions. A few have died of the stimulant effects on the heart or from cerebrovascular accidents because of raised blood pressure. There are also recorded deaths from water intoxication when users have drunk water excessively to counter imagined dehydration.
Investigation of Pituitary Disease
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Thozhukat Sathyapalan, Stephen L. Atkin
Excessive secretion or action of AVP results in the production of decreased volumes of more highly concentrated urine. If not accompanied by a commensurate reduction in fluid intake or an increase in insensible loss, the reduction in urine output results in excess water retention with expansion and dilution of all body fluids. In some patients, excessive intake results from inappropriate thirst. If the hyponatremia develops gradually or has been present for more than a few days, it may be largely asymptomatic. However, if it develops acutely, it is almost always accompanied by symptoms and signs of water intoxication that may include mild headache, confusion, anorexia, nausea, vomiting, coma and convulsions, and it could be lethal.
Urinary and sexual problems
Published in Mervyn Dean, Juan-Diego Harris, Claud Regnard, Jo Hockley, Symptom Relief in Palliative Care, 2018
Mervyn Dean, Juan-Diego Harris, Claud Regnard, Jo Hockley
Incontinence: This is a distressing symptom with effects on self-esteem, personal hygiene and social interaction, although many patients manage to cope if the problem is mild.20,21 Permanent catheterization should be a last resort since there are many causes which can be treated (see clinical decision table). Desmopressin is a synthetic analog of vasopressin (antidiuretic hormone) which reduces urinary output overnight and is occasionally helpful in otherwise intractable nocturnal incontinence.22,23 A fluid intake/output chart is started, and no fluids given after 6 pm. It is important that the patient produces a daytime output of at least 500 ml, otherwise water intoxication can occur. An intranasal or oral dose is given at bedtime.
Evaluation of the timing and safety of hysteroscopic myomectomy of large submucosal fibroids pretreated by high intensity focused ultrasound
Published in International Journal of Hyperthermia, 2023
Kaiyin Qu, Min Zou, Zhi Wang, Chunmei Gong, Yu Xiong, Lian Zhang
The hysteroscopic myomectomy was performed at different time points after HIFU according to the symptom relief and patient willingness. A disposable cervical dilation mold was placed to dilate the cervical the night before hysteroscopic myomectomy. The patient was placed in lithotomy position and the procedure was carried out under deep sedation. Respiratory rate, heart rate, blood pressure, and oxygen saturation level were monitored during the procedure. Electrolyte monitoring was also performed with the dynamical blood gas analysis to prevent acute water intoxication and hyponatremia. For non-diabetic patients, 5% dextrose solution was used as uterine distention fluid. For diabetic patients, mannitol solution was used. The hysteroscopic dilatation and perfusion system was used, and the intrauterine pressure was set to 80–100 mmHg (1 mmHg = 0.133 kPa) or less than or equal to mean arterial pressure according to the patient’s monitoring. Myomectomy was performed with a monopolar resection ring under ultrasound guidance. The necrotic fibroids were removed with oval clamp and sucked out with large suction tube under negative pressure. Electrocoagulation was used to stop bleeding. The operation was terminated when no abnormality was detected in the uterine cavity. The resected tissues were sent for pathological evaluation. Blood examination was performed within 24 h after hysteroscopic myomectomy.
Colonoscopy adverse events: are we getting the full picture?
Published in Scandinavian Journal of Gastroenterology, 2020
Lasse Pedersen, Nina Sorensen, Karen Lindorff-Larsen, Charlotte Green Carlsen, Nina Wensel, Christian Torp-Pedersen, Inge Bernstein
Bowel preparation is known to cause dehydration and electrolyte disturbances like hyponatraemia. Dehydration (with or without hyponatraemia) usually occurs due to excess sodium loss caused by bowel preparation combined with insufficient water intake. Normal hydration with hyponatraemia, known as ‘bowel prep hyponatraemia’, can also occur. It results from non-osmotic arginine vasopressin release, high-speed water intake and temporarily restricted diets found in patients undergoing bowel preparation [16]. The result is acute water intoxication similar to the condition seen in marathon runners [17]. Our findings suggest that re-admittance after colonoscopy due to dehydration/hyponatremia is a rare (0.8‰), but potentially fatal AE as some individuals with pre-existing diseases have poor tolerability to electrolyte imbalances and/or dehydration. The bowel preparation regime in the North Denmark Region is a polyethylene glycol electrolyte solution for screening colonoscopies and a sodium picosulfate solution for diagnostic colonoscopies. Sodium picosulfate has been reported to have an increased risk of hyponatraemia compared to polyethylene glycol which corresponds well to our finding that the risk of dehydration/hyponatraemia is higher among diagnostic colonoscopies (Table 6) [18]. However, a definite conclusion cannot be reached as the screening and diagnostic group might not be directly comparable.
The use of hysteroscopy in endometrial cancer: old questions and novel challenges
Published in Climacteric, 2020
P. Török, S. Molnár, R. Lampé, A. Jakab
In our literature review, no age-specific contraindication or restriction was encountered in the use of hysteroscopy. If the procedure is performed under general anesthesia, the general status of the patient should be suitable for surgery8. In patients with serious medical conditions, such as hemodynamic instability, laryngospasm, bronchial asthma, and a previous reaction to general anesthesia, the rate of failure of anesthesia is higher9. Hysteroscopy performed in an outpatient setting also allows this technique for these patients. Fluid overload should be considered a rare but important complication. Volume overload may cause pulmonary edema and congestive heart failure. Water intoxication may lead to hyponatremia, hypo-osmolarity, and cerebral edema10. In older women, these conditions can occur more frequently. Use of inhaled sevoflurane instead of intravenous propofol during operative hysteroscopy results in significantly increased glycine 1.5% absorption, which can decrease the incidence of gynecological transurethral resection of prostate (TURP) syndrome11. In conclusion, accurate fluid balancing and limiting the operation time may prevent such complications, which is more important in older age groups12.