A&A practice
-
Case Reports
Physical Dependence in Patient With Chronic Low Back Pain Treated With Topiramate: A Case Report.
In the last decade, prescription of anticonvulsants for treatment of low back pain (LBP) increased 4-fold. Among them, topiramate has frequent side effects and a mechanism of action that is not fully understood. ⋯ A significant agonistic effect by topiramate on α-2 adrenergic receptors in the brain likely accounts for the symptoms of withdrawal that were seen. We attribute the resolution of her topiramate withdrawal symptoms to reduced norepinephrine (NE) release, a known effect of duloxetine administration.
-
Case Reports
Undiagnosed Systemic Mastocytosis Presenting as Postoperative Distributive Shock: A Case Report.
Systemic mastocytosis (SM) is a rare clinical condition resulting from a clonal proliferation of abnormal mast cells. The clinical presentation may vary from mild cutaneous manifestations to aggressive systemic symptoms including intermittent episodes of anaphylaxis. ⋯ Following a complex postoperative course, a bone marrow biopsy ultimately confirmed the diagnosis. Although rare, SM should be considered in the differential diagnosis of postoperative patients with unexplained and recurrent episodes of distributive shock.
-
Continuous positive airway pressure (CPAP) has been used in multiple clinical settings with increasing frequency. However, its use in improving blood oxygenation for difficult airways has never been a specific consideration. ⋯ In selected cases involving difficult airways, helmet CPAP may have some advantages. Additional studies are warranted to assess the benefits of introducing this device to RRT equipment.