[Severe hypophosphatemia--an overlooked condition?]. / Alvorlig hypofosfatemi--en oversett tilstand?

Severe hypophosphataemia is a well known metabolic disturbance, potentially serious. Clinicians are not always aware of this condition, which most likely is missed sometimes. We present a case in which severe hypophosphataemia was an important part of the clinical picture. An alcoholic was hospitalized because of epigastric pain, nausea and poor health. Seven days after admission he still was very weak and somnolent. He did not eat, and developed urinary retention due to paresis of the bladder. An extremely low level of s-phosphate, 0.12 mmol/l, was discovered the seventh day. The next two days he was substituted with 60 mmol phosphate i.v. At the same time his general condition improved dramatically. We believe that severe hypophosphataemia was an important cause of the persistently poor clinical condition of our patient. Finally, we present the causes of hypophosphataemia, stressing that serum phosphate does not always reflect total body phosphate. We discuss the possible manifestations of hypophosphataemia, and we give practical advice on treatment.

[Carbamazepine-induced hepatitis]. / Karbamazepinindusert hepatitt.

BACKGROUND: Hepatotoxic reactions associated with carbamazepine therapy are well recognised, and it is important that clinicians are aware of this adverse effect. MATERIAL AND METHODS: We present the clinical course in three patients with carbamazepine-induced hepatitis. RESULTS: All three patients had clinical and biochemical signs of hepatitis; improvement occurred immediately after carbamazepine therapy was discontinued. Other causes of hepatitis were excluded. INTERPRETATION: Previous reports concerning this adverse effect are reviewed. Focusing on the liver as the major organ for drug metabolism, we discuss possible pathophysiological mechanisms of drug-induced hepatic injury. A thorough medication history is mandatory in all patients with hepatitis and other liver diseases. The prognosis of carbamazepine-induced hepatitis is usually excellent, but fatal cases have been reported.

[Non-alcoholic steatohepatitis]. / Ikke-alkoholisk steatohepatitt.

BACKGROUND: There is a growing interest in nonalcoholic steatohepatitis (NASH), a disease entity which is quite similar to alcoholic liver disease. MATERIAL AND METHODS: We present three patients with nonalcoholic steatohepatitis, and review current opinion on this disease entity. RESULTS: Non-alcoholic steatohepatitis is very often associated with the insulin resistance syndrome. There is also an association with hepatic iron overload. In one of our patients, biochemical improvement occurred after treatment with phlebotomy. Insulin resistance, resulting in fat accumulation, seems to be an important first step in the pathogenesis. Free fatty acids, iron, and other sources of oxidative stress probably result in cell damage. In some patients, these events result in necroinflammation mediated by various cytokines and immunoactive cells. The prognosis in pure steatosis is usually good. Presence of necroinflammation or fibrosis indicates a risk of progressive liver disease, including cirrhosis.