Southern medical journal
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Southern medical journal · Feb 1991
Case ReportsCerebrospinal fluid losses through ventricular catheters leading to hyponatremia in two children.
I have presented two cases of patients with hyponatremia due to excessive cerebrospinal fluid losses from ventricular drains. The possibility of such losses exists whether the drain is used to treat hydrocephalus or to monitor intracranial pressure. I find normal saline (sodium concentration = 154 mEq/L) to be an appropriate fluid to replace ongoing losses of cerebrospinal fluid from a ventricular drain and currently start such replacement therapy (mL for mL) when the drain is placed.
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We describe eight patients who had terminal lung cancer causing severe dyspnea unrelieved by oxygen, nonnarcotic drugs, or intermittent bolus narcotics. We treated these patients with continuous intravenous infusion of morphine, beginning with bolus IV injections of 1 or 2 mg of morphine every 5 to 10 minutes until the patient reported relief. A continuous morphine infusion was then started, with the hourly dose equal to 50% of the cumulative bolus dose. ⋯ We conclude that continuous morphine infusion is effective therapy for severe dyspnea. The treatment is ethically justified. Relief of suffering is the primary goal of therapy, and less risky treatments are unavailable.
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Southern medical journal · Feb 1991
Childhood firearms fatalities: the Metropolitan Dade County experience.
I reviewed the cases of childhood firearms fatalities in the files of the Medical Examiner Department of Metropolitan Dade County, in Miami, Florida. Comparison of cases during the 5-year period from 1966 through 1970 to those during the 5-year period from 1984 through 1988, noting basic epidemiologic parameters, showed that death due to firearms is increasing among children aged 14 years and younger.