Magnum, P.I.

​An 11-year-old boy with cerebral palsy presented to the emergency department unresponsive. His mother said the child was in his normal state earlier that morning, but was blue and unresponsive when she tried to wake him from his morning nap. A home pulse oximeter reported an oxygen level of 55%.The mother placed the child on oxygen and called 911. He was still unresponsive on arrival, and his physical examination demonstrated flaccid paralysis and a GCS score of 3 with fixed dilated pupils. He was tachycardic with shallow respirations. His initial vital signs were a temperature of 36.9°C, a heart rate of 136 bpm, a respiratory rate of 16 bpm, and a blood pressure of 89/38 mm Hg.The boy was G-tube dependent, and his mother stated that he also had chronic GI bleeding and was supposed to see the gastroenterologist the next day. His medication list included valproic acid, felbamate, topiramate, and baclofen. His initial VBG showed a pH of 7.01, a CO2 of 126.02, and an HCO3 of 31.1, with a lactic acid of 2.8. He was intubated because of his mental status and admitted to the PICU, where the mother reported that she had also given him 240 mL of magnesium citrate to prep him for a colonoscopy he was due to have the following day.What Is the Differential?Brain stem herniationSepsisBaclofen, topiramate, or valproic acid overdoseHyperammonemia secondary to valproic acidHypermagnesemia The Clinical Effects of HypermagnesemiaNormal serum levels range from 1.3 to 2.2 mEq/L. Onl...
Source: The Tox Cave - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

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Conclusion: Both hypocalcemia and hypercalcemia were associated with increased short- and long-term mortality with a U-shape relationship. PMID: 32066311 [PubMed - as supplied by publisher]
Source: Postgraduate Medicine - Category: Internal Medicine Tags: Postgrad Med Source Type: research
Publication date: Available online 19 February 2020Source: Mechanisms of Ageing and DevelopmentAuthor(s): Konstantinos Palikaras, Nektarios TavernarakisAbstractMaintenance of synaptic homeostasis is a challenging task, due to the intricate spatial organization and intense activity of synapses. Typically, synapses are located far away from the neuronal cell body, where they orchestrate neuronal signalling and communication, through neurotransmitter release. Stationary mitochondria provide energy required for synaptic vesicle cycling, and preserve ionic balance by buffering intercellular calcium at synapses. Thus, synaptic h...
Source: Mechanisms of Ageing and Development - Category: Geriatrics Source Type: research
We report a case of a young male with no prior genitourinary history who presents to an emergency department with sudden onset gross hematuria, clot retention, and right-sided flank pain. On evaluation, he was found to have a renal artery aneurysm bleeding into his collecting system and underwent renal artery embolization and rapid resolution of his hematuria. Renal vascular pathology should be considered in the differential diagnosis and timely diagnosis of this condition is imperative as surgical interventions have proven to be life-saving. PMID: 32065873 [PubMed - in process]
Source: Canadian Journal of Urology - Category: Urology & Nephrology Tags: Can J Urol Source Type: research
Authors: Marshall MR Abstract There are a number of misconceptions around the identified early survival benefit of peritoneal dialysis (PD) relative to hemodialysis (HD), including that such benefits "even out in the end" since the relative risk of death over time eventually encompasses 1.0 (or even an estimate that is unfavorable to PD); that the early benefit is, in fact, most likely due to unmeasured confounding; and such benefits are only due to the influence of central venous catheters and "crash starters" in the HD group. In fact, the early survival benefit results in a substantial gain of...
Source: Peritoneal Dialysis International - Category: Urology & Nephrology Tags: Perit Dial Int Source Type: research
Authors: Lew SQ, Sikka N Abstract The 2018 Bipartisan Budget Act in the United States extended telehealth access to Medicare beneficiaries who receive home dialysis in which two of three monthly visits in a quarter may be performed by telehealth after three initial face-to-face monthly visits. The originating site (where the patient is located) can be a dialysis unit or the patient's home and without geographic restriction. Patient awareness and interest in this new telehealth benefit in urban patients has not been well characterized. Patients receiving peritoneal dialysis (PD) treatment located in an urban facilit...
Source: Peritoneal Dialysis International - Category: Urology & Nephrology Tags: Perit Dial Int Source Type: research
CONCLUSION: Long-term survival following EPS managed conservatively with nutritional support is feasible, with the majority no longer requiring nutritional support and having a quality of life similar to other patients with ESKD. PMID: 32067553 [PubMed - as supplied by publisher]
Source: Peritoneal Dialysis International - Category: Urology & Nephrology Tags: Perit Dial Int Source Type: research
CONCLUSION: Postulated transient increases in peritoneal capillary surface area were unnecessary to predict the entire Heimburger measurements. PMID: 32065069 [PubMed - as supplied by publisher]
Source: Peritoneal Dialysis International - Category: Urology & Nephrology Tags: Perit Dial Int Source Type: research
Authors: Lam E, Lien YTK, Kraft WK, Piraino B, Vozmediano V, Schmidt S, Zhang J Abstract Intraperitoneal vancomycin is the first-line therapy in the management of peritoneal dialysis (PD)-related peritonitis. However, due to the paucity of data, vancomycin dosing for peritonitis in patients on automated peritoneal dialysis (APD) is empiric and based on clinical experience rather than evidence. Studies in continuous ambulatory peritoneal dialysis (CAPD) patients have been used to provide guidelines for dosing and are often extrapolated for APD use, but it is unclear whether this is appropriate. This review summarize...
Source: Peritoneal Dialysis International - Category: Urology & Nephrology Tags: Perit Dial Int Source Type: research
Authors: Cho Y, Davies SJ, Johnson DW PMID: 32063221 [PubMed - as supplied by publisher]
Source: Peritoneal Dialysis International - Category: Urology & Nephrology Tags: Perit Dial Int Source Type: research
CONCLUSIONS: In this randomized controlled trial, we were unable to demonstrate that regular, targeted testing and retraining of new PD patients increased the time to first peritonitis or reduced the rate of peritonitis, as the study comprised patients with a low risk of peritonitis, was underpowered, open to type 1 statistical error, and contamination between groups. PMID: 32063220 [PubMed - as supplied by publisher]
Source: Peritoneal Dialysis International - Category: Urology & Nephrology Tags: Perit Dial Int Source Type: research
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