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Anesthesia and Analgesia for Donkeys, Mules and Foals
Published in Michele Barletta, Jane Quandt, Rachel Reed, Equine Anesthesia and Pain Management, 2023
Tomas Williams, Michele Barletta
Increases in hematocrit only occur when donkeys are at least 30% dehydrated. Assessing mild to moderate dehydration by hemoconcentration is difficult and inaccurate. Clinical signs and laboratory values should be considered before general anesthesia.
Severe Influenza Pneumonia and Its Mimics in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
In the prodromal phase of hantavirus infection, the typical findings are fever, myalgias, tachypnea, and tachycardia. Most patients within 24 hours of initial evaluation progress to non-cardiogenic pulmonary edema require mechanical ventilation. Coryza and dry cough are absent. The white blood cell count tends to be raised, with a left-shifted neutrophilia, along with myeloid precursors and atypical lymphocytes. Hematocrit is usually elevated due to hemoconcentration. An initial chest radiograph is usually positive for interstitial and/or alveolar infiltrates with pleural effusions [41].
Medications That May Be Useful in the Management of Patients with Chronic Intractable Pain
Published in Michael S. Margoles, Richard Weiner, Chronic PAIN, 2019
Lethargy and decreased sensation of thirst due to central inhibition may lead to dehydration, hemoconcentration, and reduced pulmonary ventilation. If the above signs appear, especially in the elderly, remedial therapy should be instituted promptly. Use with caution in respiratory impairment due to acute pulmonary infections or chronic respiratory disorders.
An unusual case of severe hypercalcemia: as dehydrated as a bone
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Roshan Acharya, Dylan M Winters, Cameron Rowe, Nathan Buckley, Smita Kafle, Bhaskar Chhetri
In the emergency department, the rectal temperature was 37°Celsius, heart rate was 71 bpm, blood pressure was 181/75 mmHg, respiratory rate was 17 per min, and oxygen saturation was 99% on room air. On the physical examination the patient was lethargic, with Glasgow Coma Scale 13/15. The mucus membranes were extremely dry. The abdomen was soft, nontender, and no ascites were present. Deep tendon reflexes were 2+ bilaterally. She was oriented to self only. The lab work revealed hemoglobin 11.1 gm/dL, platelet count 128 x103/µL, serum sodium of 144 mmol/L, potassium 2.7 mmol/L, magnesium 1.1 mg/dL, blood urea nitrogen (BUN) of 23 mg/dL, creatinine 2.04 mg/dL, calcium 18.0 mg/dL with corrected calcium level of 19.0 mg/dL, serum albumin 3.2 g/dL, lactate 1.3 mmol/L, and ammonia 31 µg/dL. The comparison of the blood work from a week ago suggested hemoconcentration with acute kidney injury (Table 1). The Electrocardiogram demonstrated sinus rhythm, left axis deviation without ST-segment changes. Chest X-ray did not reveal perihilar lymphadenopathy, acute infiltrates, or effusion. CAT scan of the head without contrast demonstrated no evidence of intracranial pathology or mass. The patient was given 2-g intravenous magnesium sulfate, 80 mEq oral potassium, and 10 mg intravenous potassium chloride, and 200 units intramuscular calcitonin. The patient was admitted to the telemetry floor where she was started on normal saline infusion at the rate of 125 mL/hr.
Mirror Syndrome with Severe Postpartum Presentation following Stillbirth and Shoulder Dystocia
Published in Fetal and Pediatric Pathology, 2020
Pawel Bartnik, Joanna Kacperczyk-Bartnik, Aneta Malinowska-Polubiec, Ewa Romejko-Wolniewicz
Mirror syndrome (MS) is a condition occurring in pregnancy, characterized by a “triple edema”—a sequence of fetal, placental, and consequently maternal edema [1]. The most common clinical causes include rhesus immunization, viral infections, twin-to-twin transfusion syndrome, congenital heart defects and fetal tumors [2]. The direct, molecular-level cause of MS is unknown, however one hypothesis suspects “trophoblastic debris” released from placenta [3]. Symptoms are similar to pre-eclampsia, but hemodilution occurs instead of hemoconcentration [4]. Acute kidney injury (AKI) occurs in up to 25% of patients with MS [1]. There are multiple cases presented in the literature in which the reversal of fetal hydrops led to the resolution of maternal signs [5–8]. In some cases, especially those including congenital anomalies, the causative treatment is not yet available. In those situations delivery usually resolves the problem in a matter a few days [1]. Braun et al. analyzed in 2010 that in only 4 of 56 reviewed cases the MS was diagnosed postpartum [1]. In all of these patients however, maternal signs were present before birth [9,10]. The most recent review, published in 2017, analyzed a total of 74 clear cases [2]. In none of the reported cases was the development of MS associated with complicated delivery [1,2].
Oligosypthomatic ovarian hyperstimulation syndrome in a spontaneous uneventful pregnancy. A case report
Published in Gynecological Endocrinology, 2019
Elena Morotti, Cesare Battaglia
Blood investigation of white blood cell count, platelet count, coagulation profile, liver enzymes, serum creatinine, circulating proteins, and electrolytes were normal. Furthermore, rather than hemoconcentration, a slight hemodilution was observed (hemoglobin 10.8 g/dL, hematocrit 31.8%). A modest increase of d-dimer (1.08 mg/L normal range: <0.55 mg/L) was observed. Estradiol (17 015 pg/mL normal range: 2500–12,000 pg/mL), Testosterone (1.45 ng/mL normal range: <0.75 ng/mL) and androstenedione (737 ng/mL normal range: <340) were elevated. β‐hCG values were elevated (185,425 UI/L normal range: 27,832–210,612 UI/L) but comprised in the normal range. Thyroid profile was normal.