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1.
Tijdschr Psychiatr ; 60(8): 552-556, 2018.
Article in Dutch | MEDLINE | ID: mdl-30132585

ABSTRACT

An important cause of hypertriglyceridemia in psychiatric patients is the administration of antipsychotics. Mildly elevated levels of triglycerides are seen most often, occurring shortly after treatment inception. Whether hypertriglyceridemia may be caused by alcohol use has not been fully elucidated. We describe the case of a 38-year-old woman suffering from schizophrenia who had been prescribed quetiapine for five years and consumed two glasses of alcohol daily. Upon presentation with stomach pain, lab results showed alarming triglyceride levels (8348 mg/dl). She rapidly developed both a severe pancreatitis and thrombotic thrombocytopenic purpura (ttp). We discuss how this most severe case of pancreatitis and ttp in a patient on an antipsychotic described in the literature to date should encourage prevention and early management of hypertriglyceridemia in psychiatric patients.


Subject(s)
Antipsychotic Agents/adverse effects , Hypertriglyceridemia/chemically induced , Pancreatitis/diagnosis , Purpura, Thrombotic Thrombocytopenic/diagnosis , Quetiapine Fumarate/adverse effects , Adult , Antipsychotic Agents/therapeutic use , Female , Humans , Hypertriglyceridemia/complications , Pancreatitis/etiology , Purpura, Thrombotic Thrombocytopenic/etiology , Quetiapine Fumarate/therapeutic use , Schizophrenia/drug therapy
2.
Minerva Anestesiol ; 80(12): 1294-301, 2014 Dec.
Article in English | MEDLINE | ID: mdl-24705004

ABSTRACT

BACKGROUND: Nexfin® (BMEYE, Amsterdam, The Netherlands) is a totally non-invasive blood pressure and cardiac output (CO) monitor based on finger arterial pulse contour analysis. METHODS: We performed an open observational study in a mix of medical-surgical-burns critically ill patients (N.=45) to validate Nexfin obtained blood pressures (MAPnex) against PiCCO (MAPfem) derived blood pressure measurements. MAPnex, MAPfem and corresponding systolic (SBP) and diastolic (DBP) blood pressures were measured continuously and registered with a 2 hour interval during the 8-hour study period. Statistical analysis was performed by Pearson regression, Bland and Altman, Concordance plot and Polar plot analysis. RESULTS: MAPnex shows excellent correlation with MAPfem (R² 0.88, mean bias ± LA -2.3±12.4 mmHg, 14.7% error) and may be used interchangeably with invasive monitoring. The excellent MAPnex -MAPfem correlation was preserved in subgroup analysis for patients with severe hypotension, high systemic vascular resistance, low CO, hypothermia and in patients supported by inotropic/vasopressive agents. MAPnex is able to follow changes in MAPfem during the same time interval (level of concordance 85.5%). Nexfin SBP and DBP show significant correlation with PiCCO but the criteria for interchangeability were not met. Finally, polar plot analysis showed that trending capabilities were excellent when changes in MAPnex (ΔMAPnex) were compared to ΔMAPfem (96.1% of changes were within the level of 10% limits of agreement). CONCLUSION: In this sample of critically ill patients we found a good correlation between MAPnex and invasive blood pressures obtained by PiCCO.


Subject(s)
Blood Pressure Determination/instrumentation , Blood Pressure/physiology , Critical Illness , Monitoring, Physiologic/instrumentation , Adult , Aged , Arterial Pressure , Cardiac Output , Female , Humans , Male , Middle Aged
3.
Acta Clin Belg ; 65(2): 98-106, 2010.
Article in English | MEDLINE | ID: mdl-20491359

ABSTRACT

INTRODUCTION: Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) have been identified as a cause of organ dysfunction and mortality in critically ill patients. The diagnosis of IAH/ACS depends on accurate intra-abdominal pressure (IAP) measurement, which is usually performed via the bladder or the stomach.The aim of this study was to describe cases where intragastric pressure (IGP) and intrabladder pressure (IBP) were measured simultaneously. PATIENTS AND METHODS: After review of medical records, four patients admitted to our ICU department where both IGP and IBP were measured, could be identified. IGP was measured using the Spiegelberg catheter and IBP was measured using the FoleyManometer LV. In all patients, the bladder-over-gastric pressure ratio (B/G ratio) was calculated. RESULTS: In two of four patients, IGP and IBP differed significantly. In one patient the B/G ratio was lower than 1 suggesting a diagnosis of epigastric ACS and in one patient B/G ratio was greater than 1 leading to a diagnosis of pelvic ACS. The latter patient was spared a decompressive laparotomy due to the additional IGP measurement and the subsequent diagnosis of localized ACS. CONCLUSION: The preferred methods for IAP measurement are via the bladder and via the stomach. In some patients, IGP and IBP may differ significantly and this may have clinical implications. Clinicians should be aware of the possibility of localized ACS. In order to identify risk factors and to recommend treatment for localized ACS, further study of simultaneous IGP and IBP measurements are needed.


Subject(s)
Compartment Syndromes/diagnosis , Compartment Syndromes/physiopathology , Manometry , Stomach , Urinary Bladder , Aged , Aged, 80 and over , Catheterization , Compartment Syndromes/etiology , Female , Humans , Male , Middle Aged , Pressure , Transducers, Pressure
4.
Neurology ; 64(8): 1348-53, 2005 Apr 26.
Article in English | MEDLINE | ID: mdl-15851721

ABSTRACT

OBJECTIVE: To investigate the effectiveness of maintaining blood glucose levels below 6.1 mmol/L with insulin as prevention of secondary injury to the central and peripheral nervous systems of intensive care patients. METHODS: The authors studied the effect of intensive insulin therapy on critical illness polyneuropathy (CIPNP), assessed by weekly EMG screening, and its impact on mechanical ventilation dependency, as a prospectively planned subanalysis of a large randomized, controlled trial of 1,548 intensive care patients. In the 63 patients admitted with isolated brain injury, the authors studied the impact of insulin therapy on intracranial pressure, diabetes insipidus, seizures, and long-term rehabilitation at 6 and 12 months follow-up. RESULTS: Intensive insulin therapy reduced ventilation dependency (p = 0.0007; Mantel-Cox log rank test) and the risk of CIPNP (p < 0.0001). The risk of CIPNP among the 405 long-stay (> or =7 days in intensive care unit) patients was lowered by 49% (p < 0.0001). Of all metabolic and clinical effects of insulin therapy, and corrected for known risk factors, the level of glycemic control independently explained this benefit (OR for CIPNP 1.26 [1.09 to 1.46] per mmol blood glucose, p = 0.002). In turn, prevention of CIPNP explained the ability of intensive insulin therapy to reduce the risk of prolonged mechanical ventilation (OR 3.75 [1.49 to 9.39], p = 0.005). In isolated brain injury patients, intensive insulin therapy reduced mean (p = 0.003) and maximal (p < 0.0001) intracranial pressure while identical cerebral perfusion pressures were obtained with eightfold less vasopressors (p = 0.01). Seizures (p < 0.0001) and diabetes insipidus (p = 0.06) occurred less frequently. At 12 months follow-up, more brain-injured survivors in the intensive insulin group were able to care for most of their own needs (p = 0.05). CONCLUSIONS: Preventing even moderate hyperglycemia with insulin during intensive care protected the central and peripheral nervous systems, with clinical consequences such as shortening of intensive care dependency and possibly better long-term rehabilitation.


Subject(s)
Brain Damage, Chronic/complications , Hyperglycemia/complications , Insulin/therapeutic use , Polyneuropathies/drug therapy , Adult , Aged , Brain/drug effects , Brain/metabolism , Brain/physiopathology , Brain Damage, Chronic/metabolism , Brain Damage, Chronic/physiopathology , Brain Diseases, Metabolic/metabolism , Brain Diseases, Metabolic/physiopathology , Brain Diseases, Metabolic/therapy , Brain Ischemia/complications , Critical Illness , Female , Humans , Hyperglycemia/drug therapy , Hyperglycemia/prevention & control , Hypoglycemic Agents/pharmacology , Hypoglycemic Agents/therapeutic use , Insulin/pharmacology , Intensive Care Units/standards , Intracranial Hemorrhages/complications , Intracranial Hypertension/drug therapy , Intracranial Hypertension/metabolism , Intracranial Hypertension/physiopathology , Male , Middle Aged , Peripheral Nerves/drug effects , Peripheral Nerves/metabolism , Peripheral Nerves/physiopathology , Polyneuropathies/metabolism , Polyneuropathies/physiopathology , Prospective Studies , Stroke/complications , Treatment Outcome
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