Atomoxetine-induced focal seizures with contralateral hypoperfusion and hyper-CKemia.

One of the drugs used to treat attention deficit hyperactivity syndrome is atomoxetine. Usually, the drug is well tolerated but in rare cases adverse advents may occur. An 18-year-old female under atomoxetine (60 mg/d) since 2 years for attention deficit hyperactivity syndrome since age 13 years, developed sudden onset headache, hemianopia to the right, hypoesthesia of the tongue and right arm, aphasia, and depersonalisation. Blood tests revealed hyper-CK-emia of 2860U/L, cerebral magnetic resonance imaging showed disturbed perfusion on the left temporo-parieto-occipital region, and electroencephalography (EEG) revealed focal slowing and spikes and sharp waves in the same projections. After discontinuation of atomoxetine, symptoms, EEG, and magnetic resonance imaging findings resolved spontaneously within 48 hours. In conclusion, atomoxetine may rarely cause severe side effects such as complex partial seizures with CK-elevation, transient hypoperfusion of the temporal, parietal and occipital lobes, and prolonged reorientation. Atomoxetine should be discontinued if such side effects occur.

Severe Hypocalcemia and Extreme Elevation of Serum Creatinkinase in a 16-Year Old Boy with Pseudohypoparathyroidism Type Ib.

Calcium is essential for proper muscular function and metabolism. Myopathy with high creatinkinase activity can be a rare manifestation of hypocalcemia of various origin, such as vitamin D deficiency, hypoparathyroidism, pseudohypoparathyroidism (PHP). 16-year old previously healthy boy was admitted to intensive care unit with convulsions lasting for three minutes and a transient loss of consciousness. Laboratory results revealed severe hypocalcemia (total S-Ca < 1.0 mmol/L; normal 2.2-2.6 mmol/L), hyperphosphatemia (S-P 2.8 mmol/L; normal 0.6-1.6 mmol/L). Serum creatinkinase (S-CK) activity was 32 µkat/L (normal 0.57-2.45 µkat/L). Other basic biochemical parameters including creatinine, troponin, alkaline phosphatase were within normal values. Calcemia was gradually corrected within two weeks by intravenously and orally administered calcium and by cholecalciferol. S-CK reached a maximum of 222 µkat/L on day 4 and dropped to 7.2 µkat/L on day 14. Boy had no myalgias, neither clinical signs of myopathy. Echocardiography was normal with normal myocardial contractility, without any signs of calcification. The serum level of parathyroid hormone (S-PTH) was high (12 pmol/L; normal 0.7-5.5 pmol/L), fully compatible with the diagnosis of PHP. Molecular analysis revealed pseudohypoparathyroidism type Ib (PHPIb).In conclusion, manifest tetany and even mild myopathy with very high S-CK can occur in hypocalcemic patients and usually resolves after normalization of hypocalcemia.

Caso clínico: Rabdomiolisis secundaria al consumo de cocaína / Case report: Rabdomuolisis after cocaine consumption

Introducción: Las múltiples causas de Rabdomiolisis se pueden separar en 5 categorías según el mecanismo de daño del miocito: Hipóxicas, físicas, químicas, biológicas e idiopáticas. Como primera causa se describe el consumo de drogas ilícitas/alcohol, seguido por medicamentos, trauma, inmovilidad y ejercicio extenuante. Las causas químicas representan hasta el 80% de los casos de rabdomiolisis. En esta categoría se encuentran los medicamentos, alcohol y drogas donde destaca la cocaína. Se presenta el caso de un paciente masculino que cursa con insuficiencia renal aguda secundario a una rabdomiolisis por consumo de cocaína.

Introduction: The multiple causes of rhabdomyolysis can be separated into 5 categories according to the myocyte damage mechanism: hypoxic, physical, chemical and biological. However, a cause will not always be identified. The consumption of illicit drugs / alcohol has been identified as the first cause, followed by medication, trauma, immobility and extenuating exercise. The chemical causes represent up to 80% of cases of rhabdomyolysis. This category includes medications, alcohol and drugs, where cocaine stands out. Cocaine is a strong stimulant used mainly as a recreational drug that has considerably increased its consumption in the country so it should be considered. Next, we present the case of a male patient with acute renal failure secondary to rhabdomyolysis due to cocaine use. The physiopathology, diagnostic process and current management will be discussed according to the latest guidelines.

Estudio de parámetros bioquímicos en jugadores de fútbol de élite / Study of biochemical parameters in elite football players / Estudo de parÔmetros bioquímicos em jogadores de futebol de elite

El deporte exige de quienes lo practican una adaptación, entrenamiento y buen estado físico. El objetivo del trabajo fue estudiar en suero/plasma de individuos jugadores de fútbol de élite (n=32) y no entrenados (n=16), los perfiles hematológico, endocrinológico y de química clínica, relacionar los hallazgos bioquímicos con la fisiopatología deportiva y evaluar la probable implicancia clínica de los resultados. De acuerdo con los resultados obtenidos se observó disminución significativa en: hematocrito, hierro, plaquetas y bilirrubina (expansión plasmática fisiológica); magnesio (consumo enzimático); y proteínas y glucemia (incremento del metabolismo energético y recambio proteico). No se detectaron cambios significativos en el perfil endocrinológico (TSH disminuida, mayor eficacia de la hormona) y perfil lipídico (aumento de HDL y disminución de LDL; efecto protector de las lipoproteínas). Se observó un aumento significativo en: calcio (mayor disponibilidad); urea (metabolismo proteico aumentado); y aldolasa y creatinquinasa (lisis fibra muscular entrenada). Se concluye que la creatinquinasa es el marcador de pertenencia al grupo de élite; se debería implementar un valor de referencia diferente para esta población de deportistas ya que el deporte es objeto de estudio del laboratorio bioquímico; y la implementación de los conocimientos científicos en forma práctica y adecuada permite ayudar al profesional médico deportólogo a tomar decisiones oportunas y acertadas.(AU)

Sports demand from those who practice it, adaptation, training and a good physical condition. The objective of the work was to study in serum/plasma of trained people (elite football players, n=32) and untrained people (n=16) the clinical laboratory, haematological, and endocrinal profiles; 2) to relate the biochemical findings to sports physiopathology; 3) Assess the probable clinical implication of the results obtained. The results detained showe a significant decrease in hematocrit, iron, platelets and bilirrubin (physiological plasma expansion); magnesium (enzymatic consumption); proteins and glycemia (increase in energy metabolism and protein change). Without significant changes in endocrinological profile (decreased TSH, greater hormone efficiency); and lipid profile (increased HDL and decreased LDL; lipoprotein protector effect).Significant increase: calcium (more availability); urea (increased protein metabolism); and aldolase y creatinkinase (lysis of trained muscle fibre). Creatinkinase is the scoreboard of belonging to the elite group. It should be a different reference value for this group. -Thus, sport is object of study at the clinical laboratory; and implementation of the scientific knowledge in a practical and suitable manner enables the health professional to make relevant and right decisions.(AU)

O esporte exige daqueles que o praticam uma adaptaþÒo, treinamento e bom estado físico. O objetivo do trabalho foi estudar em soro/plasma de indivíduos jogadores de futebol de elite (n=32) e nÒo treinados (n=16), os perfis hematológico, endocrinológico e de química clínica, relacionar os achados bioquímicos com a fisiopatologia esportiva, e avaliar as possíveis implicaþ§es clínicas dos resultados. De acordo com os resultados obtidos se observou diminuiþÒo em hematocrito, ferro, plaquetas e bilirrubina (expansÒo do plasma fisiológico), magnésio (consumo enzimático); e proteína e glicemia (aumento do metabolismo energético e recÔmbio proteico). NÒo foram observadas alteraþ§es significativas no perfil endocrinológico (TSH diminuído, maior eficácia do horm¶nio); e perfil lipídico (aumento de HDL e diminuiþÒo de LDL; efeito protetor das lipoproteínas). Observou-se-aumento significativo em: cálcio (maior disponibilidade); ureia (metabolismo proteico aumentado); e aldolase e creatina-quinase (lise fibra muscular treinada). Conclui-se que a creatina-quinase é o marcador de pertenþa ao grupo de elite. Deveria ser implementado um valor de referÛncia diferente para esta populaþÒo de esportistas visto que o esporte é objeto de estudo do laboratório bioquímico; e a implementaþÒo dos conhecimentos científicos em forma prática e adequada permite ajudar o profissional médico esportólogo a tomar decis§es oportunas e certas.(AU)

Aumento de transaminasas: una manifestación de distrofia muscular de Duchenne / Transaminases increase: a manifestation of Duchenne's muscular dystrophy

Commonly used in clinical practice, glutamic oxalacetic (GOT) and glutamic piruvic (GPT) transaminases are produced in various body tissues, including striated muscle, so their blood elevation is not due exclusively to liver disease. The objective of this study is to demonstrate the correlation between elevated creatinkinase (CK) and transaminases in patients with diagnosis of Duchenne muscular dystrophy (DMD), the most frequent neuromuscular disease in children. Patients and Method: Assessment in 61 children with diagnosis of DMD of CK, AST and ALT levels, and their correlation. Results: Aill patients had increase of CK ( = 13.363 IU/L), AST ( = 203 lU/L) and ALT ( = 194 IU/L) above normal values. The increase of transaminases related directly with the increase of CK. Conclusion: Patients with DMD have increased transaminases, so it is necessary to include this diagnostic possibility in a child with hypertransaminemia, prior to performing liver biopsy.

Las transaminasas que comúnmente se utilizan en clínica, glutámico oxalacética (GOT) y glutámico pirúvica (GPT) son producidas en varios tejidos del organismo entre los cuales se cuenta el músculo estriado, por lo que la elevación de transaminasas en sangre no es producida exclusivamente por enfermedades hepáticas. Objetivo: Demostrar la correlación entre el alza de la creatinkinasa (CK) y transaminasas en pacientes con el diagnóstico de distrofia muscular de Duchenne (DMD), la enfermedad neuromuscular más frecuente en niños. Pacientes y Método: Evaluación en 61 niños con diagnóstico de DMD de los niveles de CK, GOT y GPT y la relación entre ellos. Resultados: Todos los pacientes presentaron aumento de CK ( = 13.363 IU/L), GOT ( = 203 IU/L) y GPT ( = 194 IU/L) sobre los valores normales. El aumento de transaminasas se relacionó en forma directa con aumento de CK. Conclusiones: Los pacientes con DMD presentan transaminasas aumentadas, por lo que es necesario incluir esta posibilidad diagnóstica en niños con hipertransaminasemia, previo a realizar biopsia hepática.