European journal of internal medicine
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Rhabdomyolysis is a syndrome of skeletal muscle cell damage that leads to the release of toxic intracellular material into the systemic circulation. The pathogenesis of rhabdomyolysis is based on an increase in free ionized calcium in the cytoplasm. Its main complications include (a) acute renal failure, which is triggered by renal vasoconstriction and ischemia, (b) myoglobin cast formation in the distal convoluted tubules, and (c) direct renal toxic effect of myoglobin on the epithelial cells of proximal convoluted tubules. ⋯ The concomitant electrolyte and metabolic disorders should also be treated appropriately; hemodialysis should be considered when life-threatening hyperkalemia and metabolic acidosis exist. In the case of compartmental syndrome, it is important to monitor the intra-compartmental pressure and to perform fasciotomy, if required. When diagnosed early and if the appropriate treatment is initiated promptly, the complications of rhabdomyolysis are preventable and the syndrome has a good prognosis.
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Eur. J. Intern. Med. · Dec 2008
Persistent dyspnea complaints at long-term follow-up after an episode of acute pulmonary embolism: results of a questionnaire.
There is a lack of information on long term complications of patients with pulmonary embolism (PE), including chronic complaints of dyspnea. ⋯ A large percentage of patients with prior PE have persistent complaints of dyspnea at long term follow-up. The majority of them developed new or worsened dyspnea after the thrombo-embolic event. In comparison to a control population without a medical history of VTE, PE patients were overall significantly more dyspnoeic. An explanation for this phenomenon needs to be studied in further functional work-up of these patients.
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Acute alcohol intoxication is a clinically harmful condition that usually follows the ingestion of a large amount of alcohol. Clinical manifestations are heterogeneous and involve different organs and apparatuses, with behavioral, cardiac, gastrointestinal, pulmonary, neurological, and metabolic effects. ⋯ One specific drug that is useful in the treatment of acute alcohol intoxication is metadoxine, which is able to accelerate ethanol excretion. In patients presenting an acute alcohol intoxication, alcohol-related disorders should be detected so that the patient can be directed to an alcohol treatment unit, where a personalized, specific treatment can be established.
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Eur. J. Intern. Med. · Dec 2008
Comparative StudyPrevalence and significance of hypoalbuminemia in an internal medicine department.
Serum albumin is commonly measured in hospitalized patients. It has habitually been included among the parameters used for nutritional assessment, and recently its use has become even more widespread. Yet, no data are available in the literature about the prevalence and clinical significance of hypoalbuminemia in patients hospitalized in an internal medicine ward. The aim of this study was to investigate the prevalence and clinical significance of hypoalbuminemia in in-hospital internal medicine patients. ⋯ Hypoalbuminemia is very frequent in an internal medicine ward. In this setting, serum albumin is related to the length of hospitalization and to other parameters with a well-known prognostic value (age, hemoglobin) and clinical usefulness (ESR). It may also play a role in the evaluation of the possible association of onco-hematological diseases.