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Signa Vitae

A Journal In Intensive Care And Emergency Medicine

Month: June 2014 (Page 1 of 4)

Liver injury after the intravenous amiodarone administration in patient with impaired heart function

Abstract

While many adverse effects have been associated with long-term oral amiodarone therapy, acute hepatotoxicity from intravenous administration of amiodarone is a rare side effect. This case report focuses on a 78-year-old critically ill female, who underwent several urgent surgical procedures and had elevated liver aminotransferases concentrations after the intravenous administration of amiodarone for the treatment of atrial fibrillation. Also, the patient developed heart failure with reduced left ventricular systolic function. Immediately after the discontinuation of amiodarone therapy, liver aminotransferases levels began to decline. Our case suggests that regular monitoring of hepatic function is required in patients receiving intravenous amiodarone, especially in the setting of impaired heart function and possible liver hypoperfusion.

Key words: amiodarone, hepatotoxicity, heart failure.

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Neuroleptic malignant syndrome: a case report and discussion

Abstract

Neuroleptic malignant syndrome (NMS) is an emergent, life threatening condition most often seen as an iatrogenic complication of neuroleptic or antipsychotic treatment. It is characterized by a tetrad of clinical features: mental status changes, fever, muscle rigidity and autonomic instability, although it is not necessary for all of them to be present at a same time for working diagnosis to be made. This paper will deal with the case of a 29-year old male patient diagnosed with schizophrenia who developed NMS, presented as a generalized tonic-clonic seizure and high fever, after 191 days of in-hospital treatment. After 13 days of hospital treatment in the Intensive Care Unit of Clinical Hospital Dubrava, the patient is in a hemodynamical and proper quantitative mental state and discharged for further psychiatric treatment at his parent hospital institution.

Key words: neuroleptic malignant syndrome, neuroleptics, creatine kinase

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Incessant ventricular tachycardia as a manifestation of septic cardiomyopathy – case report

Abstract

Incessant ventricular tachycardia is defined as frequent, repetitive and persistent ventricular arrhythmia or appropriate activation of an implantable cardioverter-defibrillator when present, which occurs more than three times within 24 hours and is ultimately followed by hemodynamic collapse. It is usually associated with structural heart disease ischaemia and often has a poor prognosis. The treatment strategy involves defining the aetiology through a targeted medical history and a physical examination (toxins, drugs, etc.), a 12-lead ECG, laboratory tests (electrolytes, etc.) and the detection of ischaemia. This report presents a case of young puerpera with peripartal sepsis, with no evidence of peripartal cardiomyopathy or ischaemia, which manifested itself initially with an arrhythmic cardiac arrest and a sequentially lethal outcome after a prolonged resuscitation procedure.

Keywords: peripartal sepsis, septic shock, septic cardiomyopathy, electrical storm, ventricular tachycardia

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Idiopathic hypoparathyreoidism, reversible cardiomyopathy and nephrogenic diabetes insipidus – case report

Abstract

We are presenting a case of a 36-year-old patient with idiopathic hypoparathyroidism and reversible dilated cardiomyopathy as a result of hypocalcaemia. Twelve years later, the patient presented a picture of nephrogenic diabetes insipidus, which according to available literature has so far not yet been described.

Key words: hypoparathyreoidism, cardiomyopathy, nephrogenic diabetes insipidus

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Renal denervation in patients with resistant hypertension-beyond blood pressure reduction

Abstract

Renal sympathetic denervation (RDN) has been demonstrated as an antihypertensive treatment in resistant hypertension patients, and triggers additional positive effects on glucose metabolism and insulin sensitivity in type 2 diabetes. The clinical implications of RDN in patients with type 2 diabetes, diabetic nephropathy and resistant hypertension have not yet been fully defined.
We hypothesized that the small antihypertensive effects of RDN treatment will induce additional benefits on renal function in CKD patients with type 2 diabetes and resistant hypertension.
We report the effects of RDN in two patients with type 2 diabetes, diabetic nephropathy, stage 3 chronic kidney disease and resistant hypertension. The blood pressure (BP) reduction after RDN was an 8-9% reduction of ABPM (sustained at consecutive follow-up visits at 3 and 6 months when compared to the baseline) and restoration of the night time dipping pattern was associated with amelioration of albuminuria (UAR).
As proteinuria may accelerate kidney disease progression to end-stage renal failure, recognition of the antiproteinuric treatment is essential for providing renoprotection.  Therefore, randomized clinical trials are required to assess the impact of reported changes.

Key words: resistant hypertension, renal denervation

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