Hypoalbuminemia-Related Prolonged Sedation After General Anesthesia: A Case Report.

A 69-year-old man underwent total laryngopharyngectomy with radial forearm free flap reconstruction. He had lost 15 kg over a period of 6 months and did not receive any preoperative nutritional workup or management. The patient had a general total intravenous anesthetic with ketamine, lidocaine, and propofol, which was uneventful for an 8-hour surgery. The patient remained deeply sedated for 4 hours after discontinuation of all sedative medications. Diagnostic workup only revealed hypoalbuminemia and hypoproteinemia. We hypothesized relative overdosage of sedative anesthetic drugs due to preoperative malnutrition accentuated by intraoperative fluid administration.

Reproductive toxicity of fluoroquinolones in birds.

BACKGROUND: While commercial poultry and captive birds are exposed to antimicrobials through direct medication, environmental pollution may result in contamination of wild birds. Fluoroquinolones are commonly used medications to treat severe avian bacterial infections; however, their adverse effects on birds remain understudied. Here, we examine toxicity of enrofloxacin and marbofloxacin during the egg incubation period using the chicken (Gallus Gallus domesticus) as a model avian species. Laboratory tests were based on eggs injected with 1, 10 and 100 µg of fluoroquinolones per 1 g of egg weight prior to the start of incubation and monitoring of chick blood biochemistry, reproductive parameters and heart rate during incubation. RESULTS: Eggs treated with fluoroquinolones displayed reduced hatchability due to embryonic mortality, particularly on day 13 of incubation. Total hatching success showed a similar pattern, with a significantly reduced hatchability in low and high exposure groups treated with both enrofloxacin and marbofloxacin. From 15 to 67% of chicks hatching in these groups exhibited joint deformities. Hatching one-day pre-term occurred with a prevalence of 31 to 70% in all groups treated with fluoroquinolones. Embryonic heart rate, measured on days 13 and 19 of incubation, increased in all enrofloxacin-treated groups and medium and high dose groups of marbofloxacin-treated eggs. Blood biochemistry of chicks sampled at hatch from medium dose groups showed hypoproteinaemia, decreased uric acid and increased triglycerides. Chicks from the enrofloxacin-treated group displayed mild hyperglycaemia and a two-fold rise in the blood urea nitrogen to uric acid ratio. Principal components analysis based on blood biochemistry clearly separated the control bird cluster from both enrofloxacin- and marbofloxacin-treated birds. CONCLUSIONS: Fluoroquinolones induce complex adverse effects on avian embryonic development, considerably reducing the performance of incubated eggs and hatching chicks. Cardiotoxicity, which quickens embryonic heart rate, meant that the total number of heart beats required for embryogenesis was achieved earlier than in the standard incubation period, resulting in pre-term hatching. Our data suggest that enrofloxacin has a higher potential for adverse effects than marbofloxacin. To conclude, care should be taken to prevent exposure of reproducing birds and their eggs to fluoroquinolones.

[Case of atopic dermatitis in infant treated with Chinese herbal medicines and nsaids ointment, which induced weight loss, electrolyte disturbance and hypoproteinemia].

We report here a 4-month-old girl with atopic dermatitis accompanied by weight loss, electrolyte disturbance, hypoproteinemia and hypogammaglobulinemia. She has suffered from eczema since one-month of age. Although she was treated with Chinese herbal medicines, including Syosaikotokakikyosekko, Tokishigyakukagoshuyushokyoto and Jumihaidokuto and ibuprofen ointment since three-month of age, she was referred to our hospital due to deteriorated eczema, severe diarrhea and failure to thrive. Laboratory examination revealed hyponatremia, hyperpotassemia, hypoproteinemia, hypogammaglobulinemia and elevated levels of serum IL-18, TARC and fecal EDN. Drug-induced lymphocyte stimulation tests were positive for the prescribed Chinese herbal medicines. Discontinuation of these medicines and application of steroid ointments improved loose bowels and skin lesions as well as laboratory data. It is suggested that the application of inadequate ointment and Chinese herbal medicines exaggerated inflammation in the skin and the intestinal mucosa leading to electrolyte disturbance, hypoproteinemia and hypogammaglobulinemia. Chinese herbal medicines are depicted as an additional therapy in Japanese guideline for atopic dermatitis, whereas their indication to infants with atopic dermatitis should be carefully assessed.

Synchronous triple cancers of the pancreas, stomach, and cecum treated with S-1 followed by pancrelipase treatment of pancreatic exocrine insufficiency.

CONTEXT: Pancreatic cancer is frequently complicated by malignancies in other organs. However, synchronous triple cancers including pancreatic cancer have been seldom reported in the English language literature. CASE REPORT: We describe the rare case of a 77-year-old man with triple cancers of the pancreas, stomach, and cecum. Biopsies revealed that all three tumors were adenocarcinomas. The pancreatic and gastric tumors were positive for cytokeratin 7 and negative for cytokeratin 20, whereas the cecal tumor was negative for cytokeratin 7 and positive for cytokeratin 20. K-ras mutations were present at codon 12 in the pancreatic tumor and at codon 13 in the cecal tumor, but were absent from the gastric tumor. Since the three tumors had different characteristics, the patient was diagnosed with synchronous triple cancers. Because invasive surgery was required to remove all three tumors and the patient had risk factors for surgery, we elected to treat him with chemotherapy. All three cancers were markedly reduced in size by treatment with cycles of 100 mg/day S-1 for 2 weeks, followed by a 1-week rest. The patient later developed hypoproteinemia and anasarca, which was diagnosed as pancreatic exocrine insufficiency due to pancreatic head cancer. Treatment with pancrelipase resulted in dramatic improvements in hypoproteinemia and anasarca. CONCLUSIONS: This is the first case report in which S-1 was effective in triple cancers of the pancreas, stomach, and cecum. Patients with pancreatic head cancer should be monitored for pancreatic exocrine insufficiency.

Subacute intoxication of a deltamethrin-based preparation (Butox) 5% EC) in monosex Nile tilapia, Oreochromis niloticus L.

The monosex Nile tilapia, Oreochromis niloticus L., was exposed to subacute concentration (1.46 microg/l) of a pyrethroid insecticide, deltamethrin for 28 consecutive days. Behavioural, clinical, haematological, serum biochemical and histopathological consequences were assayed at a regular interval of 7 days. The abnormal behavioural responses and toxic symptoms were described. Exposure to deltamethrin not only significantly decreased lymphocyte and basophile percentages, total leucocytic and total erythrocytic counts, haemoglobin percentage and packed cell volume value, but also caused serious effects in the form of hypoproteinaemia, hypoalbuminaemia, hypercholesterolaemia, hyperglycaemia and significantly increased serum aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase activities. Moreover, the histopathological results indicated that the haemobiotic organs were affected by deltamethrin, primarily liver and gills. Our data suggest that subacute exposure to deltamethrin exerts a serious metabolic distress on the fish corresponding to the exposure period. In addition, the assayed parameters and histopathological findings can be as good biomarkers of pyrethroid ecosystem pollution.

[Nefopam by continuous intravenous injection and adverse drug reactions: which causality assessment?]. / Néfopam en perfusion continue et effets secondaires indésirables: quelle imputabilité ?

We report the case of a 77-year-old man, with nefopam postoperative analgesia, who developed subacute neurological symptoms, whereas he had profound hypoprotidemia and acute renal failure. Chronological, semiological and bibliographical criteria are in favour of causality assessment. The plasma nefopam concentration (135 ng/ml) during the neurological symptoms is another argument.

Effects of phenylbutazone alone or in combination with flunixin meglumine on blood protein concentrations in horses.

OBJECTIVE: To assess effects of treatment with phenylbutazone (PBZ) or a combination of PBZ and flunixin meglumine in horses. ANIMALS: 24 adult horses. PROCEDURE: 13 horses received nonsteroidal antiinflammatory drugs (NSAIDs) in a crossover design. Eleven control horses were exposed to similar environmental conditions. Treated horses received PBZ (2.2 mg/kg, PO, q 12 h, for 5 days) and a combination of PBZ and flunixin meglumine (PBZ, 2.2 mg/kg, PO, q 12 h, for 5 days; flunixin meglumine, 1.1 mg/kg, IV, q 12 h, for 5 days). Serum samples were obtained on day 0 (first day of treatment) and day 5, and total protein, albumin, and globulin were measured. RESULTS: 1 horse was euthanatized with severe hypoproteinemia, hypoalbuminemia, and colitis during the combination treatment. Comparisons revealed no significant difference between control horses and horses treated with PBZ alone. There was a significant difference between control and treated horses when administered a combination of PBZ and flunixin meglumine. Correction for horses with values >2 SDs from the mean revealed a significant difference between control horses and horses administered the combination treatment, between control horses and horses administered PBZ alone, and between horses receiving the combination treatment and PBZ alone. Gastroscopy of 4 horses revealed substantial gastric ulcers when receiving the combination NSAID treatment. CONCLUSIONS AND CLINICAL RELEVANCE: Analysis of results of the study indicates the need for caution when administering a combination NSAID treatment to horses because the detrimental effects may outweigh any potential benefits.

Effect of ascorbic acid, alpha-tocopherol, lecithin and L-ornithine-L-aspartate on ethanol induced hypoproteinemia and hyperlipidemia in rats.

We studied effect of exogenous ascorbic acid, alpha-tocopherol, lecithin and L-ornithine-L-aspartate on serum lipids and proteins in experimental hepatotoxic Wistar rats. Eleven groups (n = 6) of animals were used. Hepatotoxicity was induced by administering ethanol (1.6 g/kg/day) for 28 days. Both preventive and curative options were studied. Percentage increase in body weight was significantly lower in ethanol treated rats. Ethanol significantly (P<0.05) increased cholesterol, triglycerides and LDL, and decreased protein, albumin and A:G ratio in serum. Ascorbic acid, alpha-tocopherol, lecithin and L-ornithine-L-aspartate exhibited an ability to counteract the alcohol-induced changes in the body weight and biochemical parameters in preventive and therapeutic models in varying degree. Antioxidants showed better effect.

Developmental atrazine exposure suppresses immune function in male, but not female Sprague-Dawley rats.

Each year, 75 million pounds of the broadleaf herbicide atrazine (ATR) are applied to crops in the United States. Despite limited solubility, ATR is common in ground and surface water, making it of regulatory concern. ATR suppresses the immunomodulatory hormones prolactin (PRL) and the thyroid hormones (THs), with developmental exposure to ATR permanently disrupting PRL regulation. We hypothesized that ATR may cause developmental immunotoxicity through its disruption of PRL or THs. To test this hypothesis, pregnant Sprague-Dawley (SD) rats were exposed to 35-mg ATR/kg/d from gestational day (GD) 10 through postnatal day (PND) 23. Separate groups were exposed to bromocryptine (BCR) at 0.2 mg/kg/2x/day to induce hypoprolactinemia or to propylthiouracil (PTU) at 2 mg/kg/day to induce hypothyroidism. After the offspring reached immunologic maturity (at least 7 weeks old), the following immune functions were evaluated: natural killer (NK) cell function; delayed-type hypersensitivity (DTH) responses; phagocytic activity of peritoneal macrophages; and antibody response to sheep erythrocytes (SRBC). ATR decreased the primary antibody and DTH responses in male offspring only. Neither PTU nor BCR caused immunosuppression in any measured variable, although PTU increased phagocytosis by peritoneal macrophages. These results demonstrate that developmental exposure to ATR produced gender-specific changes in immune function in adult rats and suggest that immune changes associated with ATR are not mediated through the suppression of PRL or THs.

Sodium fluoride-induced hypoproteinemia and hypoglycemia in parental and F(1)-generation rats and amelioration by vitamins.

Oral administration of sodium fluoride (NaF; 40 mg/kg body weight) daily from day 6 of gestation to day 21 of lactation caused, compared with the distilled water control (group 2), significant reductions in body weight and feed consumption as well as concentration of glucose and protein in the serum of P- and F(1)-generation rats; however, sodium and potassium concentrations in the serum were significantly higher than those of the vehicle control (group 2). Administration of either vitamins C (50 mg/kg body weight/day), D (2 ng/0.2 ml olive oil/animal/day) or a combination of vitamins C+D+E along with NaF caused significant amelioration in body weight and feed consumption, as well as glucose, protein, sodium and potassium concentrations in the serum of P- and F(1)-generation rats compared with the NaF-only treated group. Withdrawal of NaF treatment during lactation caused significant amelioration in feed consumption (days 15-21 only), sodium, potassium, glucose and protein concentrations in the serum of both P- and F(1)-generation rats. Co- treatment with vitamin E (2 mg/0.2 ml olive oil/animal/day) caused significant amelioration in body weight (days 15 and 20 of gestation only), sodium, potassium, glucose (only in P-generation females) and protein (only in P-generation female) concentrations in the serum of rats than in NaF-treated rats alone. It is concluded that co-treatment with vitamins C, D and C+D+E were found more effective in ameliorating NaF-induced effects than vitamin E and withdrawal of NaF treatment during lactation.

Chronic toxicity of propoxur on carbohydrate, protein and serum electrolyte levels in catfish, Heteropneustes fossilis.

Alterations in the biochemical parameters of the catfish treated with low sublethal concentration (2.15 mg.L-1; 1/3 of 96 h LC50) of a carbamate pesticide-propoxur under static laboratory conditions for 10, 20 and 30 days were assayed. The fish elicited consistent hyperglycemia, concomitant with liver and muscle glycogenolysis, and hypoproteinemia in muscle and liver except 10 day post exposure to the pesticide, where hyperproteinemia was noticed in the liver. Throughout the exposure period the fish exhibited hyperphosphatemia. Hypocalcemia were recorded after 20 and 30 days, and serum magnesium level increased significantly only at 30 day exposure to the pesticide.

Medical management of right dorsal colitis in 5 horses: a retrospective study (1987-1993).

Right dorsal colitis in horses has been associated with administration of phenylbutazone. Although reports of right dorsal colitis in this species have described surgical treatment associated with a poor prognosis, we have had success treating this condition medically. This report describes 5 horses with right dorsal colitis confirmed during celiotomy that were initially managed medically. All horses had a history of intermittent abdominal pain; weight loss was noted in only 1 horse. The doses (2.0 to 4.6 mg/kg PO bid) and duration (5 to 30 days) of administration of phenylbutazone were not unusually high relative to those recommended (4.4 mg/kg PO bid). Hypoproteinemia and hypoalbuminemia were observed in all horses at the time of admission; packed cell volume was low in 4 horses, and hypocalcemia was also observed in 4 horses. Three of 5 horses (60%) appeared to respond to dietary management and discontinuation of administration of nonsteroidal anti-inflammatory drugs. Dietary management consisted of feeding pelleted feed, and restricting or eliminating roughage for a period of at least 3 months. Two horses developed strictures of the right dorsal colon. One horse that developed a colonic stricture, possibly because its owners did not comply with recommendations for management, was subsequently treated surgically. The remaining horse that developed a stricture of the right dorsal colon was euthanized. These data indicate that some horses with right dorsal colitis can be successfully managed with medical treatment.

Increased lymphatic hyaluronan output and preserved hyaluronan content of the rat small intestine in prolonged hypoproteinaemia.

Nephrotic syndrome was induced in seven rats by daily aminonucleoside injections. Experiments were performed in anaesthesia 6 or 7 d later when protein loss in urine had reduced serum colloid osmotic pressure (COP) to 8.2 +/- 0.9 (SD) mmHg compared with 20.2 +/- 2.2 mmHg in controls (P < 0.01). Due to the decreased COP in the nephrotic rats, lymph flow in the main mesenteric lymphatic was 29.5 +/- 11.5 microliters min-1 compared with 4.2 +/- 2.2 microliters min-1 in the control rats (P < 0.01). The corresponding hyaluronan concentrations were 3.4 +/- 0.9 micrograms ml-1 and 12.0 +/- 3.5 micrograms ml-1, respectively (P < 0.01). Nevertheless lymphatic hyaluronan output was doubled in the nephrotic rats, but this did not affect the hyaluronan content of the small intestine of 192 +/- 58 micrograms g-1 dry wt compared with 215 +/- 69 micrograms g-1 in controls (P > 0.05). During a 20 min intravenous 0.9% saline infusion of 4 ml 100 g-1 rat, the hyaluronan concentration increased to 18.3 (6.0) micrograms ml-1 in mesenteric lymph in controls, whereas the concentration in lymph from the nephrotic rats remained unchanged. Lymphatic output increased, however, in this group as well due to the elevated flow. The amount of hyaluronan cleared daily by the main mesenteric lymphatic in awake rats corresponds to about half the tissue hyaluronan content in the drained area (østgaard & Reed 1993 b).(ABSTRACT TRUNCATED AT 250 WORDS)

Tissue lipoperoxidation and glutathione peroxidase activity in puromycin aminonucleoside injected rats.

1. Lipoperoxidation (LPx) and glutathione peroxidase (GPx) activity were measured in kidney, liver, heart, lung, brain and testis from control and puromycin aminonucleoside (PAN) injected rats on days 1-6, 8, 10, 16 and 22 after vehicle or PAN injection. 2. PAN-injected rats developed proteinuria on day 3. 3. In PAN-injected rats: (a) LPx increased in kidney, liver, lung, brain and testis before day 3 and in heart on day 3; (b) GPx activity increased in kidney, liver, heart, lung and testis and diminished in brain on day 3 or after.

[Evaluation of daunorubicin nephrotoxicity and effect of tocopherol and ascorbic acid on lesions induced in rat kidneys. I. Histologic, histochemical and biochemical studies]. / Ocena nefrotoksycznosci daunorubicyny oraz wplywu tokoferolu i kwasu askorbinowego na zmiany powstale w nerkach szczurów. Czesc I. Badania histologiczne, histochemiczne i biochemiczne.

Nephrotoxicity of daunorubicin in rats and effect of tocopherol and ascorbic acid on lesions induced in kidneys by daunorubicin were examined. Daunorubicin induced nephrotic syndrome with proteinuria and hypoproteinemia. Histological changes in the glomeruli appeared as a dilatation of capillary loops and enlargement of the urinary space. The glomerular basement membrane showed minimal thickening. In tubuli protein casts were noticed. No beneficial influence of tocopherol and ascorbic acid on daunorubicin related nephrotoxicity was observed.

Hypoproteinemia related with chronic lithium therapy in two patients.

We present here two cases of reversible hypoproteinemia which could have occurred as an adverse effect of chronic lithium administration. In the present cases, protein losing a renal dysfunction, liver dysfunction and malabsorption syndrome were not observed, and the relationship between their dietary volume and serum protein levels was poor. The mechanism of hypoproteinemia in these cases was not identified from previously obtained data. We suggested that this type of hypoproteinemia might be a new adverse effect of lithium.

Intestinal absorption of peptide enteral formulas in hypoproteinemic (volume expanded) rats: a paired analysis.

Previous studies have confirmed the improved tolerance of a peptide enteral compared to standard enteral alimentation in hypoalbuminemic, critically ill patients. Animal studies, including hypoproteinemic, volume-expanded rats, demonstrated that the protein hydrolysate of a peptide enteral formula was responsible for the enhanced absorption. The purpose of this study was to determine whether the composition of small MW peptides (protein hydrolysate) in two commercially available peptide enteral formulas would affect the rate of intestinal absorption and albumin clearance in intact jejunal loops before and during hypoproteinemia induced by iv infusion of Tyrode's solution in Sprague-Dawley rats. Net transmucosal water movement was calculated using a volume recovery method; albumin clearance was calculated using iv radiolabeled albumin. We studied three groups of animals during luminal perfusion with either Tyrode's solution, diet A containing 21% peptides, or diet B containing 56% peptides. When compared to luminal perfusion with Tyrode's solution (control animals), both diets significantly enhanced net transmucosal water absorption before volume expansion (p less than .05). With the induction of hypoproteinemia, diet B continued to stimulate water absorption when compared to control animals (p less than .01). Luminal perfusion with diet A failed to attenuate net water secretion induced by hypoproteinemia. Capillary and mucosal albumin clearance was similar for all groups studied. These findings suggest the percentage of small MW peptides may affect the rate of intestinal absorption in patients with acute kwashiorkor-like hypoalbuminemia.