Subject(s)
Atrial Fibrillation/etiology , Cardiac Imaging Techniques , Heart Failure/etiology , Thrombosis/complications , Thrombosis/diagnostic imaging , Anticoagulants/therapeutic use , Antithrombins/therapeutic use , Female , Heparin/therapeutic use , Humans , Middle Aged , Pyrazoles/therapeutic use , Pyridones/therapeutic use , Thrombosis/therapy , Treatment OutcomeABSTRACT
CME: Ethylene Glycol Intoxication Abstract. Ethylene glycol is a sweet-tasting alcohol used in common antifreeze and other industrial solutions. Without appropriate therapy, intoxication with ethylene glycol can result in severe metabolic acidosis, acute renal failure, and in death. After gastrointestinal resorption, hepatic metabolism starts with oxidation by alcohol dehydrogenase and results in severe anion gap metabolic acidosis. Other metabolic products are calcium oxalate crystals, which can deposit in several tissues like the kidneys and lead to acute tubular necrosis with reversible renal failure. The crucial therapeutic step is rapid inhibition of alcohol dehydrogenase with fomepizole or ethanol to avoid the formation of toxic metabolites. Additionally, haemodialysis is the most effective way to eliminate ethylene glycol as well as its toxic metabolites. If therapy is initiated rapidly, prognosis is favorable.
Subject(s)
Acidosis/chemically induced , Acute Kidney Injury/chemically induced , Ethylene Glycol/poisoning , Acid-Base Equilibrium , Acidosis/mortality , Acidosis/therapy , Acute Kidney Injury/mortality , Acute Kidney Injury/therapy , Adult , Combined Modality Therapy , Critical Care/methods , Diagnosis, Differential , Early Diagnosis , Early Medical Intervention , Emergency Service, Hospital , Ethylene Glycol/pharmacokinetics , Humans , Kidney Cortex Necrosis/chemically induced , Kidney Cortex Necrosis/mortality , Kidney Cortex Necrosis/therapy , Male , Renal Dialysis , Suicide, AttemptedABSTRACT
BACKGROUND: Transfusion practice might significantly influence patient morbidity and mortality. Between European countries, transfusion practice of red blood cells (RBC) greatly differs. Only sparse data are available on transfusion practice of general internal medicine physicians in Switzerland. METHODS: In this cross-sectional survey, physicians working in general medicine teaching hospitals in Switzerland were investigated regarding their self-reported transfusion practice in anemic patients without acute bleeding. The definition of anemia, transfusion triggers, knowledge on RBC transfusion, and implementation of guidelines were assessed. RESULTS: 560 physicians of 71 hospitals (64%) responded to the survey. Anemia was defined at very diverging hemoglobin values (by 38% at a hemoglobin <130 g/L for men and by 57% at <120 g/L in non-pregnant women). 62% and 43% respectively, did not define anemia in men and in women according to the World Health Organization. Fifty percent reported not to transfuse RBC according to international guidelines. Following factors were indicated to influence the decision to transfuse: educational background of the physicians, geographical region of employment, severity of anemia, and presence of known coronary artery disease. 60% indicated that their knowledge on Transfusion-related Acute Lung Injury (TRALI) did not influence transfusion practice. 50% of physicians stated that no local transfusion guidelines exist and 84% supported the development of national recommendations on transfusion in non-acutely bleeding, anemic patients. CONCLUSION: This study highlights the lack of adherence to current transfusion guidelines in Switzerland. Identifying and subsequently correcting this deficit in knowledge translation may have a significant impact on patient care.
