Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række
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Accidental hypothermia is an important clinical condition in emergency and disaster medicine. It is usually classified as mild, moderate, severe, or extreme (body temperature below 18-20 degrees C; no recordable EEG activity). However, exposure time, trauma, serious illness, or the effects of drugs or alcohol may both attenuate and complicate the clinical course. ⋯ The author also discusses choice of treatment in the acute stages, during transportation and in hospital. The treatment should take into account not only the degree of hypothermia, but also exposure time, state of consciousness, and complicating factors such as trauma, drugs or alcohol. When hypothermia is associated with cardiac arrest, rewarming by extracorporal support is recommended.
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The medical causes of coma fall into two main categories: intercranial diseases, and metabolic disturbances. The clinical examination should define 1) vital functions, 2) depth of coma, 3) whether cerebral signs are diffuse or local, 4) any signs of organ disease. The blood sugar level must be determined. ⋯ Head injury and intoxication/poisoning must always be considered, even if a medical cause is suspected. Prolonged coma calls for repeated clinical and laboratory examination. Combinations of causes, e.g. organ disease plus intoxication should be considered.
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Tidsskr. Nor. Laegeforen. · Aug 1993
[Therapeutic drug monitoring with the help of serum concentration measurements. How are the analytic results distributed in a population?].
Therapeutic drug monitoring includes measurement of serum concentrations of drugs when this is possible and appropriate. A therapeutic range is defined for populations where the serum levels represent an optimal relationship between clinical effects and side effects for most of the individuals in the population. Compared with the rest of the population, some individuals are atypical, both with respect to response to and elimination of drugs. ⋯ Compilation of serum level measurements for different drugs for a period of six months showed that the tailoring of digitoxin, carbamazepine, lithium and phenobarbital is as close to optimal as can be expected for a population. For amitriptyline, digoxin and theophylline, a considerable increase in clinical effect within a population of users could probably be achieved by bringing more individual serum levels from the subtherapeutic into the therapeutic range. Nor does the therapeutic potential of phenytoin, nortriptyline and valproate seem to be fully utilized.