Clin Med
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Review
Management of acute exacerbations of chronic obstructive pulmonary disease: the first 24 hours.
Successful outcome is more likely with early treatment and lesser degrees of acidosis. While aiming for maximum treatment for the first 24 hours, some patients improve so rapidly that they can discontinue after a shorter time. Most patients need a full face mask and oxygen, and nebulised bronchodilators can be incorporated. ⋯ Patients can often be quickly weaned on to NIV and returned to the ward after an initial period of invasive support and secretion management. Initial assessment and the past history should identify those markedly disabled patients with recurrent admissions who are likely to be entering the terminal stages of their illness in whom intubation is inappropriate. Here, NIV may be the ceiling of treatment, providing useful symptom palliation while waiting for treatment to
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In a paper in the last issue of Clinical Medicine, some of the background to attitudes to newly dead bodies, the current context of an urgent need for organs for transplant and the objections to calling a proposal to address this 'presumed consent' were outlined. Here further concerns are explored.
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This report highlights a case of severe hyponatraemia secondary to excessive sweating and salt [corrected] poor fluid consumption and low salt diet in hot conditions. The case was complicated by the presence of marked hypokalaemia caused by secondary hyperaldosteronism confirmed, for the first time, by the presence of grossly elevated serum renin and aldosterone concentrations. With the rise in global temperature affecting even temperate climates doctors, especially in acute and general medicine, may be faced with this condition more often.