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[PMID]:29182003
[Au] Autor:Stedman T; Chew P; Truran P; Lim CB; Balasubramanian SP
[Ad] Endereço:Sheffield Teaching Hospitals NHS Foundation Trust , UK.
[Ti] Título:Modification, validation and implementation of a protocol for post-thyroidectomy hypocalcaemia.
[So] Source:Ann R Coll Surg Engl;100(2):135-139, 2018 Feb.
[Is] ISSN:1478-7083
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Introduction The management of post-thyroidectomy hypocalcaemia should facilitate early discharge, and reduce risks of hypocalcaemia, readmission and treatment related hypercalcaemia. This paper describes the implementation, evaluation and revision a protocol for the optimal management of this condition. Methods Day 1 parathyroid hormone (PTH) measurements in addition to calcium measurements were commenced following review of the unit's outcomes and literature on post-thyroidectomy hypocalcaemia. Outcomes from a three-year cohort of patients undergoing thyroid surgery helped amend this protocol (revision 1) to reduce biochemical tests, stipulate the need, nature and dose of vitamin D/calcium supplements, and encourage early discharge. This was further validated over seven months to assess compliance, episodes of hyper and/or hypocalcaemia after discharge, readmissions and need for treatment changes. Further revisions were made (revision 2) and implemented. Results The temporary and long-term postoperative hypocalcaemia rates were 29.1% and 3.2% respectively. Repeat calcium measurements on the first day altered management in only 1.4% of cases. The revised protocol was adhered to in 90% of cases. One patient had hypocalcaemia (due to non-compliance) and one had hypercalcaemia. Revision 2 involved reducing the dose of calcium. Conclusions This is a good example of a unit protocol for post-thyroidectomy hypocalcaemia being developed and modified on the basis of the literature and local experience. Day 1 PTH and calcium levels determine the need for treatment and frequency of follow-up visits, facilitate early discharge, reduce risk of over and/or undertreatment, and are good indicators of permanent hypocalcaemia.
[Mh] Termos MeSH primário: Hipocalcemia
Complicações Pós-Operatórias
Tireoidectomia/efeitos adversos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Feminino
Seres Humanos
Hipocalcemia/diagnóstico
Hipocalcemia/tratamento farmacológico
Hipocalcemia/epidemiologia
Hipocalcemia/prevenção & controle
Masculino
Meia-Idade
Hormônio Paratireóideo/sangue
Complicações Pós-Operatórias/diagnóstico
Complicações Pós-Operatórias/tratamento farmacológico
Complicações Pós-Operatórias/epidemiologia
Complicações Pós-Operatórias/prevenção & controle
Guias de Prática Clínica como Assunto
Estudos Retrospectivos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Parathyroid Hormone)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180209
[Lr] Data última revisão:
180209
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171129
[St] Status:MEDLINE
[do] DOI:10.1308/rcsann.2017.0194


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[PMID]:28448680
[Au] Autor:Wither RG; Borlot F; MacDonald A; Butcher NJ; Chow EWC; Bassett AS; Andrade DM
[Ad] Endereço:Division of Neurology, Department of Medicine, Toronto Western Hospital, Krembil Neuroscience Centre, University of Toronto, Toronto, Ontario, Canada.
[Ti] Título:22q11.2 deletion syndrome lowers seizure threshold in adult patients without epilepsy.
[So] Source:Epilepsia;58(6):1095-1101, 2017 06.
[Is] ISSN:1528-1167
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Previous studies examining seizures in patients with 22q11.2 deletion syndrome (22q11.2DS) have focused primarily on children and adolescents. In this study we investigated the prevalence and characteristics of seizures and epilepsy in an adult 22q11.2DS population. METHODS: The medical records of 202 adult patients with 22q11.2DS were retrospectively reviewed for documentation of seizures, electroencephalography (EEG) reports, and magnetic resonance imaging (MRI) findings. Epilepsy status was assigned in accordance with 2010 International League Against Epilepsy Classification. RESULTS: Of 202 patients, 32 (15.8%) had a documented history of seizure. Of these 32, 23 (71.8%) had acute symptomatic seizures, usually associated with hypocalcemia and/or antipsychotic or antidepressant use. Nine patients (9/32, 28%; 9/202, 4%) met diagnostic criteria for epilepsy. Two patients had genetic generalized epilepsy; two patients had focal seizures of unknown etiology; two had epilepsy due to malformations of cortical development; in two the epilepsy was due to acquired structural changes; and in one patient the epilepsy could not be further classified. SIGNIFICANCE: Similarly to children, the prevalence of epilepsy and acute symptomatic seizures in adults with 22q11.2DS is higher than in the general population. Hypocalcemia continues to be a risk factor for adults, but differently from kids, the main cause of seizures in adults with 22q11.2DS is exposure to antipsychotics and antidepressants. Further prospective studies are warranted to investigate how 22q11.2 microdeletion leads to an overall decreased seizure threshold.
[Mh] Termos MeSH primário: Anormalidades Múltiplas/genética
Anormalidades Múltiplas/fisiopatologia
Síndrome de DiGeorge/genética
Síndrome de DiGeorge/fisiopatologia
Eletroencefalografia
Epilepsia/genética
Epilepsia/fisiopatologia
Convulsões/genética
Convulsões/fisiopatologia
Processamento de Sinais Assistido por Computador
[Mh] Termos MeSH secundário: Anormalidades Múltiplas/diagnóstico
Adolescente
Adulto
Idade de Início
Deleção Cromossômica
Cromossomos Humanos Par 22/genética
Estudos Transversais
Síndrome de DiGeorge/diagnóstico
Epilepsia/diagnóstico
Feminino
Seres Humanos
Hipocalcemia/complicações
Hipocalcemia/fisiopatologia
Imagem por Ressonância Magnética
Masculino
Meia-Idade
Estudos Retrospectivos
Fatores de Risco
Convulsões/diagnóstico
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1707
[Cu] Atualização por classe:180107
[Lr] Data última revisão:
180107
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170428
[St] Status:MEDLINE
[do] DOI:10.1111/epi.13748


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[PMID]:29231762
[Au] Autor:Balaet C; Coculescu BI; Balaet M; Manole G; Dinca GV
[Ad] Endereço:a Faculty of General Nursing , Bioterra University , Bucharest , Romania.
[Ti] Título:Haemolytic anaemia and hepatocitolysis associated with hypermagnesaemia by repeated exposures to copper-calcium fungicides.
[So] Source:J Enzyme Inhib Med Chem;33(1):184-189, 2018 Dec.
[Is] ISSN:1475-6374
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:For the medical practice, our manuscript acts as a signal, despite only presenting three cases which feature the association between hepatocytolysis, haemolysis and hypermagnesaemia. This clinical-biologic triad was highlighted with the workers who through the nature of their profession were exposing themselves periodically to vapours which contained copper sulphate neutralised with calcium hydroxide, a fungicide used for fruit trees. We are exclusively assessing the haematological perturbation. In this aetiological context, the generating mechanism for haemolysis is very probable biochemical, where hypercupraemia interferes with cellular antioxidant defence mechanisms. Hypothetically, the role of the redox homeostasis disorder in the intravascular destruction of erythrocytes is sustained, and particularly the coexistence of cell cytolysis in the medullary erythroid compartment, which can be assimilated with a possible ineffective erythropoiesis.
[Mh] Termos MeSH primário: Anemia Hemolítica/induzido quimicamente
Hidróxido de Cálcio/efeitos adversos
Sulfato de Cobre/efeitos adversos
Fungicidas Industriais/efeitos adversos
Hipocalcemia/induzido quimicamente
Fígado/efeitos dos fármacos
[Mh] Termos MeSH secundário: Adulto
Anemia Hemolítica/complicações
Hidróxido de Cálcio/administração & dosagem
Hidróxido de Cálcio/química
Sulfato de Cobre/administração & dosagem
Sulfato de Cobre/química
Eritropoese/efeitos dos fármacos
Fungicidas Industriais/administração & dosagem
Fungicidas Industriais/química
Seres Humanos
Hipocalcemia/complicações
Fígado/metabolismo
Masculino
Meia-Idade
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Fungicides, Industrial); LRX7AJ16DT (Copper Sulfate); PF5DZW74VN (Calcium Hydroxide)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171221
[Lr] Data última revisão:
171221
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171213
[St] Status:MEDLINE
[do] DOI:10.1080/14756366.2017.1409745


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[PMID]:28877925
[Au] Autor:Kaderli RM; Riss P; Dunkler D; Pietschmann P; Selberherr A; Scheuba C; Niederle B
[Ad] Endereço:Section of Endocrine SurgeryDivision of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria reto.kaderli@insel.ch.
[Ti] Título:The impact of vitamin D status on hungry bone syndrome after surgery for primary hyperparathyroidism.
[So] Source:Eur J Endocrinol;178(1):1-9, 2018 Jan.
[Is] ISSN:1479-683X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Prolonged hypocalcemia but normal intact parathyroid hormone (iPTH) levels after surgery for primary hyperparathyroidism (PHPT) are referred to as 'hungry bone syndrome' (HBS). The aim was to evaluate preoperative risk factors for HBS with a focus on the impact of 25-hydroxyvitamin D (25(OH)D) deficiency. DESIGN: Patients having undergone initial successful surgery for sporadic PHPT within 6 years were considered for retrospective analysis. METHODS: A total of 385 patients were evaluated, of whom 33 (8.6%) developed HBS influencing negatively the postoperative bone metabolism. All patients underwent biochemical evaluations two days before parathyroid surgery and were followed biochemically on a daily basis in the first postoperative week and thereafter at 8 weeks and 6 months. CONCLUSIONS: No relationship was established between preoperative 25(OH)D deficiency and HBS. The only significant risk factor for HBS in multivariable analysis was high levels of preoperative iPTH. As HBS therefore cannot be predicted preoperatively, we recommend a consistent postoperative calcium and vitamin D supplementation to improve the bone metabolism.
[Mh] Termos MeSH primário: Hiperparatireoidismo Primário/sangue
Hiperparatireoidismo Primário/cirurgia
Hipocalcemia/sangue
Complicações Pós-Operatórias/sangue
Deficiência de Vitamina D/sangue
[Mh] Termos MeSH secundário: Idoso
Biomarcadores/sangue
Feminino
Seres Humanos
Hiperparatireoidismo Primário/diagnóstico
Hipocalcemia/diagnóstico
Masculino
Meia-Idade
Hormônio Paratireóideo/sangue
Complicações Pós-Operatórias/diagnóstico
Estudos Prospectivos
Estudos Retrospectivos
Vitamina D/sangue
Deficiência de Vitamina D/diagnóstico
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Biomarkers); 0 (Parathyroid Hormone); 1406-16-2 (Vitamin D)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171128
[Lr] Data última revisão:
171128
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170908
[St] Status:MEDLINE
[do] DOI:10.1530/EJE-17-0416


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[PMID]:28953654
[Au] Autor:Nomoto H; Miyoshi H; Nakamura A; Nagai S; Kitao N; Shimizu C; Atsumi T
[Ad] Endereço:aDepartment of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University bDivision of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan.
[Ti] Título:A case of osteomalacia due to deranged mineral balance caused by saccharated ferric oxide and short-bowel syndrome: A case report.
[So] Source:Medicine (Baltimore);96(39):e8147, 2017 Sep.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Saccharated ferric oxide has been shown to lead to elevation of fibroblast growth factor 23, hypophosphatemia, and, consequently, osteomalacia. Moreover, mineral imbalance is often observed in patients with short-bowel syndrome to some degree. PATIENT CONCERNS: A 62-year-old woman with short-bowel syndrome related with multiple resections of small intestines due to Crohn disease received regular intravenous administration of saccharated ferric oxide. Over the course of treatment, she was diagnosed with tetany, which was attributed to hypocalcemia. Additional assessments of the patient revealed not only hypocalcemia, but also hypophosphatemia, hypomagnesemia, osteomalacia, and a high concentration of fibroblast growth factor 23 (314 pg/mL). DIAGNOSES: We diagnosed her with mineral imbalance-induced osteomalacia due to saccharated ferric oxide and short-bowel syndrome. INTERVENTIONS: Magnesium replacement therapy and discontinuation of saccharated ferric oxide alone. OUTCOMES: These treatments were able to normalize her serum mineral levels and increase her bone mineral density. LESSONS: This case suggests that adequate evaluation of serum minerals, including phosphate and magnesium, during saccharated ferric oxide administration may be necessary, especially in patients with short-bowel syndrome.
[Mh] Termos MeSH primário: Densidade Óssea/efeitos dos fármacos
Compostos Férricos/efeitos adversos
Ácido Glucárico/efeitos adversos
Magnésio/administração & dosagem
Osteomalacia
Síndrome do Intestino Curto
[Mh] Termos MeSH secundário: Feminino
Compostos Férricos/administração & dosagem
Fatores de Crescimento de Fibroblastos/sangue
Ácido Glucárico/administração & dosagem
Hematínicos/administração & dosagem
Hematínicos/efeitos adversos
Seres Humanos
Hipocalcemia/diagnóstico
Hipocalcemia/etiologia
Hipofosfatemia/diagnóstico
Hipofosfatemia/etiologia
Deficiência de Magnésio/diagnóstico
Deficiência de Magnésio/etiologia
Meia-Idade
Osteomalacia/diagnóstico
Osteomalacia/etiologia
Síndrome do Intestino Curto/complicações
Síndrome do Intestino Curto/tratamento farmacológico
Síndrome do Intestino Curto/metabolismo
Resultado do Tratamento
Suspensão de Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Ferric Compounds); 0 (Hematinics); 0 (fibroblast growth factor 23); 62031-54-3 (Fibroblast Growth Factors); FZ7NYF5N8L (ferric oxide, saccharated); I38ZP9992A (Magnesium); QLZ991V4A2 (Glucaric Acid)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171016
[Lr] Data última revisão:
171016
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170928
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008147


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[PMID]:28874217
[Au] Autor:Erlem M; Klopp-Dutote N; Biet-Hornstein A; Strunski V; Page C
[Ad] Endereço:Department of ENT and Head and Neck Surgery,University Hospital,Amiens,France.
[Ti] Título:Impact of pre-operative serum 25-hydroxyvitamin D on post-operative serum calcium in patients undergoing total thyroidectomy for benign goitre: retrospective study of 246 patients.
[So] Source:J Laryngol Otol;131(10):925-929, 2017 Oct.
[Is] ISSN:1748-5460
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To determine whether pre-operative serum 25-hydroxyvitamin D has an impact on post-operative parathyroid hormone and serum calcium levels in patients undergoing total thyroidectomy for benign goitre. METHODS: This single-centre, retrospective study comprised 246 unselected surgical patients who had undergone total thyroidectomy for bilateral, benign, multinodular goitre. The correlation between pre-operative serum 25-hydroxyvitamin D and post-operative serum parathyroid hormone and serum calcium was studied to determine whether low pre-operative serum 25-hydroxyvitamin D was predictive of post-operative hypocalcaemia. RESULTS: Seventy-nine patients (32 per cent) had post-operative hypocalcaemia. Eighteen patients (7.32 per cent) experienced unintentional parathyroidectomy (1 parathyroid gland in 15 patients, 2 parathyroid glands in 3 patients). In univariate analysis, pre-operative serum 25-hydroxyvitamin D was not correlated with post-operative serum calcium (p = 0.69) or post-operative serum parathyroid hormone (p = 0.5804). Furthermore, in multivariate analysis, which took into account unintentional parathyroidectomy, no correlation was found (p = 0.33). Bilateral unintentional parathyroidectomy was statistically associated with post-operative hypocalcaemia (p = 0.032). CONCLUSION: Pre-operative serum 25-hydroxyvitamin D did not appear to have any impact on post-operative serum calcium in patients undergoing total thyroidectomy for benign goitre.
[Mh] Termos MeSH primário: Cálcio/sangue
Bócio Nodular/cirurgia
Hipocalcemia/sangue
Vitamina D/análogos & derivados
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Feminino
Bócio Nodular/sangue
Seres Humanos
Masculino
Meia-Idade
Paratireoidectomia/métodos
Estudos Retrospectivos
Tireoidectomia/métodos
Resultado do Tratamento
Vitamina D/sangue
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
1406-16-2 (Vitamin D); 64719-49-9 (25-hydroxyvitamin D); SY7Q814VUP (Calcium)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171010
[Lr] Data última revisão:
171010
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170907
[St] Status:MEDLINE
[do] DOI:10.1017/S0022215117001797


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[PMID]:28806048
[Au] Autor:Barstow C
[Ad] Endereço:Womack Army Medical Center, 2817 Reilly Road, Fort Bragg, NC 28310.
[Ti] Título:Electrolytes: Calcium Disorders.
[So] Source:FP Essent;459:29-34, 2017 Aug.
[Is] ISSN:2159-3000
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:A normal serum calcium level is 8 to 10 mg/dL. The diagnosis of hypercalcemia (ie, levels 10.5 mg/dL or greater) should be confirmed with an albumin-adjusted or ionized calcium level. The two most common causes of hypercalcemia are hyperparathyroidism and malignancy. Drugs, notably lithium and thiazide diuretics, also can cause hypercalcemia. Patients with severe or symptomatic hypercalcemia should be treated initially with hydration to decrease calcium levels. The evaluation should include a parathyroid hormone (PTH) level. If the PTH level is low, cancer is a likely cause, particularly multiple myeloma, breast cancer, or lymphoma. If the PTH level is normal or elevated, hyperparathyroidism is the likely cause. Symptomatic patients with hyperparathyroidism and patients with certain clinical markers should be considered for surgery. For patients with mild disease, monitoring is an option. Hypocalcemia often is caused by vitamin D deficiency. Symptomatic patients and patients with calcium levels less than 7.6 mg/dL should be treated with intravenous calcium gluconate; concomitant magnesium deficiency should be addressed. There is no evidence that routine calcium and vitamin D supplementation reduces the risk of fractures, but studies have shown that vitamin D supplementation does decrease the number of falls in older adults at risk.
[Mh] Termos MeSH primário: Cálcio/metabolismo
Hipercalcemia/metabolismo
Hipocalcemia/metabolismo
Hormônio Paratireóideo/metabolismo
Vitamina D/metabolismo
[Mh] Termos MeSH secundário: Acidentes por Quedas/prevenção & controle
Antimaníacos/efeitos adversos
Cálcio/uso terapêutico
Gluconato de Cálcio/uso terapêutico
Suplementos Nutricionais
Hidratação
Fraturas Ósseas/prevenção & controle
Seres Humanos
Hipercalcemia/diagnóstico
Hipercalcemia/etiologia
Hipercalcemia/terapia
Hiperparatireoidismo/complicações
Hiperparatireoidismo/cirurgia
Hipocalcemia/diagnóstico
Hipocalcemia/etiologia
Hipocalcemia/terapia
Lítio/efeitos adversos
Neoplasias/complicações
Paratireoidectomia
Inibidores de Simportadores de Cloreto de Sódio/efeitos adversos
Vitamina D/uso terapêutico
Deficiência de Vitamina D/complicações
Deficiência de Vitamina D/tratamento farmacológico
Vitaminas/uso terapêutico
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Antimanic Agents); 0 (Parathyroid Hormone); 0 (Sodium Chloride Symporter Inhibitors); 0 (Vitamins); 1406-16-2 (Vitamin D); 9FN79X2M3F (Lithium); SQE6VB453K (Calcium Gluconate); SY7Q814VUP (Calcium)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171031
[Lr] Data última revisão:
171031
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170815
[St] Status:MEDLINE


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[PMID]:28805198
[Au] Autor:Elikowski W; Malek-Elikowska M; Lachowska-Kotowska P
[Ad] Endereço:Department of Internal Medicine, Józef Strus Hospital, Poznan, Poland.
[Ti] Título:Severe reversible hypocalcemic cardiomyopathy diagnosed 36 years after subtotal thyroidectomy - a case report.
[So] Source:Pol Merkur Lekarski;43(253):26-31, 2017 Jul 21.
[Is] ISSN:1426-9686
[Cp] País de publicação:Poland
[La] Idioma:eng
[Ab] Resumo:Chronic hypocalcemia, irrespectively of its etiology, can lead to severe impairment of the left ventricular (LV) contractility manifesting as dilated cardiomyopathy, usually defined as hypocalcemic cardiomyopathy (hypocaCM). This rarely diagnosed type of heart failure (HF), can be completely reversible, when treated properly with calcium and vitamin D supplementation or, in some subjects, with human recombinant parathormone. A CASE REPORT: The authors present a case of a 60-year-old male admitted with advanced pulmonary congestion, recurrent pulmonary edema and pleural effusion. He was refractory to standard HF therapy. One year earlier, the patient was diagnosed with primary dilated cardiomyopathy with ejection fraction decreased to 25% and after coronary angiography, which revealed normal coronary arteries, he received implantable cardioverter-defibrillator (ICD). However, 36 years before, the patient underwent subtotal thyroidectomy, and at the moment presented with multiplicitous symptoms suggestive of profound hypocalcemia. Laboratory investigations confirmed hypocalcemia due to iatrogenic hypoparathyroidism. Improvement of LV function during supplementation with calcium and vitamin D was monitored by echocardiography using two-dimensional longitudinal strain. One should always consider reversible causes of HF, including hypocalcemia, especially when obvious consequences of chronic hypocalcemia as myopathy, depression or cataract are seen. Correct therapy can restore LV function and prevent unnecessary implantation of ICD.
[Mh] Termos MeSH primário: Cardiomiopatia Dilatada/etiologia
Hipocalcemia/etiologia
Tireoidectomia/efeitos adversos
[Mh] Termos MeSH secundário: Cardiomiopatia Dilatada/diagnóstico
Cardiomiopatia Dilatada/terapia
Desfibriladores Implantáveis
Seres Humanos
Hipocalcemia/complicações
Hipocalcemia/tratamento farmacológico
Masculino
Meia-Idade
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171030
[Lr] Data última revisão:
171030
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170815
[St] Status:MEDLINE


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[PMID]:28739329
[Au] Autor:Negro A; Rossi GM; Nicoli D; Versari A; Farnetti E; Santi R; De Pietri S
[Ad] Endereço:Internal Medicine and Hypertension Unit, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
[Ti] Título:Peptide Receptor Radionuclide Therapy-Induced Gitelman-like Syndrome.
[So] Source:Am J Kidney Dis;70(5):725-728, 2017 Nov.
[Is] ISSN:1523-6838
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Peptide receptor radionuclide therapy (PRRT) is a molecular-targeted therapy in which a somatostatin analogue (a small peptide) is coupled with a radioligand so that the radiation dose is selectively administered to somatostatin receptor-expressing metastasized neuroendocrine tumors, particularly gastroenteropancreatic. Reported toxicities include myelotoxicity and nephrotoxicity, the latter manifesting as decreased kidney function, often developing months to years after treatment completion. We present a case of PRRT-induced kidney toxicity manifesting as a severe Gitelman-like tubulopathy with preserved kidney function. Because profound hypokalemia and hypocalcemia can lead to life-threatening arrhythmias, we highlight the necessity for careful monitoring of serum and urine electrolytes in patients receiving PRRT.
[Mh] Termos MeSH primário: Síndrome de Gitelman/induzido quimicamente
Neoplasias do Íleo/radioterapia
Tumores Neuroendócrinos/radioterapia
Octreotida/análogos & derivados
Compostos Organometálicos/efeitos adversos
Desequilíbrio Hidroeletrolítico/induzido quimicamente
[Mh] Termos MeSH secundário: Acidose/induzido quimicamente
Acidose/metabolismo
Acidose/terapia
Idoso
Calcitriol/uso terapêutico
Carbonato de Cálcio/uso terapêutico
Quimiorradioterapia Adjuvante
Procedimentos Cirúrgicos do Sistema Digestório
Hidratação
Síndrome de Gitelman/metabolismo
Síndrome de Gitelman/terapia
Seres Humanos
Hipocalcemia/induzido quimicamente
Hipocalcemia/metabolismo
Hipocalcemia/terapia
Hipopotassemia/induzido quimicamente
Hipopotassemia/metabolismo
Hipopotassemia/terapia
Sulfato de Magnésio/uso terapêutico
Masculino
Octreotida/efeitos adversos
Vitaminas/uso terapêutico
Desequilíbrio Hidroeletrolítico/metabolismo
Desequilíbrio Hidroeletrolítico/terapia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 ((177lutetium-DOTA(O)Tyr3)octreotate); 0 (Organometallic Compounds); 0 (Vitamins); 7487-88-9 (Magnesium Sulfate); FXC9231JVH (Calcitriol); H0G9379FGK (Calcium Carbonate); RWM8CCW8GP (Octreotide)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171030
[Lr] Data última revisão:
171030
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170726
[St] Status:MEDLINE


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[PMID]:28704250
[Au] Autor:MacKay EJ; Stubna MD; Holena DN; Reilly PM; Seamon MJ; Smith BP; Kaplan LJ; Cannon JW
[Ad] Endereço:From the *Department Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; †Mountain Track Apps, Philadelphia, Pennsylvania; ‡Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; §Department of Surgery, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania; and ‖Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
[Ti] Título:Abnormal Calcium Levels During Trauma Resuscitation Are Associated With Increased Mortality, Increased Blood Product Use, and Greater Hospital Resource Consumption: A Pilot Investigation.
[So] Source:Anesth Analg;125(3):895-901, 2017 Sep.
[Is] ISSN:1526-7598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Admission hypocalcemia predicts both massive transfusion and mortality in severely injured patients. However, the effect of calcium derangements during resuscitation remains unexplored. We hypothesize that any hypocalcemia or hypercalcemia (either primary or from overcorrection) in the first 24 hours after severe injury is associated with increased mortality. METHODS: All patients at our institution with massive transfusion protocol activation from January 2013 through December 2014 were identified. Patients transferred from another hospital, those not transfused, those with no ionized calcium (Ca) measured, and those who expired in the trauma bay were excluded. Hypocalcemia and hypercalcemia were defined as any level outside the normal range of Ca at our institution (1-1.25 mmol/L). Receiver operator curve analysis was also used to further examine significant thresholds for both hypocalcemia and hypercalcemia. Hospital mortality was compared between groups. Secondary outcomes included advanced cardiovascular life support, damage control surgery, ventilator days, and intensive care unit days. RESULTS: The massive transfusion protocol was activated for 77 patients of whom 36 were excluded leaving 41 for analysis. Hypocalcemia occurred in 35 (85%) patients and hypercalcemia occurred in 9 (22%). Mortality was no different in hypocalcemia versus no hypocalcemia (29% vs 0%; P = .13) but was greater in hypercalcemia versus no hypercalcemia (78% vs 9%; P < .01). Receiver operator curve analysis identified inflection points in mortality outside a Ca range of 0.84 to 1.30 mmol/L. Using these extreme values, 15 (37%) had hypocalcemia with a 60% mortality (vs 4%; P < .01) and 9 (22%) had hypercalcemia with a 78% mortality (vs 9%; P < .01). Patients with extreme hypocalcemia and hypercalcemia also received more red blood cells, plasma, platelets, and calcium repletion. CONCLUSIONS: Hypocalcemia and hypercalcemia occur commonly during the initial resuscitation of severely injured patients. Mild hypocalcemia may be tolerable, but more extreme hypocalcemia and any hypercalcemia should be avoided. Further assessment to define best practice for calcium management during resuscitation is warranted.
[Mh] Termos MeSH primário: Substitutos Sanguíneos/administração & dosagem
Recursos em Saúde/utilização
Mortalidade Hospitalar
Hipercalcemia/sangue
Hipocalcemia/sangue
Ressuscitação/mortalidade
[Mh] Termos MeSH secundário: Adulto
Cálcio/sangue
Feminino
Recursos em Saúde/tendências
Mortalidade Hospitalar/tendências
Seres Humanos
Hipercalcemia/diagnóstico
Hipocalcemia/diagnóstico
Masculino
Meia-Idade
Mortalidade/tendências
Projetos Piloto
Ressuscitação/tendências
Ferimentos e Lesões/sangue
Ferimentos e Lesões/diagnóstico
Ferimentos e Lesões/terapia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Blood Substitutes); SY7Q814VUP (Calcium)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170907
[Lr] Data última revisão:
170907
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170714
[St] Status:MEDLINE
[do] DOI:10.1213/ANE.0000000000002312



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