The American journal of medicine
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Review Case Reports
Osmotic demyelination syndrome following correction of hyponatremia: association with hypokalemia.
The osmotic demyelination syndrome (ODS) is a neurologic complication associated with rapid correction of hyponatremia. A case is described in which the patient was found to have hypokalemia as well as hyponatremia prior to the development of ODS. The literature was reviewed for cases of ODS in which patients had hyponatremia (serum sodium < or = 126 mmol/L) at presentation followed by correction of the hyponatremia. ⋯ The etiology of this complication is unclear. In neurologically stable patients with severe hyponatremia, it may be beneficial to correct hypokalemia prior to correction of the serum sodium. This maneuver may further reduce the incidence of ODS.
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To investigate the prevalence of certain chronic conditions among the elderly and to estimate the relative risk for pneumonia associated with each condition. ⋯ We found which elderly persons have an increased risk for pneumonia. Although the highest relative risk was associated with alcoholism, that condition was rare in this elderly population. Chronic obstructive lung diseases were more common and were also associated with a high relative risk. Heart disease had the highest public health impact because it was very common among the elderly and increased the risk of contracting pneumonia almost twofold; it also increased the risk of pneumonia-related death. These population-based data confirm and extend previous findings derived from selected patient groups and are useful for designing cost-effective pneumonia prevention programs.
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This study was designed to describe the cerebrospinal fluid (CSF) findings and neurologic diagnoses observed in human immunodeficiency virus (HIV)-infected adults undergoing diagnostic lumbar puncture (LP) and to correlate the results of LP with indications and CD4 counts. ⋯ CSF abnormalities were common at all stages of disease. LP was diagnostic in 22% of cases, but fewer than half of the diagnoses were of treatable secondary complications. Patients with a CD4 count higher than 0.200 x 10(9) have a very low incidence of opportunistic complications. The relatively low yield of LP in patients with altered mental status suggests that other testing modalities should be used prior to LP.
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The medical futility debate is usually framed as a conflict between physician and patient (or surrogate) over the right to decide whether a particular life-saving treatment is futile and should not be attempted. Arguments on behalf of physician-determined futility emphasize the limits of physicians' obligations; arguments on behalf of patient-determined futility reflect concerns over the potential erosion of recent gains in patient autonomy against medical paternalism. ⋯ Often overlooked in this debate, both at the bedside and in public commentary, is the ethical duty of the physician to redirect efforts from life-saving treatments toward the conscientious pursuit of treatments that maximize comfort and dignity for the patient and the grieving family. To supplement the limited terms of the futility debate with an ethic of care, physicians should lead in advocating greater awareness of the ethics of care in doctor-nurse interactions, institutional facilities, insurance policies, and public education.