Hyponatremia is a common clinical problem in hospitalized patients and nursing home residents. It may also occur in healthy athletes after endurance exercise. The majority of patients with hyponatremia are asymptomatic and do not require immediate correction of the hyponatremia. While mild hyponatremia has traditionally been considered benign, symptomatic hyponatremia is a medical emergency requiring rapid correction to prevent the worsening of brain edema. However, it has been suggested that mild hyponatremia may be associated with gait disturbance, attention deficits, and an increased risk of falls, which may result in fracture, and its presence predicts a poor prognosis. The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is among the most frequent causes of chronic hyponatremia. Hyponatremia must be corrected slowly (<10~12 mmol/L within the first 24 h, and <18 mmol/L within the first 48 h) to avoid osmotic myelinolysis. Fluid restriction and demeclocycline are the treatments for chronic hyponatremia used most widely. However, fluid restriction is of limited use because of poor long-term compliance and demeclocycline lacks broad availability. In controlled clinical trials vaptans (a vasopressin receptor antagonist) was efficacious in mild to moderate SIADH with an acceptable safety profile. However, its long-term use is currently impractical and more data are needed.
Athletes ; Brain Edema ; Compliance ; Demeclocycline ; Emergencies ; Gait ; Humans ; Hyponatremia ; Inappropriate ADH Syndrome ; Nursing Homes ; Prognosis ; Receptors, Vasopressin

No abstract available.
Erythropoiesis ; Hematinics ; Hemoglobins

BACKGROUND: We evaluated the effectiveness of isolation measures using cohorting rooms and antimicrobial use in reducing the isolation rate of methicillin-resistant Staphylococcus aureus (MRSA) and multidrug-resistant Acinetobacter baumannii (MDR-AB). METHODS: Four cohorting rooms (16 beds) for patients colonized or infected with multidrug-resistant organisms (MDRO) have been created in the general wards of our 894-bed hospital since October 2003. We prospectively evaluated the isolation rates of MRSA and MDR-AB, and amount of antimicrobial use during the 8-year study period. We also investigated the relationship between antimicrobial use density (AUD) and the isolation rates of MRSA and MDR-AB. RESULTS: After creating cohorting rooms, the isolation rates of MRSA decreased from 1.56 cases per 1,000 patient-days from 2004-2005 to 1.24 from 2006-2007 (P=0.57). The isolation rates of MDR-AB also decreased from 0.72 from 2004-2005 to 0.36 from 2010-2011 (P<0.01). The mean quarterly AUDs of glycopeptides and carbapenems were 30.17+/-6.80 and 19.5+/-7.10, respectively. There were no significant correlations between AUD values and the isolation rate of MRSA or MDR-AB. CONCLUSION: This study suggests that isolation measures using cohorting rooms to help limit the transmission of MDRO infection and colonization, especially MDR-AB, in resource-limited settings is feasible and efficacious.
Acinetobacter ; Acinetobacter baumannii ; Carbapenems ; Cohort Studies ; Colon ; Drug Resistance ; Glycopeptides ; Humans ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Patient Isolation ; Patients' Rooms ; Prospective Studies

No abstract available.
Eating ; Humans ; Ketosis

Most cases of hypercalcaemia are secondary to malignancy or primary hyperparathyroidism. We report a patient presenting with a triad of hypercalcemia, metabolic alkalosis, and renal failure secondary to treatment of iatrogenic hypoparathyroidism and osteoporosis. Persistent ingestion of calcium carbonate and vitamin D caused milk-alkali syndrome. The patient was managed with intravenous fluids and withdrawal of calcium carbonate and vitamin D. She responded well to the treatment and the calcium concentration, renal function and metabolic alkalosis were normalized. Milk-alkali syndrome may be important as a reemerging cause of hypercalcemia.
Acute Kidney Injury ; Alkalosis ; Calcium ; Calcium Carbonate ; Eating ; Humans ; Hypercalcemia ; Hyperparathyroidism, Primary ; Hypoparathyroidism ; Osteoporosis ; Renal Insufficiency ; Vitamin D

Fungal infections are associated with the lowest incidence of post-operative infection following renal transplantation. These infections, however, are associated with a high mortality rate. A 58-year-old man who had received a kidney transplant presented with confused mental status. A brain computed tomography (CT) scan showed a 5.4 cm-sized, septate and thin-walled ring-enhancing lesion. The patient underwent aspiration and drainage of the brain lesion. Aspergillus fumigatus was stained in cultures of the aspirated material. Following surgery, the patient was treated with voriconazole for four months. After four months of anti-fungal treatment, the size of the brain abscess was decreased and serum creatinine was 1.5 mg/dL. Here, we present details of the case, which showed a favorable outcome with the combination of early surgery and voriconazol administration.
Aspergillosis ; Aspergillus fumigatus ; Brain ; Brain Abscess ; Creatinine ; Drainage ; Humans ; Incidence ; Kidney ; Kidney Transplantation ; Middle Aged ; Pyrimidines ; Transplants ; Triazoles