RESUMO
Euglycaemic diabetic ketoacidosis is a possible adverse effect of selective sodium-glucose cotransporter inhibitors 2 (isGLT2) in patients with diabetes. However, the main scientific societies have recently recommended low or very low carbohydrate diets for the treatment of diabetes, relating the latter with the onset of ketosis. The combination of treatment with these drugs and following this type of diet can be dangerous. We present the case of a 64-year-old patient, suffering from LADA type diabetes, under usual treatment with intensive insulin therapy in 4 doses, who a few days after starting empagliflocin and a very low carbohydrate diet presented severe euglycaemic ketoacidotic decompensation.
Assuntos
Cetoacidose Diabética/etiologia , Dieta Cetogênica/efeitos adversos , Hipoglicemiantes/efeitos adversos , Diabetes Autoimune Latente em Adultos/complicações , Compostos Benzidrílicos/administração & dosagem , Compostos Benzidrílicos/efeitos adversos , Glucosídeos/administração & dosagem , Glucosídeos/efeitos adversos , Humanos , Hipoglicemiantes/administração & dosagem , Insulina/administração & dosagem , Insulina/efeitos adversos , Diabetes Autoimune Latente em Adultos/terapia , Masculino , Pessoa de Meia-Idade , Inibidores do Transportador 2 de Sódio-Glicose/administração & dosagem , Inibidores do Transportador 2 de Sódio-Glicose/efeitos adversosRESUMO
Currently, each of the different scientific societies advocate one kind or another nutritional recommendations for patients with vascular risk. This variety of diets on the one hand enrich the nutritional therapeutic possibilities, but on the other can lead to some confusion, both for the patient and for the professional that advises. Furthermore, most studies assessing vascular risk mention a "diet" without defining or specifying to which kind of diet they refer, thereby introducing an important bias in the results of those studies. In fact, some of them bear a degree of contradiction. This review aims to shed some light on such a controversial topic.
Assuntos
Doenças Cardiovasculares , Resistência à Insulina , Obesidade/dietoterapia , Diabetes Mellitus Tipo 2 , Humanos , Fatores de RiscoAssuntos
Carcinoma de Células Escamosas/diagnóstico , Gonadotropinas Hipofisárias/deficiência , Ginecomastia/complicações , Hipogonadismo/complicações , Neoplasias Pulmonares/diagnóstico , Carcinoma de Células Escamosas/complicações , Humanos , Neoplasias Pulmonares/complicações , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: The aim of this study was to analyze the complications derived from the use of intravenous cannulae with particular attention being paid to the possible predisposing factors. METHODS: A prospective follow up of 569 intravenous cannulae placed in the emergency department or the medical ward of a county hospital was carried out. 492 of these cannulae were peripheral (PC) and 77 central inserted through peripheral veins (CPVC). RESULTS: Fifty-one percent of the catheters were withdrawn due to complications with the most frequent being phlebitis (35%), followed by extravasation (11.5%). The mean time in situ was 3.61 +/- 3.2 days. The daily risk of complications ranged from 2 to 9% for the CPVC (non significant differences) and between 15% (day 1) and 30% (6 or more days) for the PC. In the latter case there were no differences in the daily specific rate of complications after the first 24 hours. The probability of a catheter remaining in place more than three and six days without complications was 51% and 31%, respectively for the CP and 91% and 87% for the CPVC (p < 0.0001). Of the variables analyzed, age > 65 years, female sex, insertion of the cannula into the back of the hand, the fact of the route being peripheral without the administration of heparin were significantly associated to the development of complications, while the intravenous administration of aminophillin was associated with the appearance of phlebitis. Thirteen percent of the catheters withdrawn due to phlebitis were infected. CONCLUSIONS: The complication most frequent observed in intravenous cannulation was phlebitis, an entity which is generally not of an infectious nature. The risk of unspecific complications every day during catheterization is constant in the case of central peripheral vein cannulae as well as in peripheral cannulae which do show problems during the first 24 hours after placement. Insertion of the cannulae into the veins of the back of the hand, female sex, advanced age and intravenous administration of certain drugs influence in the development of phlebitis.
Assuntos
Cateterismo Venoso Central/efeitos adversos , Cateterismo Periférico/efeitos adversos , Doenças Vasculares/etiologia , Análise Atuarial , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Causalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Prospectivos , Doenças Vasculares/epidemiologiaAssuntos
Febre/diagnóstico por imagem , Hematoma/diagnóstico por imagem , Pneumopatias/diagnóstico por imagem , Infecções Estreptocócicas/diagnóstico por imagem , Acidentes por Quedas , Diagnóstico Diferencial , Febre/etiologia , Hematoma/complicações , Humanos , Pulmão/diagnóstico por imagem , Pneumopatias/complicações , Lesão Pulmonar , Masculino , Pessoa de Meia-Idade , Radiografia , Infecções Estreptocócicas/etiologiaRESUMO
We report a microepidemic of tuberculosis (TBC) in a family of 12 members, 4 of which were parenteral drug abusers and 3 had anti-human immunodeficiency virus (HIV) antibodies. Four new cases were simultaneously diagnosed in the investigation of the contacts of a patient with extrapulmonary tuberculosis and acquired immunodeficiency syndrome. We review the requirements for the development of these epidemic outbreaks, both in noninfected communities and in the family contacts, where positive anti-HIV antibodies may increase the risk. We emphasize the importance of a systematic study of contacts in these families and the indication of chemoprophylaxis in all those sharing the same household, without age limit.
Assuntos
Surtos de Doenças , Tuberculose/epidemiologia , Síndrome da Imunodeficiência Adquirida/complicações , Adulto , Criança , Saúde da Família , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Linhagem , Conglomerados Espaço-Temporais , Espanha/epidemiologia , Tuberculose/complicaçõesAssuntos
Ciprofloxacina/efeitos adversos , Paniculite/induzido quimicamente , Idoso , Feminino , HumanosRESUMO
We revised four cases of hypocalcemia diagnosed yr after thyroid surgery, including 1 man and 3 women, operated 5-23 yr before the onset of symptoms, which ranged from mild paresthesia to convulsive seizures. Total serum calcium levels ranged from 1.1 to 2.05 mmol/l, and PTH levels were low in the 3 cases in which they were measured. Hypoparathyroidism appearing as late-onset hypocalcemia after extense thyroid surgery is a poorly understood condition, perhaps not as unfrequent as it is considered.
Assuntos
Hipocalcemia/etiologia , Tireoidectomia/efeitos adversos , Adulto , Idoso , Cálcio/sangue , Feminino , Humanos , Hipocalcemia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Hormônio Paratireóideo/sangue , Fatores de TempoRESUMO
A 25-year-old woman with persistent nephrogenic diabetes insipidus (NDI) following parathyroidectomy for primary hyperparathyroidism is described. NDI is a well recognized complication of primary hyperparathyroidism, generally imputed to hypercalcemia, and promptly reversible after correcting it. In our case, the impaired concentrating ability of the renal tubule was irreversible after the removal of the parathyroid adenoma and the correction of the hypercalcemia, presumptively due to the morphological irreversible changes in the kidney. In addition, hypercalciuria persisted and was the cause of a compensatory hyperparathyroidism. Treatment with thiazide diuretic was effective to decrease relative hypercalciuria, thus reversing the compensatory hyperparathyroidism.
Assuntos
Diabetes Insípido/etiologia , Hiperparatireoidismo/cirurgia , Nefropatias/etiologia , Adenoma/complicações , Adenoma/cirurgia , Adulto , Fosfatase Alcalina/sangue , Benzotiadiazinas , Cálcio/urina , Diabetes Insípido/tratamento farmacológico , Diabetes Insípido/fisiopatologia , Diuréticos , Feminino , Humanos , Hipercalcemia/complicações , Hiperparatireoidismo/complicações , Nefropatias/tratamento farmacológico , Nefropatias/fisiopatologia , Túbulos Renais/fisiopatologia , Glândulas Paratireoides/cirurgia , Neoplasias das Paratireoides/complicações , Neoplasias das Paratireoides/cirurgia , Inibidores de Simportadores de Cloreto de Sódio/uso terapêuticoAssuntos
Síndrome de Kearns-Sayre , Oftalmoplegia , Adolescente , Hormônio Adrenocorticotrópico/sangue , Glicemia/análise , Peptídeo C/sangue , Feminino , Hormônios Esteroides Gonadais/sangue , Humanos , Hidrocortisona/sangue , Insulina/sangue , Síndrome de Kearns-Sayre/diagnóstico , Síndrome de Kearns-Sayre/patologia , Oftalmoplegia/diagnóstico , Oftalmoplegia/patologia , Hormônios Adeno-Hipofisários/sangue , Hormônios Tireóideos/sangueRESUMO
Erythromelalgia is a syndrome characterized by erythema, burning pain and increased skin temperature of the affected extremities. It can be either primary (idiopathic) or secondary, but both forms require a critical temperature between 32-36 degrees C to provoke the crisis. Among the secondary forms, its association with diabetes mellitus is infrequent and its significance is little known. The histological studies have been fundamentally performed in patients with this syndrome affected by thrombocythemia; vascular thrombosis and fibromuscular intimal arteriolar proliferation were the prominent findings not corroborated in patients with the primary form. We studied one patient with acute diabetic neuropathy who developed erythromelalgia. We noted the absence of histopathological lesions, suggesting a disorder in vascular motility regulation favored by the severe neuropathy, without being able to discount a possible immunomediated mechanism. We describe the favourable evolution of the patient after treatment with aspirin and methysergide.