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4.
Emergencias (St. Vicenç dels Horts) ; 28(1): 38-40, feb. 2016. tab
Artigo em Espanhol | IBECS | ID: ibc-148465

RESUMO

El objetivo de este estudio es la detección de parámetros analíticos asociados a la mortalidad en los pacientes con diabetes mellitus tipo 2 (DM2) con tratamiento crónico con metformina que acuden a urgencias por un cuadro clínico agudo con presencia de acidosis láctica. Se trata de un estudio observacional-analítico retrospectivo realizado en un hospital de tercer nivel. Se recogieron datos clínicos y analíticos en una serie de pacientes con acidosis láctica, estratificada por gravedad, y tratamiento con metformina para DM2. Se compararon los resultados en función de la mortalidad o supervivencia del episodio. De 16 pacientes estudiados, con una edad media de 70 años (rango de 60 a 77), el 75% presentó sintomatología gastrointestinal los 5 días previos a su ingreso. La mortalidad total observada fue del 19%, que se asoció a la presencia de sepsis al ingreso, leucocitosis con neutrofilia, plaquetopenia, elevación de proteína C reactiva (PCR), valores altos de procalcitonina y la comorbilidad con una o más patologías crónicas. Las cifras sé- ricas de metformina no se correlacionaron significativamente con la mortalidad. Se concluye que en pacientes con acidosis láctica y tratamiento con metformina pueden ser factores asociados a la mortalidad la presencia de criterios de sepsis, neutrofilia con plaquetopenia, elevación de PCR y de procalcitonina y la existencia de una o más patologías comórbidas (AU)


To identify analytical factors associated with mortality in patients with type-2 diabetes under long-term treatment with metformin who come to the emergency department with acute symptoms of lactic acidosis. Retrospective observational analysis of patient records in a referral hospital. We collected clinical data and laboratory results for a series of metformin-treated patients with type-2 diabetes who developed lactic acidosis, stratified by severity. Factors related to the episode were analyzed for associations with mortality or survival. Of 16 patients studied (mean age 70 years; range, 60-77 years), 75% had gastrointestinal symptoms in the 5 days before they came to the emergency department. Mortality (19%) was associated with sepsis on arrival; elevated white blood cell counts, particularly neutrophil counts; low platelet counts; high C-reactive protein (CRP) and procalcitonin levels; and 1 or more chronic concomitant diseases. Metformin concentration was not significantly associated with mortality. Signs of sepsis, high neutrophil counts with low platelet counts, elevated CRP and procalcitonin levels, and the presence of 1 or more concomitant diseases may be risk factors for death in metformin-treated patients with lactic acidosis (AU)


Assuntos
Humanos , Diabetes Mellitus Tipo 2/complicações , Acidose Láctica/mortalidade , Diabetes Mellitus Tipo 2/tratamento farmacológico , Metformina/uso terapêutico , Serviço Hospitalar de Emergência/estatística & dados numéricos , Tratamento de Emergência/métodos , Estudos Retrospectivos
5.
Emergencias ; 28(1): 38-40, 2016 02.
Artigo em Espanhol | MEDLINE | ID: mdl-29094825

RESUMO

EN: To identify analytical factors associated with mortality in patients with type-2 diabetes under long-term treatment with metformin who come to the emergency department with acute symptoms of lactic acidosis. Retrospective observational analysis of patient records in a referral hospital. We collected clinical data and laboratory results for a series of metformin-treated patients with type-2 diabetes who developed lactic acidosis, stratified by severity. Factors related to the episode were analyzed for associations with mortality or survival. Of 16 patients studied (mean age 70 years; range, 60-77 years), 75% had gastrointestinal symptoms in the 5 days before they came to the emergency department. Mortality (19%) was associated with sepsis on arrival; elevated white blood cell counts, particularly neutrophil counts; low platelet counts; high C-reactive protein (CRP) and procalcitonin levels; and 1 or more chronic concomitant diseases. Metformin concentration was not significantly associated with mortality. Signs of sepsis, high neutrophil counts with low platelet counts, elevated CRP and procalcitonin levels, and the presence of 1 or more concomitant diseases may be risk factors for death in metformin-treated patients with lactic acidosis.

7.
Emergencias (St. Vicenç dels Horts) ; 27(3): 169-173, jun. 2015. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-139123

RESUMO

Objetivo. Analizar el rendimiento de un punto de corte de 3 μg/mL en la determinación de paracetamol urinario (PCTo) como método de cribado para detectar paracetamol en posibles sobreingestas en población pediátrica. Método. Estudio de caso-control, observacional, analítico y prospectivo realizado en una unidad de cuidados intensivos pediátricos (UCIP). Se seleccionó una muestra compuesta por aquellos pacientes ingresados en UCIP, considerando el grupo de casos aquellos con administración pautada de una dosis terapéutica endovenosa de paracetamol y un grupo control sin administración del fármaco. Se recogió una muestra de orina dentro de la primera hora y una segunda muestra pasadas 4 horas de la dosis del fármaco. En todos se determinó PCTo cuantitativamente. Se comparó la proporción de pacientes con PCTo _ 3 μg/mL. Se calcularon sensibilidad, especificidad y valores predictivos. Resultados. Se incluyeron 40 niños de edades entre 1 mes y 19 años (20 en cada grupo). No se obtuvo ningún paciente de control con PCTo positiva. La sensibilidad de la prueba en la primera orina recogida fue del 95% (IC 95%: 85,5-100%) y su especificidad del 100%. El valor predictivo positivo fue 100%, y el negativo del 95,2% (IC 95%: 86,1-100%). En las segundas orinas recogidas todos los valores de rendimiento del test fueron del 100%. Conclusión. La detección de PCTo antes de las 4 horas es útil para descartar la ingesta de paracetamol en población pediátrica. Se requieren estudios que permitan validar el nuevo punto de corte de 3 μg/mL para su posible inclusión en el algoritmo de sospecha de intoxicación aguda (AU)


Objective. To analyze the diagnostic yield of a cut-point of 3 μg/mL for paracetamol in urine to screen for poisoning in children. Methods. Prospective case–control observational study in a pediatric intensive care unit (PICU). All enrolled patients had been admitted to the PICU. Cases were children receiving a therapeutic dose of intravenous paracetamol. Controls were not receiving paracetamol. Urine samples were collected early in the morning and 4 hours after a dose of paracetamol was received by case patients. Paracetamol concentration was measured in all samples. We compared the percentages of cases and controls who had a concentration of 3 μg/mL or more. The sensitivity, specificity, and predictive values of the cut-point were calculated. Results. Forty children aged between 1 month and 19 years (20 per matched group) were enrolled. Paracetamol was not detected in any of the control samples. The sensitivity of the test in early morning urine was 95% (95% CI, 85.5%–100%); specificity was 100%. The positive predictive value was 100%; the negative predictive value was 95.2% (95% CI, 86.1%–100%). Paracetamol was detected in all of the second samples collected from cases. Conclusions. Measuring the paracetamol concentration in urine within 4 hours of dosing is useful to rule out prior intake of paracetamol and overdosing in PICU patients. Studies to validate the new cut-point of 3 μg/mL for paracetamol in urine are required with a view to possibly including it in a diagnostic protocol for suspected acute poisoning (AU)


Assuntos
Criança , Feminino , Humanos , Masculino , Acetaminofen/uso terapêutico , Sensibilidade e Especificidade , Valor Preditivo dos Testes , Envenenamento/complicações , Amostras de Medicamentos , Acetaminofen/toxicidade , Programas de Rastreamento/métodos , Estudos de Casos e Controles , Estudos Prospectivos , Cuidados Críticos/métodos
8.
Emergencias ; 27(3): 169-173, 2015 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-29077309

RESUMO

OBJECTIVES: To analyze the diagnostic yield of a cut-point of 3 µg/mL for paracetamol in urine to screen for poisoning in children. MATERIAL AND METHODS: Prospective case-control observational study in a pediatric intensive care unit (PICU). All enrolled patients had been admitted to the PICU. Cases were children receiving a therapeutic dose of intravenous paracetamol. Controls were not receiving paracetamol. Urine samples were collected early in the morning and 4 hours after a dose of paracetamol was received by case patients. Paracetamol concentration was measured in all samples. We compared the percentages of cases and controls who had a concentration of 3 µg/mL or more. The sensitivity, specificity, and predictive values of the cut-point were calculated. RESULTS: Forty children aged between 1 month and 19 years (20 per matched group) were enrolled. Paracetamol was not detected in any of the control samples. The sensitivity of the test in early morning urine was 95% (95% CI, 85.5%-100%); specificity was 100%. The positive predictive value was 100%; the negative predictive value was 95.2% (95% CI, 86.1%-100%). Paracetamol was detected in all of the second samples collected from cases. CONCLUSION: Measuring the paracetamol concentration in urine within 4 hours of dosing is useful to rule out prior intake of paracetamol and overdosing in PICU patients. Studies to validate the new cut-point of 3 µg/mL for paracetamol in urine are required with a view to possibly including it in a diagnostic protocol for suspected acute poisoning.

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