Subject(s)
Arthritis, Infectious , Gout , Aged , Arthritis, Infectious/diagnosis , Campylobacter fetus , Female , HumansABSTRACT
We present a man undergoing regular haemodialysis sessions, who presented with non-specific symptoms of nausea, vomiting and light-headedness. He was found to have significantly raised serum digoxin concentrations, as well as a heart rate of 30 beats per minutes. An ECG showed complete heart block. He has a history of non-ischaemic dilated cardiomyopathy with resistant supraventricular and ventricular tachycardias and was on concomitant beta-blockade and digoxin. On questioning, he reported a gradual decline in his residual urine output over the past 6 months. He was reviewed by the cardiology team and required both pharmacological therapy for reversal of digoxin toxicity and temporary pacing in view of significant bradyarrhythmias. The beta-blockade and digoxin were discontinued. He was kept on continuous monitoring at the Cardiac Critical Care Unit. His symptoms resolved spontaneously once digoxin-specific antibody fragments were administered and temporary pacing successfully performed.
Subject(s)
Bradycardia , Cardiac Pacing, Artificial/methods , Cardiomyopathy, Dilated/complications , Digoxin , Drug-Related Side Effects and Adverse Reactions , Immunoglobulin Fab Fragments/administration & dosage , Kidney Failure, Chronic , Renal Dialysis/methods , Tachycardia, Supraventricular/drug therapy , Aged , Anti-Arrhythmia Agents/administration & dosage , Anti-Arrhythmia Agents/blood , Anti-Arrhythmia Agents/toxicity , Bradycardia/chemically induced , Bradycardia/diagnosis , Bradycardia/therapy , Cardiomyopathy, Dilated/diagnosis , Digoxin/administration & dosage , Digoxin/blood , Digoxin/toxicity , Drug-Related Side Effects and Adverse Reactions/blood , Drug-Related Side Effects and Adverse Reactions/etiology , Drug-Related Side Effects and Adverse Reactions/physiopathology , Drug-Related Side Effects and Adverse Reactions/therapy , Electrocardiography/methods , Humans , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/therapy , Male , Protective Agents/administration & dosage , Risk Adjustment/methods , Tachycardia, Supraventricular/etiology , Treatment OutcomeSubject(s)
Anti-Arrhythmia Agents/poisoning , Anti-Bacterial Agents/adverse effects , Atrial Fibrillation/drug therapy , Bradycardia/chemically induced , Bundle-Branch Block/chemically induced , Clarithromycin/adverse effects , Digoxin/poisoning , Helicobacter Infections/drug therapy , Tachycardia, Ventricular/chemically induced , Acute Kidney Injury/chemically induced , Acute Kidney Injury/diagnosis , Acute Kidney Injury/drug therapy , Aged, 80 and over , Amoxicillin/therapeutic use , Atrial Fibrillation/complications , Bradycardia/diagnosis , Bradycardia/drug therapy , Bundle-Branch Block/diagnosis , Bundle-Branch Block/drug therapy , Drug Interactions , Electrocardiography , Female , Helicobacter Infections/complications , Helicobacter pylori , Humans , Hyperkalemia/chemically induced , Hyperkalemia/diagnosis , Hyperkalemia/drug therapy , Immunoglobulin Fab Fragments/therapeutic use , Omeprazole/therapeutic use , Tachycardia, Ventricular/diagnosis , Tachycardia, Ventricular/drug therapyABSTRACT
BACKGROUND: Peritoneal dialysis (PD) patients with sarcopenia have increased risk of mortality. There is consensus that sarcopenia should combine assessments of muscle function and mass. We wished to determine the effect of using different operational definitions in PD patients. METHODS: Hand grip strength (HGS) and segmental bioimpedance derived appendicular lean mass (ALM) were measured and the prevalence of sarcopenia determined using the Foundation for the National Institutes of Health Sarcopenia Project (FNIH), European Working Group on Sarcopenia Older Persons (EWGSOP), and Asian Working Group on Sarcopenia (AWGS) definitions. RESULTS: We studied 155 PD patients, 95 men (61.3%), mean age 63.0 ± 14.9 years, 37.4% diabetic, treated by PD 9 (3-20) months with a HGS of 22.5 (15.5-30.2) kg, weight 73.6 ± 16.6 kg, % body fat 31.4 ± 4.2, and ALM index 7.52 ± 1.40 kg/m2. More patients were defined with muscle weakness using the EWGSOP compared to the FNIH criteria (X2 = 6.8, p = 0.009), whereas fewer patients met the EWGSOP criteria for muscle wasting compared to FNIH body mass index adjustment (X2 = 7.7, p = 0.006). However, when combining both criteria, there was no difference in the prevalence of sarcopenia between the different recommended definitions (11-15.5%). CONCLUSION: We report a much lower prevalence of sarcopenia compared to studies in haemodialysis patients. Although there may be an element of patient selection bias, PD patients are not subject to changes in hydration and electrolytes with haemodialysis, which can affect HGS and muscle mass measurements. Using HGS and segmental bioimpedance we found similar prevalence of sarcopenia using EWGSOP, FNIH, AWGS definitions.
