RESUMO
Chinese herbal medicine is widely used globally. In many instances, it is associated with severe adverse outcomes. We report case of a Chinese herbal nephropathy occurring in a 43-year-old woman showing renal impairment, metabolic acidosis, Stokes - Adams syndrome, hypernatremia, and hypokalemia, characteristics not usually encountered in published cases.
Assuntos
Acidose/induzido quimicamente , Síndrome de Adams-Stokes/induzido quimicamente , Medicamentos de Ervas Chinesas/efeitos adversos , Fármacos para a Fertilidade Feminina/efeitos adversos , Hipernatremia/induzido quimicamente , Hipopotassemia/induzido quimicamente , Nefropatias/induzido quimicamente , Rim/efeitos dos fármacos , Acidose/diagnóstico , Acidose/fisiopatologia , Acidose/terapia , Síndrome de Adams-Stokes/diagnóstico , Síndrome de Adams-Stokes/fisiopatologia , Síndrome de Adams-Stokes/terapia , Adulto , Feminino , Humanos , Hipernatremia/diagnóstico , Hipernatremia/fisiopatologia , Hipernatremia/terapia , Hipopotassemia/diagnóstico , Hipopotassemia/fisiopatologia , Hipopotassemia/terapia , Rim/fisiopatologia , Nefropatias/diagnóstico , Nefropatias/fisiopatologia , Nefropatias/terapia , Resultado do TratamentoRESUMO
INTRODUCTION: We evaluated emergency physicians' (EP) current perceptions, practice, and attitudes towards evaluating stroke as a cause of dizziness among emergency department patients. METHODS: We administered a survey to all EPs in a large integrated healthcare delivery system. The survey included clinical vignettes, perceived utility of historical and exam elements, attitudes about the value of and requisite post-test probability of a clinical prediction rule for dizziness. We calculated descriptive statistics and post-test probabilities for such a clinical prediction rule. RESULTS: The response rate was 68% (366/535). Respondents' median practice tenure was eight years (37% female, 92% emergency medicine board certified). Symptom quality and typical vascular risk factors increased suspicion for stroke as a cause of dizziness. Most respondents reported obtaining head computed tomography (CT) (74%). Nearly all respondents used and felt confident using cranial nerve and limb strength testing. A substantial minority of EPs used the Epley maneuver (49%) and HINTS (head-thrust test, gaze-evoked nystagmus, and skew deviation) testing (30%); however, few EPs reported confidence in these tests' bedside application (35% and 16%, respectively). Respondents favorably viewed applying a properly validated clinical prediction rule for assessment of immediate and 30-day stroke risk, but indicated it would have to reduce stroke risk to <0.5% to be clinically useful. CONCLUSION: EPs report relying on symptom quality, vascular risk factors, simple physical exam elements, and head CT to diagnose stroke as the cause of dizziness, but would find a validated clinical prediction rule for dizziness helpful. A clinical prediction rule would have to achieve a 0.5% post-test stroke probability for acceptability.