QJM : monthly journal of the Association of Physicians
-
Accidental hypothermia is an uncommon problem that affects people of all ages, but particularly the elderly. This review briefly outlines the aetiological factors that may predispose to hypothermia, with particular reference to the effects of sepsis, although the specific situation of cold-water immersion is not addressed. ⋯ Clinically relevant findings are highlighted and some associated management points are related to the physiological changes. Most of these changes are reversible on rewarming, and are resistant to pharmacological manipulation; some of the pathological effects are related more to the process of rewarming than to the hypothermia itself.
-
Suspected meningitis is a frequent reason for admission to hospital in the UK. While bacterial meningitis requires prompt antibiotic therapy to reduce mortality and morbidity, enteroviral meningitis, the most frequent viral cause, is almost invariably a benign disease. ⋯ The proportion of patients with meningitis given pre-hospital antibiotics by GPs is still worryingly low, although early hospital management has improved. Improved diagnostic facilities, particularly viral PCR assays, reduce antibiotic usage and hospital stay, with considerable financial savings.
-
Renal replacement therapy (RRT) for acute renal failure (ARF) may be provided in many settings within the hospital. Such patients require a high level of care and often have a poor prognosis. No prospective studies have accurately defined this population, making the prediction of necessary resources and the planning of services difficult. ⋯ The annual incidence of ARF requiring RRT is just over 200 per million population, almost twice that of end-stage renal disease requiring RRT. Such treatment places high demands upon health care resources.
-
Increased opioidergic neurotransmission in the brain appears to contribute to the pruritus that complicates cholestasis and certain non-cholestatic chronic liver diseases. Opiate antagonists have been shown to decrease scratching activity in patients with the pruritus of cholestasis. ⋯ The infusion rate of naloxone should initially be very low; it should be increased gradually and stopped when a rate known to be associated with opioid antagonist effects has been attained. Oral therapy with an opiate antagonist can then be initiated.