Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0023380 (lethargy)
 5,697 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A Phase I trial of acivicin [L-(alpha S,5S)-alpha-amino-3-chloro-4,5-dihydro-5-isoxazoleacetic acid] has been performed on an escalating-dosage 24-hr continuous i.v. infusion schedule. Thirty-one patients received 77 courses of treatment, and all but one were evaluable for toxicity. Pharmacological monitoring in selected patients demonstrated that peak plasma levels correlated with dose. Postinfusion t1/2 beta was 6 to 9 hr, and urinary recovery of the administered dose was 14 to 19% as unchanged drug during the 24-hr infusion. Hematological and gastrointestinal toxicities were variable and not dose related. In contrast, neurotoxicity characterized by lethargy, fatigue, confusion, disorientation, hallucinations, nightmares, and truncal ataxia was dose limiting and related to plasma drug levels. A minimal antitumor response was observed in a patient with colorectal carcinoma, and a partial response occurred in a patient with liver metastases from gastric carcinoma. The recommended dose for Phase II trial by 24-hr infusion is 160 mg/sq m.
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PMID:Phase I and pharmacological study of acivicin by 24-hour continuous infusion. 710 49

Hyperparathyroid crisis is a rare disease but should be suspected in acutely ill patients complaining of weakness, lethargy, nausea, vomiting, confusion and abdominal pain. Despite the variety of clinical manifestations, the syndrome forms a distinctive pattern which, in the presence of a serum calcium level greater than 16 mg/100 ml, should be recognized. The most difficult problem in diagnosis is the differentiation of hyperparathyroid crisis from ectopic parathyroid hormone-producing tumors. The disease is an endocrine emergency which requires prompt surgery after rapid correction of dehydration and hypercalcemia. The best results are achieved by removing offending parathyroid tissue within 72 hours after the onset of symptoms.
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PMID:Primary hyperparathyroidism: hyperparathyroid crisis. 730 6

Acetazolamide-induced central nervous system toxicity occurred in two patients undergoing hemodialysis. Symptoms of toxicity included fatigue, lethargy, and confusion, which resolved several days after discontinuing acetazolamide. Pharmacokinetic studies showed markedly elevated serum concentrations of the drug during the period of toxicity, which decreased at a slower rate compared with that reported in patients with normal renal function. The effect of hemodialysis on acetazolamide clearance was quantified. The agent should be avoided in patients receiving dialysis unless the dosage is reduced and serum concentration monitoring can be performed in a timely manner. These patients should be monitored closely for central nervous system toxicity if acetazolamide is given.
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PMID:Acetazolamide toxicity and pharmacokinetics in patients receiving hemodialysis. 747 8

The use of psychotropic drugs has been associated with the syndrome of inappropriate antidiuretic hormone secretion (SIADH) in a number of case reports. SIADH is characterised by the sustained release of antidiuretic hormone (ADH) from the posterior pituitary. The patients have a reduced ability to excrete diluted urine, ingested fluid is retained, and the extracellular fluid expands and becomes hypo-osmolar. The cardinal signs are hyponatraemia, serum hypoosmolality and a less than maximally diluted urine. Common symptoms include weakness, lethargy, headache, anorexia and weight gain. These symptoms may be followed by confusion, convulsions, coma and death. The early symptoms are vague and nonspecific, and they may even mimic the symptoms of the psychiatric disorder itself. For antidepressants, the risk of SIADH seems to be highest during the first weeks of treatment. For antipsychotics, the risk seems to be more spread out in time. The causative role of the drug may sometimes be difficult to estimate, as even drug-free psychiatric patients, mostly those with schizophrenia, develop SIADH on the basis of psychogenic polydipsia. Smoking is another factor associated with the development of SIADH, and the risk may also increase with age. The acute treatment of SIADH induced by a psychotropic drug includes discontinuation of the drug as well as restriction of fluid intake. In cases with significant clinical symptoms, infusion of sodium chloride is recommended. After the acute management, it is useful to evaluate the causative role of the drug by performing a water loading test and/or drug rechallenge. If continued treatment with an antidepressant or antipsychotic is indicated, a drug with a different pharmacological profile should be chosen, and the serum sodium levels should be monitored closely. If treatment with the drug that caused SIADH must be continued, concomitant treatment with demeclocycline may reduce the tendency of hyponatraemia.
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PMID:Hyponatraemia and the syndrome of inappropriate antidiuretic hormone secretion (SIADH) induced by psychotropic drugs. 761 32

We report a case of subacute encephalopathy with seizures in chronic alcoholism (age 34 years). This syndrome clearly differs from the known neurological complications of chronic alcoholism. One of the authors has observed (and reported) such cases in the Baltimore area. Subacute encephalopathy is characterized by lethargy, confusion and neurological deficits such as hemiparesis, homonymous hemianopsia and aphasia. Epileptic seizures (generalized tonic-clonic, focal) are obligatory. The EEG shows very prominent slowing and periodic lateralized paroxysmal discharges (PLEDs). The condition is complicated by a variety of internal-medical complications. Structural neuroradiological tests are either normal or irrelevant. The cause and pathogenesis remain obscure. The subacute course ends with gradual resolution.
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PMID:[Subacute encephalopathy with seizures in chronic alcoholism]. 768 29

The value of the PCR for CMV in the CSF was evaluated. 23 samples from 20 patients were examined for CMV DNA, of which 11 were positive and 12 were negative for CMV. The clinical spectrum of the patients with positive samples included encephalitis, encephalitis, and polyradiculopathy, or isolated polyradiculopathy. The main symptoms were fever, confusion, lethargy, cognitive disturbance, cranial neuropathy, weakness of the legs, and incontinence. The laboratory evaluation showed a low CD4 lymphocyte count, a slightly increased blood sedimentation rate and a large variation of CSF patterns. The CMV early antigen tests were negative in all cases. In 4 cases the neuroradiological examination was compatible with CMV infection. 8 patients were treated with ganciclovir or foscarnet. Improvement of symptoms was observed in 2 cases and stabilization in 2 others. However, the CMV infection was rapidly progressive and 9 out of 10 patients died after a mean of 53 days after diagnosis.
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PMID:[Clinical value of a polymerase chain reaction on cytomegalovirus DNA in cerebrospinal fluid in HIV patients with neurological symptoms]. 774 Feb 95

From the literature and our own experience, 11 cases of hemorrhage or infarction of a pituitary adenoma associated with cardiac surgery have been identified over a 13-year period. Males outnumbered females by 10 to 1. Symptoms observed were headache, lethargy, confusion, obtundation, unilateral ptosis, meiosis, and opthalmoplegia involving cranial nerves III, IV, and VI, visual field deficits, and hemiparesis. Diagnosis in most recent cases has been confirmed with computerized tomography or magnetic resonance imaging. All patients received adrenocortical steroid therapy initially. Eight patients underwent transsphenoidal hypophysectomy and all survived. One patient underwent decompression craniotomy and died. Intracranial surgery was deferred in 1 patient who survived and in another who died of a massive stroke. Residual neurological deficits were noted to be either absent, minimal, or resolving in 7 of the 9 patients who survived their initial hospitalization. While numerous mechanisms have been proposed to explain the hemorrhage and necrosis of a pituitary adenoma during heart surgery, no direct cause has been clearly identified. Surgical treatment is commonly necessary since untreated pituitary apoplexy is often fatal. Transsphenoidal hypophysectomy with decompression is the preferred method of treatment with a low perioperative mortality and fairly good long-term prognosis.
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PMID:Pituitary adenomas complicating cardiac surgery: summary and review of 11 cases. 777 76

Adiposis dolorosa is a disease characterized by painful, subcutaneous fatty tumors. This disorder usually occurs in obese, postmenopausal women and is associated with weakness and mental disturbances such as depression, confusion, lethargy, and dementia. The cause is unknown, and there is no specific treatment. Pain may be relieved by steroids, intravenous lidocaine, or analgesics. Surgical treatment consists of excision or liposuction of the painful masses. We present two cases of adiposis dolorosa in men, with a follow-up of more than 10 years.
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PMID:Adiposis dolorosa (Dercum's disease): 10-year follow-up. 788 63

Hypopituitarism is uncommon in elderly people. We report 12 cases of hypopituitarism diagnosed after the age of 60 (range 63-89, mean 74.9) years over a 10-year period. Aetiology was evident in eight cases, viz. pituitary tumour in six and previous post-partum haemorrhage and giant aneurysm of carotid artery in one each. The presentation was often non-specific with symptoms such as lethargy, pallor, falls, urinary incontinence, confusion, fever and flexion contractures. Subtle clues to the condition were missed in four cases resulting in delayed diagnosis. Although levels of pituitary trophic hormones are generally low in this condition, the thyrotrophin (TSH) was normal in seven cases in the present series. Normal levels of serum sodium and potassium did not exclude cortisol deficiency. Hormone replacement therapy resulted in improved quality of life. Physicians dealing with elderly patients should bear this easily treated condition in mind.
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PMID:Hypopituitarism: a difficult diagnosis in elderly people but worth a search. 776 67

The two physiologic components of conscious behaviour, namely arousal (vigilance) and content of consciousness (presence of mind), may be affected differently, depending on the type and distribution of the underlying brain disease. Disturbance of arousal primarily affects wakefulness and awareness and leads to obtundation, stupor and coma. States of reduced arousal are caused by bilateral lesions of the so-called ascending reticular activating system (ARAS), which is situated in the upper brainstem and the paramedian diencephalon. If, on the other hand, cognitive and mnemic function are degraded, the contents of consciousness are disordered; depending on the extent of the disturbance, confusion, lethargy and, finally, a vegetative state ensues. The chronic vegetative state (coma vigil) describes a condition of total mental loss with preserved vegetative functions and arousal. Degraded cognitive and mnenic functions results from either toxic-metabolic or extensive structural disorders of the cerebral cortex, where the limbic and mesial frontal areas play a dominant role for conscious behaviour. If the function of extensive areas of both hemispheres is suddenly depressed, temporarily reduced arousal also results. In order to differentiate between toxic-metabolic and structural brain diseases, the motor reactions, the ocular and the pupillary reflexes must be examined apart from responsiveness.
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PMID:[Neurology of consciousness and of consciousness disorders]. 813 47


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