Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0035078 (renal failure)
 31,970 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

There have been recent reports of rhabdomyolysis associated with cocaine abuse. The pathologic findings from these cases have not been described. Pathologic abnormalities in two fatalities with cocaine-associated rhabdomyolysis, including one with hyperpyrexia, acute renal failure, and disseminated intravascular coagulation, are discussed in detail. Skeletal muscle in both cases showed necrosis without evidence of vasculitis, polarizable foreign crystals, or other specific lesions. The individual with renal failure showed acute tubular necrosis with granular myoglobin casts in tubules. The mechanism of cocaine-associated rhabdomyolysis is unclear, but potentially includes ischemia due to vasoconstriction, direct toxicity, hyperpyrexia, and increased muscle activity from agitation or seizure. Adulterants may also play a role. In unexplained cases of rhabdomyolysis, toxicologic evidence of cocaine should be sought. In those cases of rhabdomyolysis associated with acute renal failure, the presence of cocaine in blood may be prolonged because of impaired renal clearance.
 ...
PMID:Rhabdomyolysis associated with cocaine abuse. 174 98

Lithium salts are used in psychiatry, for their sedative properties in states of agitation and, above all, for their ability to prevent recurring manic and depressive episodes in manic-depressive psychosis. In addition to manic-depressive psychosis, lithium is used as an antidepressant and the treatment of aggressive behaviors. Pharmacologic characteristics of lithium are incompletely elucidated; a few sedative and antiaggressive properties have been demonstrated in animals, but lithium fits into none of the known classes of psychoactive agents. Following absorption into the body, lithium does not bind to proteins. Penetration through the blood-brain barrier is poor. Elimination is mainly through the kidneys. Penetration of lithium into cells seems to vary across individuals. Lithium has a number of neurochemical effects, including stabilization of the number and sensitivity of monoaminergic receptors, which may be the mechanism for the drug's therapeutic properties. The main rule of lithium treatment is to achieve serum levels between 0.6 and 1 nM/l. Before starting a patient on lithium, tests are needed, especially to assess renal function: patients with renal failure are at risk for accumulation of lithium with toxic side effects. Most of the side effects are minor. The only serious risk is hyperlithemic intoxication that may cause mental confusion, coma and death. Lithium may induce malformations if given during the first trimester of pregnancy. The only true contraindications to lithium are renal failure, treatment by thiazide diuretics, and organic brain disease.
 ...
PMID:[Lithium]. 352 2

The prevalence, presentation, and outcome of bacteremia due to Shigella and other gram-negative bacteria were determined by review of records of 2,018 inpatients with shigellosis who had their blood cultured in a Bangladeshi hospital in 1976-1983. Shigella bacteremia occurred in 82 (4.1%) patients; other bacteremia occurred in 102 (5.1%) patients. Patients with shigella sepsis more frequently (P less than .02) manifested severe dehydration, abdominal tenderness or ileus, agitation or lethargy, and leukocytosis than did nonbacteremic controls; they developed more frequently (P less than .05) renal failure (26%), leukemoid reaction (22%), thrombocytopenia (20%), and hemolytic-uremic syndrome (6%). The prevalence of all bacteremia was highest in the first year of life. Protein-energy malnutrition was a strong risk factor for shigella sepsis (P less than .01). The fatality rate in shigella bacteremia (21%) was higher (P less than .005) than in nonbacteremic shigellosis (10%) but lower (P less than .001) than in other bacteremia (51%). At highest risk of death from shigella bacteremia (P less than .01) were patients less than one year old, non-breast-fed, malnourished, and afebrile.
 ...
PMID:Shigella septicemia: prevalence, presentation, risk factors, and outcome. 404 31

Between 27 September and 27 December 1969, 103 patients diagnosed as having yellow fever were admitted to Vom Christian Hospital, near Jos, Nigeria. Headache and vomiting were the commonest presenting complaints, and 95% of the patients showed scleral icterus or bile pigments in the urine. Haemorrhage, signs of renal failure, and CNS involvement (agitation, seizures) were associated with a grave prognosis. The overall case-fatality ratio was 45.6%. The average duration of illness for fatal cases was 6.4 days and for non-fatal cases 17.8 days. Six illustrative case histories are presented.
 ...
PMID:Clinical features of yellow fever cases at Vom Christian Hospital during the 1969 epidemic on the Jos Plateau, Nigeria. 453 38

The symptomatology and management of toxicity caused by nonprescription stimulants is reviewed. Nonprescription stimulants contain (singly or in combination) the same basic active ingredients: caffeine 100-200 mg, phenylpropanolamine 25-50 mg, and ephedrine 25 mg. Generally, toxic reactions involve excessive CNS stimulation (e.g., increased motor activity, anxiety, and agitation) and mildly elevated pulse rate and blood pressure that resolve in six to eight hours without specific treatment. However, reactions following the ingestion of these stimulants have included severe hypertension, possible renal failure, cerebral hemorrhage, and cardiac arrhythmias. Neither ephedrine nor caffeine ingested as single entities have been reported to produce increases in blood pressure associated with end-organ damage; however, severe hypertension has followed therapeutic doses of phenylpropanolamine. General management in the overdosed patient involves establishing respiration, initiating emesis, administering activated charcoal and a cathartic, and monitoring the patient's blood pressure, ECG, fluid intake, and urinary output. The increased availability of tablets and capsules containing substantial quantities of phenylpropanolamine, caffeine, and ephedrine creates a potential for drug-induced morbidity and mortality.
 ...
PMID:Managing acute toxicity from nonprescription stimulants. 676 97

We describe four major and five minor clinical patterns of acute phencyclidine (PCP) intoxication and give the incidence of findings in each pattern. Major patterns were acute brain syndrome (248 cases; 24.8%), toxic psychosis (166 cases; 16.6%), catatonic syndrome (117 cases; 11.7%), and coma (106 cases; 10.6%). Minor patterns included lethargy or stupor (38 cases; 3.8%), and combinations of bizarre behavior, violence, agitation, and euphoria in patients who were alert and oriented (325 cases; 32.5%). Patients with major patterns of PCP toxicity usually required hospitalization and accounted for most complications. In general, patients with minor patterns had mild intoxication and did not require hospitalization except for the treatment of injuries or autonomic effects of PCP. Various types of injuries occurred in 16%, and aspiration pneumonia occurred in 1.0% of all cases. There were 22 cases of rhabdomyolysis (2.2%), with three patients requiring dialysis for renal failure. One patient who had been comatose from PCP died suddenly. A fresh pulmonary embolism was found at autopsy.
 ...
PMID:Acute phencyclidine intoxication: clinical patterns, complications, and treatment. 723 37

Haemolytic transfusion reactions can be defined as the occurrence after transfusion of measurably increased destruction of red cells, of donor or recipient, by alloantibodies. They may be acute (occurring within 24 hours of transfusion) or delayed (when signs of red cell destruction do not occur until 4 to 10 days after transfusion). The severest signs and symptoms of acute reactions follow intravascular red cell lysis and progress to anaemia, fever, haemoglobinuria and jaundice. The subjective responses of pain, restlessness, nausea, skin flushing, dyspnoea and shock are mediated by cleavage products of complement (C3a, C5a) activated by red cell antigen-antibody reaction. The bleeding and renal failure complications that follow are multi-factoral in aetiology but also stem from the activation of intravascular clotting and from the vasomotor disturbances following histamine and kinin release.
 ...
PMID:Clinical presentation of haemolytic transfusion reactions. 739 74

Phenylpropanolamine hydrochloride is an amphetamine-like substance that is found in 64 different over-the-counter preparations for colds and appetite suppression. It is also found in numerous prescription drugs. Recently, it has been reported to cause symptoms of sympathomimetic-like effects, such as severe hypertension, hypertensive crisis, and possible renal failure. Also, several cases of psychotic episodes while taking phenylpropanolamine have been reported. This is the report of seven patients who have experienced acute CNS effects. These effects range from stimulation of the medullary respiratory center to tremor, restlessness, increased motor activity, agitation, and hallucinations.
 ...
PMID:Amphetamine-like reactions to phenylpropanolamine. 745 88

Rhabomyolysis with myoglobinuria has been added relatively recently to the neurologic complications associated with the increased use of cocaine and the introduction of its alkaloid form (crack). This retrospective study reports our experience with 14 patients who presented with rhabdomyolysis after cocaine use in a municipal hospital over a 3-year period. Seven patients used "crack", 2 intravenous and 3 nasal insufflation. All patients but one had hyperthermia, 11 altered mental status, 8 tachycardia, and 4 muscle rigidity. Nine developed renal failure; 3 of these patients died. Two other patients died of cardiorespiratory arrest. Cocaine-related rhabdomyolysis has a high mortality. The observed association with hyperthermia and other central neurologic features resembles the neuroleptic malignant syndrome. Since chronic cocaine use may alter the availability of dopamine either through transmitter depletion or decrease in the number of dopamine receptors, a common pathogenetic mechanism is possible. However, other mechanisms, which are not mutually exclusive but rather frequently overlapping, may play an important role. These include agitation, hyperthermia, adrenergic overstimulation leading to vasoconstriction and ischemia or calcium release from the sarcoplasmic reticulum resulting in increased entry into the muscle cell leading to cell death; in addition, cocaine has direct toxic effect on the muscles.
 ...
PMID:Rhabdomyolysis and hyperthermia after cocaine abuse: a variant of the neuroleptic malignant syndrome? 748 66

Based on the discussion of NMS, certain conclusions may be reached in regard to this patient. In the psychiatric setting, agitation and confusion alone are not suggestive of NMS. However in this patient, the symptoms of agitation, the rapid development of EPS symptoms unresponsive to anticholinergic therapy, autonomic changes (tachycardia, diaphoresis, and incontinence), and elevated CPK, met most of the diagnostic criteria described in Table VI. However, this case may have described an atypical presentation of NMS because of the absence of temperature increases during the onset of symptoms and the 7-week hospitalization for NMS. The patient's later onset of temperature elevations was a result of an aspiration pneumonia. Pneumonia and renal failure significantly increased the morbidity and extended the course of the illness. As a result, the diagnosis and specific treatment of NMS were delayed because of atypical symptoms and complications. In this patient, treatment of NMS with bromocriptine did not start until 10 days into hospitalization. A delay in pharmacologic therapy in this patient may have contributed to persistence of symptoms. The patient showed signs of improvement on day 21 during combination bromocriptine, benztropine, and dantrolene therapy. Moreover, this case exemplifies the rigorous need for supportive therapy and adjunctive pharmacologic therapy for primary and secondary complications resulting from NMS. In conclusion, because of the wide range of risk factors and variations of NMS, a systematic approach to diagnosing and treating NMS is critical to a successful outcome. Discontinuation of antipsychotics, maintenance of supportive therapy aimed at preventing dehydration, hemodynamic, and electrolyte imbalances, and pharmacotherapy are essential in the treatment of NMS.
 ...
PMID:An atypical course of neuroleptic malignant syndrome. 800


1 2 3 4 Next >>