ABSTRACT
Brucella endocarditis is an underdiagnosed, fatal complication of human brucellosis. Four successfully treated cases of Brucella endocarditis are reported. The development of a new valvar lesion and bulky vegetations seen on echocardiography helped to identify Brucella endocarditis occurring during systemic brucellosis. The aortic valve was affected in all four patients, and in one the mitral valve was also affected. Medical treatment did not cure the patients and all needed valve replacement--for haemodynamic deterioration in three and because a further embolism was feared in one. Antibiotics were continued for six to nine months after operation. There was no early or late mortality and no recurrence after a follow up of 15 months.
Subject(s)
Brucellosis , Endocarditis, Bacterial/etiology , Adult , Anti-Infective Agents/therapeutic use , Brucellosis/diagnosis , Brucellosis/therapy , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/therapy , Follow-Up Studies , Heart Valve Prosthesis , Humans , Male , Middle Aged , Postoperative PeriodABSTRACT
We observed prospectively 20 consecutive patients with severe hypomagnesemia (serum Mg 0.01 to 1.2 mg/dl [0.01 to 0.5 mmol/L], mean 0.8 mg/dl [0.33 mmol/L]) before and after correction with parenteral magnesium sulfate. Only three patients, all with hypocalcemia, had tremor and muscle twitching and none showed tetany, a positive Trousseau's test, arrhythmias, or ECG abnormalities. Moreover, review of the literature on hypomagnesemia did not justify attributing these clinical symptoms to hypomagnesemia. In a follow-up study of 111 consecutive serum samples from hypocalcemic patients, 36 (32%) indicated hypomagnesemia (serum Mg no greater than 1.5 mg/dl [0.6 mmol/L]); however, hypomagnesemia had been unsuspected in all but two patients. We conclude that hypomagnesemia rarely shows specific signs or symptoms; its diagnosis depends on a high index of suspicion in patients with hypokalemia, especially after its correction, and in patients with unexplained hypocalcemia.
Subject(s)
Magnesium Deficiency/physiopathology , Adult , Arrhythmias, Cardiac/etiology , Female , Humans , Hypocalcemia/complications , Hypocalcemia/physiopathology , Intensive Care Units , Magnesium Deficiency/complications , Magnesium Deficiency/drug therapy , Magnesium Sulfate/therapeutic use , Male , Middle Aged , Prospective Studies , Tetany/etiologyABSTRACT
A 4-h infusion of 310 to 465 mg (10 to 15 mMol) phosphorus given to 28 of 31 consecutive seriously ill hypophosphatemic patients increased the serum phosphorus level above 1.2 mg/dl in all but one patient. There was no significant change in the mean serum calcium, potassium or blood pressure, no patient deteriorated, and six patients were stronger and more alert after the infusion. In seriously ill patients we recommend a 4-h infusion of 15 mg/kg (0.5 mMol/kg) phosphorus if the serum phosphorus is less than 0.5 mg/dl, or a 7.7-mg/kg (0.25 mMol/kg) infusion if the serum phosphorus is between 0.5 and 1.0 mg/dl.
