Internal medicine journal
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Internal medicine journal · Mar 2020
Addition of low dose acetazolamide as an adjunct in patients undergoing high dose methotrexate is safe and beneficial.
High-dose methotrexate (HDMTx) is utilised in central nervous system lymphoma and acute lymphoblastic leukaemia due to its ability to penetrate the blood-brain barrier. Despite its efficacy, nephrotoxicity is a potentially serious toxicity that could also exacerbate other methotrexate-related toxicities and compromise dose intensity. Acetazolamide (AZL) is a carbonic anhydrase inhibitor that causes an increase in bicarbonate excretion and consequently urine alkalinisation. Following occurrences of HDMTx-induced acute kidney injury (AKI) due to inadequate urine alkalinisation at our institution, routine AZL was administered to appropriate patients from 2010 onwards. ⋯ AZL appeared to diminish the incidence of HDMTx-induced toxicities, including reducing oedema-related weight gain. With mild, preventable hypokalaemia as the only noteworthy toxicity, AZL could be considered as an adjunct to HDMTx patient care.
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Internal medicine journal · Mar 2020
Diagnosis and management of pregnancies complicated by haemolysis, elevated liver enzymes and low platelets syndrome in the tertiary setting.
Haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome occurs in one to six per 1000 pregnancies; maternal death has been reported in 1-24% of cases. Vague presentation is common; hypertension and proteinuria which characterise pre eclampsia are often absent when HELLP syndrome presents. Physicians are often called on to review gravid patients with unexplained symptoms or abnormal laboratory results, and it is vital that these clinicians are aware of the myriad of ways in which HELLP syndrome may present and evolve. ⋯ Misdiagnosis and delayed recognition of HELLP syndrome are common due to vague and varying presentation. When HELLP syndrome is identified delivery is required to avoid catastrophic maternal and neonatal outcomes. We hope to provide guidance for general and obstetric physicians by providing contemporary evidence of the presentation and clinical course of pregnancies complicated by HELLP syndrome.