Acta Medica Port
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Review Case Reports
Lithium Intoxication after Bariatric Surgery: A Case Report.
Bariatric surgery is a therapeutic option to treat obesity in (carefully selected) patients with psychiatric disorders. About half of the patients referred for bariatric surgery have a diagnosis of (at least one) mental disorder and most of them are treated with psychotropic drugs. This procedure may modify the bioavailability of drugs and lithium is no exception. ⋯ We conducted a review of the published clinical cases in the scientific literature about lithium toxicity after bariatric surgery, and we propose potential preventive clinical solutions. It is essential to increase awareness of changes to the absorption of psychotropic drugs in the post-surgery period, particularly in the case of lithium. Regular postoperative clinical and laboratory monitoring of lithium serum levels is strongly recommended.
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Diabetes is a very common chronic disease in the Portuguese population, with an estimated prevalence of 13.6% in the adults. Doubts often arise regarding the best preparation and the risks associated with doing imaging tests in these patients. ⋯ The main topics addressed in this article are the need to suspend metformin after the administration of endovascular iodinated contrast due to the risk of lactic acidosis, the precautions in insulin-treated patients or those taking medicines with a higher risk of hypoglycemia when performing imaging tests that require fasting, and the influence of hyperglycemia and of anti-diabetic therapy on the sensitivity of PET-FDG. With this review and the presentation of a guideline, we intend to demystify and simplify the management of individuals with diabetes who are undergoing imaging tests.
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Determination of renal function is particularly important when prescribing antibiotics to elderly patients. This study aims to determine the correlation between estimated creatinine clearance and the estimated glomerular filtration rate, for a hospitalized population of very elderly patients, and to audit antibiotic prescribing errors. ⋯ This study supports the maintenance of the Cockcroft-Gault equation for drug dosing in the very elderly population. Further studies are needed to investigate underlying causes of prescribing errors.