Lab Rats In Lab Coats
Tumor-lysis syndrome (TLS) & Rhabdomyolysis
They both cause:
- Hyperuricemia.
- Hyperkalemia.
- Hyperphosphatemia.
- Hypocalcemia (but can become hypercalcemia in later stages).
- Hypoalbuminemia (due to AKI).
- Rhabdo alone causes myoglobinuria.
- Hyperuricemia.
- Hyperkalemia.
- Hyperphosphatemia.
- Hypocalcemia (but can become hypercalcemia in later stages).
- Hypoalbuminemia (due to AKI).
- Rhabdo alone causes myoglobinuria.
A case of Rhabdomyolysis
A 28-year-old woman is admitted to the emergency department in a coma. The patient was found unconscious on the floor by her boyfriend. She had not been seen by anyone for the previous 48 h. No history was available from the patient, but her partner volunteered the information that they are both intravenous heroin addicts. She is unemployed, smokes 25 cigarettes per day, drinks 40 units of alcohol per week and has used heroin for the past 4 years. They have occasionally shared needles with other addicts. They both had negative HIV tests about 1 year ago. She has not made any suicide attempts in the past. She has had no other medical illnesses.
On examination, there are multiple old scarred needle puncture sites. Her PR is 64/min regular, BP 110/60 mmHg, JVP not raised, heart sounds normal. Her RR is 12/min, and she has dullness to percussion and bronchial breathing at the left base posteriorly. Abdominal examination is normal. Her conscious level is depressed but she is rousable to painful stimuli. She has pinpoint pupils, but has no focal neurological signs. A bolus injection of intravenous naloxone causes her conscious level to rise transiently. Her left arm is swollen and painful from the shoulder down.
A 28-year-old woman is admitted to the emergency department in a coma. The patient was found unconscious on the floor by her boyfriend. She had not been seen by anyone for the previous 48 h. No history was available from the patient, but her partner volunteered the information that they are both intravenous heroin addicts. She is unemployed, smokes 25 cigarettes per day, drinks 40 units of alcohol per week and has used heroin for the past 4 years. They have occasionally shared needles with other addicts. They both had negative HIV tests about 1 year ago. She has not made any suicide attempts in the past. She has had no other medical illnesses.
On examination, there are multiple old scarred needle puncture sites. Her PR is 64/min regular, BP 110/60 mmHg, JVP not raised, heart sounds normal. Her RR is 12/min, and she has dullness to percussion and bronchial breathing at the left base posteriorly. Abdominal examination is normal. Her conscious level is depressed but she is rousable to painful stimuli. She has pinpoint pupils, but has no focal neurological signs. A bolus injection of intravenous naloxone causes her conscious level to rise transiently. Her left arm is swollen and painful from the shoulder down.
The stimulation of serotonin receptor 2B (5-HT2B) causes abnormal proliferation of the cardiac valves and subsequently valvular disease.
This is one of the reasons why carcinoid syndrome causes valvular disease: because the excessive amounts of serotonin activate this receptor and, as a result, alter the architecture of the valves.
Some drugs can also activate this receptor and, therefore, cause valvular disease. Pergolide was used to treat Parkinson's disease but was withdrawn from US markets due to reports of valvular disease among its users. It is still used in veterinary medicine (to treat equine cushing's disease).
This is one of the reasons why carcinoid syndrome causes valvular disease: because the excessive amounts of serotonin activate this receptor and, as a result, alter the architecture of the valves.
Some drugs can also activate this receptor and, therefore, cause valvular disease. Pergolide was used to treat Parkinson's disease but was withdrawn from US markets due to reports of valvular disease among its users. It is still used in veterinary medicine (to treat equine cushing's disease).
Also known as: Pituitary Pars Intermedia Dysfunction (PPID)
Forwarded from 0/0 (Haidar A. Fahad)
هاي كلما أبدي بموضوع طبي، الكة روحي بموضوع بيه نباتات سامة وتاريخ محشش
Lab Rats In Lab Coats
Tumor-lysis syndrome (TLS) & Rhabdomyolysis
بالمناسبة، نسيت أذكر هالسالفة:
Legionella is the most common bacteria associated with rhabdomyolysis.
Malaria due to P. falciparum is also an important cause of rhabdo.
Legionella is the most common bacteria associated with rhabdomyolysis.
Malaria due to P. falciparum is also an important cause of rhabdo.
Lab Rats In Lab Coats
Tumor-lysis syndrome (TLS) & Rhabdomyolysis
And, if I can remember correctly, allopurinol is used for prophylaxis (not the correction) of hyperuricemia associated with TLS.
Lab Rats In Lab Coats
Hypercalcemia
Etiology:
90% of hypercalcemia cases are caused by hyperparathyroidism (HPT) & malignancy. Other less common, but more interesting causes, include granulomatous disorders, thiazide use, vitamin A toxicity, and William-Beuren syndrome.
It occurs in about 1-2% of the population, and is usually asymptomatic, unless it is severe or the onset is acute.
90% of hypercalcemia cases are caused by hyperparathyroidism (HPT) & malignancy. Other less common, but more interesting causes, include granulomatous disorders, thiazide use, vitamin A toxicity, and William-Beuren syndrome.
It occurs in about 1-2% of the population, and is usually asymptomatic, unless it is severe or the onset is acute.
Signs and symptoms:
The severity of symptoms are related to how fast the condition develops, rather than the degree of hypercalcemia. Therefore, it is not uncommon for a fairly high, but chronic hypercalcemia to be asymptomatic, but a relatively moderate, yet acute hypercalcemia to cause symptoms.
Signs and symptoms of hypercalcemia are usually combined in the mnemonic "groans bones stones moans thrones psychic overtones":
• Groans: Gastrointestinal symptoms like pain, nausea, and vomiting. Hypercalcemia can lead to peptic ulcer disease and pancreatitis.
• Bones: Bone related complications like bone pain. Hypercalcemia can lead to osteoporosis, osteomalacia, arthritis and pathological fractures.
• Stones: Renal stones causing pain.
• Moans: Refers to fatigue and malaise.
• Thrones: Polyuria, polydipsia, and constipation (sitting on the toilet as you are sitting on a throne).
• Psychic overtones: Lethargy, confusion, depression and memory loss.
Hypercalcemia also causes muscle weakness and ECG changes: prolonged PR interval, short QT interval, widened QRS complex, and bradycardia.
The severity of symptoms are related to how fast the condition develops, rather than the degree of hypercalcemia. Therefore, it is not uncommon for a fairly high, but chronic hypercalcemia to be asymptomatic, but a relatively moderate, yet acute hypercalcemia to cause symptoms.
Signs and symptoms of hypercalcemia are usually combined in the mnemonic "groans bones stones moans thrones psychic overtones":
• Groans: Gastrointestinal symptoms like pain, nausea, and vomiting. Hypercalcemia can lead to peptic ulcer disease and pancreatitis.
• Bones: Bone related complications like bone pain. Hypercalcemia can lead to osteoporosis, osteomalacia, arthritis and pathological fractures.
• Stones: Renal stones causing pain.
• Moans: Refers to fatigue and malaise.
• Thrones: Polyuria, polydipsia, and constipation (sitting on the toilet as you are sitting on a throne).
• Psychic overtones: Lethargy, confusion, depression and memory loss.
Hypercalcemia also causes muscle weakness and ECG changes: prolonged PR interval, short QT interval, widened QRS complex, and bradycardia.