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Oncology and Bone Marrow Transplantation
Published in Praveen S. Goday, Cassandra L. S. Walia, Pediatric Nutrition for Dietitians, 2022
Deena Altschwager, McGreggor Crowley
To calculate the fluid needs of a pediatric oncology patient, the Holliday-Segar method should be used. Patients with fever, physiological stress, diarrhea, ostomy or drain loss, and diabetes insipidus may require additional fluids. Conversely, patients with heart failure, renal failure, fluid overload, or syndrome of inappropriate antidiuretic hormone secretion (SIADH) may require less fluid. The dietitian should always confirm the patient’s goal fluids with the medical team and update these goals as treatment progresses.
Renal
Published in Faye Hill, Sash Noor, Neel Sharma, Tiago Villanueva, Medical and Surgical Emergencies for Students and Junior Doctors, 2021
Faye Hill, Sash Noor, Neel Sharma
From a pharmacological perspective, individuals with SIADH (syndrome of inappropriate antidiuretic hormone secretion – elevated urine osmolality and low plasma osmolality) are best managed with demeclocycline. In addition, vaptans and arginine vasopressin receptor antagonists have been utilised in the management of euvolaemic and hypervolaemic hyponatraemia.
Head and Neck
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
Systemic complications Cardiovascular – brain injury results in a massive catecholamine release with increased sympathetic outflow and dysfunction of the autonomic nervous system. This results in a hyperdynamic circulation with increased myocardial oxygen demand and workload leading to transient myocardial ischaemia and failure.Pulmonary – 80% of patients may have impaired oxygenation due to aspiration pneumonitis, neurogenic or cardiogenic pulmonary oedema, pneumonia, acute lung injury or ARDS.Metabolic – hyperglycaemia is a marker of the severity of SAH and is associated with a worse outcome. However, tight glycaemic control may be detrimental because of the risk of hypoglycaemia.Electrolytes – hyponatraemia may be due to administration of excessive hypotonic fluids, cerebral salt wasting syndrome, or the syndrome of inappropriate antidiuretic hormone secretion (SIADH).
Fatal serotonin syndrome: a systematic review of 56 cases in the literature
Published in Clinical Toxicology, 2021
Sanjay Prakash, Chaturbhuj Rathore, Kaushik Rana, Anurag Prakash
About 50% (n = 28) patients developed some form of cardiac complications and it was the most common reason for the fatality (Table 3). Cardiopulmonary arrest was the most common complication (20%) in this observation. The other cardiac complications were different forms of arrhythmia (18%), left ventricular dysfunction/heart failure (5%), and circulatory collapse (4%). Disseminated intravascular coagulation (DIC), multi-organ failure (MOF), and acute renal failure (ARF) were noted with equal frequency (16% each). Rhabdomyolysis was reported in 13% of cases. The respiratory complications include pulmonary edema (7%), acute respiratory distress syndrome (ARDS) (4%), and pulmonary embolism (4%). Trismus led to difficult intubations and to immediate death in three patients [10, 11, 13]. Other rare complications included hypertensive crisis, cerebral hemorrhage, cerebral infarct, cerebral edema, syndrome of inappropriate antidiuretic hormone secretion (SIADH), and limb ischemia (one patient each).
New drugs on the horizon for cerebral edema: what’s in the clinical development pipeline?
Published in Expert Opinion on Investigational Drugs, 2020
Stephanie M. Robert, Benjamin C. Reeves, Seth L. Alper, Jinwei Zhang, Kristopher T. Kahle
Arginine vasopressin (AVP), also known as antidiuretic hormone (ADH), a peptide produced in the posterior pituitary, has been implicated in intracerebral volume regulation. AVP exerts homeostatic effects via signaling through G protein-coupled receptors expressed on vasculature (V1A), the anterior pituitary gland (V1B/V3), and in renal collecting duct principal cells (V2), conferring integrated control of body fluid volume. Physiologically present in non-pathological CSF, AVP demonstrates an ability to increase brain water content [1], and plasma concentrations can be significantly increased in stroke patients [26]. Indeed, the hyponatremia characteristic of the syndrome of inappropriate antidiuretic hormone secretion (SIADH) is present in a significant proportion of TBI and SAH patients, indirectly exacerbating brain edema [27].
Orbital apex syndrome caused by Alternaria species: A novel invasive fungus and new treatment paradigm
Published in Orbit, 2020
Alina Y. Lou, Todd J. Wannemuehler, Paul T. Russell, Behin Barahimi, Rachel K. Sobel
On presentation, the patient’s best-corrected visual acuity was 20/20 in the right eye and 20/400 in the left eye. An afferent pupillary defect was present in the left eye. Intraocular pressures were 14 in both eyes. He was noted to have motility deficits in almost all ductions in the left eye, with ptosis of the left upper eyelid. The patient noted numbness over the left brow and forehead; the corneal sensation was symmetric. A CT scan showed opacification of the left ethmoid air cells with erosion of the left lamina papyracea and extension of inflammation through the medial left orbit to the orbital apex, without evidence of intracranial involvement (Figure 1). Complete blood count (CBC) showed a mild anemia with normal white blood cell count without left shift; absolute neutrophil count (ANC) was normal. Labs were otherwise notable for hyponatremia secondary to syndrome of inappropriate antidiuretic hormone secretion (SIADH). Otolaryngology (ENT) was consulted and performed bedside endoscopy, which revealed evidence of prior partial ethmoidectomy with purulent drainage along the patient’s remaining ethmoid cells. There were otherwise no abnormalities noted.