65 research outputs found
O dijalizabilnosti lijekova
Drug dialyzability is determined by complex interaction of many factors, including the characteristics of the drug and the technical aspects of the dialysis system. Numerous aspects of dialysis prescription, including some elaborated in this article, have the potential to influence drug removal by dialysis. Care must be exercised when applying information from published reports of drug dialyzability to the individual patient. In order to provide the best information for individual patients, healthcare professionals should become familiar with the dialysis membranes utilized at their healthcare facility, and interpret literature information in that light. This article includes a table on dialyzability of drugs during conventional and high-permeability dialysis, and during peritoneal dialysis.Dijalizabilnost lijekova je odreÄena složenim meÄudjelovanjem mnogih Äimbenika ukljuÄujuÄi osobine lijeka i tehniÄke osobitosti sustava za dijalizu. Brojni Äimbenici propisivanja dijalize navedeni u ovom Älanku imaju bitan utjecaj na odstranjivanje lijeka. Potrebna je posebna pažnja pri uporabi postojeÄih informacija o dijalizabilnosti lijekova iz objavljenih izvjeÅ”Äa za svakoga bolesnika ponaosob. U cilju pronalaženja najbolje informacije za svakoga pojedinog bolesnika zdravstveni djelatnici trebaju dobro poznavati dijalizne membrane koje rabe i u tom svjetlu objasniti podatke iz literature. Ovaj Älanak sadrži tablicu s podacima o dijalizabilnosti lijekova tijekom konvencionalne, visokopropusne i peritonejske dijalize
O dijalizabilnosti lijekova
Drug dialyzability is determined by complex interaction of many factors, including the characteristics of the drug and the technical aspects of the dialysis system. Numerous aspects of dialysis prescription, including some elaborated in this article, have the potential to influence drug removal by dialysis. Care must be exercised when applying information from published reports of drug dialyzability to the individual patient. In order to provide the best information for individual patients, healthcare professionals should become familiar with the dialysis membranes utilized at their healthcare facility, and interpret literature information in that light. This article includes a table on dialyzability of drugs during conventional and high-permeability dialysis, and during peritoneal dialysis.Dijalizabilnost lijekova je odreÄena složenim meÄudjelovanjem mnogih Äimbenika ukljuÄujuÄi osobine lijeka i tehniÄke osobitosti sustava za dijalizu. Brojni Äimbenici propisivanja dijalize navedeni u ovom Älanku imaju bitan utjecaj na odstranjivanje lijeka. Potrebna je posebna pažnja pri uporabi postojeÄih informacija o dijalizabilnosti lijekova iz objavljenih izvjeÅ”Äa za svakoga bolesnika ponaosob. U cilju pronalaženja najbolje informacije za svakoga pojedinog bolesnika zdravstveni djelatnici trebaju dobro poznavati dijalizne membrane koje rabe i u tom svjetlu objasniti podatke iz literature. Ovaj Älanak sadrži tablicu s podacima o dijalizabilnosti lijekova tijekom konvencionalne, visokopropusne i peritonejske dijalize
LIJEÄENJE TEÅ KE DIJABETIÄKE KETOACIDOZE U MLADE OSOBE
We present a case of severe diabetic ketoacidosis in a 19-year-old male with a history of poor compliance to insulin therapy. At arrival to our Emergency Department, the patient was comatose with extreme hyperglycemia, severe diabetic ketoacidosis, lactic acidosis and dehydration. The treatment consisted of intensive fl uid replacement and correction of all metabolic disturbances until complete recovery. In the vast majority of severe diabetic ketoacidosis cases, relatively fast and successful treatment result can be expected if intensive therapy is applied and if ketoacidosis is not triggered by a serious illness. Some essential contemporary guidelines and the importance of individual treatment approach are pointed out in the article. The role of high serum procalcitonin value in diabetic ketoacidosis is discussed.Prikazan je sluÄaj 19-godiÅ”njeg bolesnika od dijabetesa koji nije redovito primjenjivao inzulin. Bolesnik je doveden na naÅ” objedinjeni hitni prijam u komatoznom stanju, s ekstremnom hiperglikemijom, teÅ”kom dijabetiÄkom ketoacidozom, laktacidozom i dehidracijom. LijeÄen je intenzivnom nadoknadom volumena i korekcijom svih metaboliÄkih poremeÄaja do potpunog oporavka. U velikoj veÄini sluÄajeva teÅ”kih dijabetiÄkih ketoacidoza može se oÄekivati relativno brza i uspjeÅ”na korekcija ako se primijeni intenzivno lijeÄenje i ako ketoacidoza nije potaknuta ozbiljnom bolesti. U Älanku su navedene neke bitne suvremene smjernice u lijeÄenju i naglaÅ”ena je važnost individualnog pristupa. Raspravljena je i uloga visoke serumske vrijednosti prokalcitonina u dijabetiÄkoj ketoacidozi
Primarni obostrani apsces boÄnoslabinskog miÅ”iÄa u starijeg muÅ”karca
Primary bilateral iliopsoas abscesses in the elderly are very rare in Europe. We report a case of an elderly male misdiagnosed with rheumatic low back pain. The delay in accurate diagnosis and therapy led to severe worsening of his general condition and septic shock. The diagnosis was established by multi-slice computed tomography (MSCT) and the patient was successfully treated by MSCT-guided percutaneous drainage of both psoas muscles. Septic shock and miscellaneous complications required continuous intensive care. The patient was discharged after 42 days of hospital treatment. Antibiotic therapy continued for the next six weeks until his complete recovery. Pain remains the most frequent and predominant symptom of spinal pathology regardless of the etiology. Immunocompromised patients or signs suggestive of bacterial infection require caution and a more comprehensive diagnostic work-up.Primarni, bilateralni apsces boÄnoslabinskog miÅ”iÄa (m. iliopsoasa) u starijih osoba vrlo je rijedak u Europi. Prikazujemo sluÄaj starijeg muÅ”karca u kojeg je postavljena pogreÅ”na dijagnoza križobolje. ZakaÅ”njenje u utvrÄivanju bilateralnog apscesa iliopsoasa i primjeni odgovarajuÄe terapije uzrokovalo je pogorÅ”anje opÄeg stanja i septiÄki Å”ok. Dijagnoza je potvrÄena multi-slice kompjutoriziranom tomografijom (MSCT), a bolesnik je uspjeÅ”no lijeÄen postavljanjem drena pod kontrolom MSCT u oba psoasa. SeptiÄki Å”ok i druge popratne komplikacije zahtijevale su kontiunirani nadzor u Jedinici intenzivne skrbi. Bolesnik je otpuÅ”ten kuÄi nakon 42 dana hospitalizacije. Antibiotska terapija nastavljena je joÅ” Å”est tjedana nakon otpusta do potpunog oporavka. Bol ostaje najÄeÅ”Äi i dominantni simptom bilo kojeg patoloÅ”kog procesa u podruÄju kralježnice. Imunokompromitirani bolesnici kao i bolesnici sa znacima koji upuÄuju na bakterijsku infekciju zahtijevaju posebnu pažnju i Å”iru dijagnostiÄku obradu
Masivna pluÄna embolija nakon trombocitopenije izazvane heparinom
Immunomediated heparin-induced thrombocytopenia still presents a serious problem, especially when accompanied by thromboembolic complications. We report on a rare case of massive pulmonary embolism following perioperative prophylaxis with unfractionated and low-molecular-weight heparin. The lack of efficacious and safe heparin substitution only allowed for immediate heparin discontinuation and application of adjuvant therapy. A few days after heparin cessation the platelet count tended to return to normal, leading to the patient\u27s full recovery and discharge from the hospital. Heparin therapy requires careful examination of previous history of heparin use as well as close platelet monitoring for up to three weeks of therapy cessation.Imuna trombocitopenija izazvana heparinom joÅ” uvijek predstavlja ozbiljan problem, osobito ako je praÄena tromboemboliÄnim komplikacijama. Ovdje prikazujemo rijedak sluÄaj masivne pluÄne embolije nastale nakon profilaktiÄne primjene nefrakcioniranog i niskomolekularnog heparina. Manjak uÄinkovitog i sigurnog nadomjeska za heparin ostavio je samo moguÄnost neposrednog ukidanja heparina i uvoÄenja pomoÄne terapije. Nekoliko dana nakon prestanka lijeÄenja heparinom broj trombocita poÄeo se je normalizirati, a nakon toga bolesnica se je potpuno oporavila i bila otpuÅ”tena iz bolnice. LijeÄenje heparinom zahtijeva brižno prikupljanje anamnestiÄnih podataka o ranijoj primjeni ovoga pripravka te pažljivo praÄenje broja trombocita i do tri tjedna nakon prekida heparinske terapije
Perioperacijsko zbrinjavanje bolesnika s kroniÄnim bubrežnim zatajenjem
Any surgical procedure, ranging from general operation (the most common procedures is surgical creation of arteriovenous fistula and catheter for peritoneal dialysis placement) to open heart surgery, may be performed in patients with chronic renal failure treated conservatively or with dialysis without a significant increase in the perioperative mortality and morbidity in comparison to patients without renal disease. This is possibly only with good perioperative management of these patients and multidisciplinary collaboration of nephrologist, anesthesiologist, cardiologist, surgeon, primary care physician and nursing staff to recommend strategies for reducing cardiac and renal risk for the planned surgical procedures.Svaki kirurÅ”ki postupak, od relativno jednostavnih (u ovih bolesnika najÄeÅ”Äi su operacijsko stvaranje arteriovenske fistule i postavljanje katetera za peritonejsku dijalizu) do operacije na otvorenom srcu, može se u bolesnika s kroniÄnim bubrežnim zatajenjem koji se lijeÄe konzervativno ili dijalizom uÄiniti bez znaÄajnog porasta pobola i smrtnosti u odnosu na bolesnike bez bubrežne bolesti. Kako bi se mogli provesti planirani kirurÅ”ki zahvati uz smanjenje srÄanog i bubrežnog rizika za ove bolesnike neophodna je multidisciplinska suradnja nefrologa, anesteziologa, kardiologa, kirurga, lijeÄnika opÄe medicine i sestrinskog tima za njegu bolesnika
Perioperacijsko zbrinjavanje bolesnika s kroniÄnim bubrežnim zatajenjem
Any surgical procedure, ranging from general operation (the most common procedures is surgical creation of arteriovenous fistula and catheter for peritoneal dialysis placement) to open heart surgery, may be performed in patients with chronic renal failure treated conservatively or with dialysis without a significant increase in the perioperative mortality and morbidity in comparison to patients without renal disease. This is possibly only with good perioperative management of these patients and multidisciplinary collaboration of nephrologist, anesthesiologist, cardiologist, surgeon, primary care physician and nursing staff to recommend strategies for reducing cardiac and renal risk for the planned surgical procedures.Svaki kirurÅ”ki postupak, od relativno jednostavnih (u ovih bolesnika najÄeÅ”Äi su operacijsko stvaranje arteriovenske fistule i postavljanje katetera za peritonejsku dijalizu) do operacije na otvorenom srcu, može se u bolesnika s kroniÄnim bubrežnim zatajenjem koji se lijeÄe konzervativno ili dijalizom uÄiniti bez znaÄajnog porasta pobola i smrtnosti u odnosu na bolesnike bez bubrežne bolesti. Kako bi se mogli provesti planirani kirurÅ”ki zahvati uz smanjenje srÄanog i bubrežnog rizika za ove bolesnike neophodna je multidisciplinska suradnja nefrologa, anesteziologa, kardiologa, kirurga, lijeÄnika opÄe medicine i sestrinskog tima za njegu bolesnika
The Epidemiology and Diagnostic Approach to Acute Pulmonary Embolism in the University Hospital
The aim of this retrospective study was to evaluate the demographics and clinical characteristics of patients with pulmonary embolism treated in medical intensive care unit (ICU) at the University Hospital during a six-year period, and to assess the impact of several risk factors on patientsā survival. The study included 165 patients, mean age 69.3 Ā± 13.7 years, predominantly female (70.3%). Dominant symptom was dyspnea (97.0%), the most common sign tachypnea (69.6%). Pulmonary embolism was confirmed by high-probability ventilation/perfusion lung scan or multidetector computed tomography in 71.5% and was regarded as massive in 63 (38.2%), submassive in 23 (13.9%) and non massive in 79 patients (47.9%). Mean hospital stay was 5.7 Ā± 4.4 days for ICU, and 14.8 Ā± 9.1 days, overall. The ICU mortality was 26.7% and in-hospital mortality 30.9%. No statistical difference in mortality between male and female patients was observed (30.6% and 31.0%, respectively; p=0.965), but prolonged immobilization (p=0.002), recent operation (p=0.034) or malignancy (p=0.009) were shown to influence the outcome. Although a number of risk factors for developing pulmonary embolism have been identified and heparin prophylaxis along with early mobilization proposed to reduce the incidence, pulmonary embolism remains an important clinical problem with high mortality rate. The diagnostics should not wait and the therapy should start as soon as possible
Obostrani endogeni endoftalmitis uzrokovan bakterijom pseudomonas aeruginosa u imunokompetentnog bolesnika s nozokomijalnom urosepsom nakon abdominalnog kirurŔkog zahvata
Endogenous endophthalmitis is a vision-threatening condition that results from hematogenous spread of infection to the eye, originating from a distant primary focus. It is considered as a rare entity that predominantly occurs in immune-compromised patients. We present a case of a critically ill immune-competent patient who underwent abdominal surgery later followed by nosocomial urosepsis complicated with bilateral Pseudomonas aeruginosa endogenous endophthalmitis that resulted in blindness. This case is clinically important because of the absence of predisposing factors for this kind of eye infection.Endogeni endoftalmitis je akutna komplikacija hematogenog rasapa infekcije iz udaljenog žariÅ”ta u oÄi, Å”to u najveÄem broju sluÄajeva rezultira sljepilom. Bolest je rijetka, a najÄeÅ”Äe se javlja u imuno kompromitiranih bolesnika. Prikazujemo imuno kompetentnog bolesnika kod kojega se nakon hitne operacije inkarcerirane ingvinalne hernije razvila nozokomijalna urosepsa komplicirana obostranim endogenim endoftalmitisom uzrokovanim bakterijom Pseudomonas aeruginosa, koji je rezultirao sljepilom. BuduÄi da se radi o bolesniku bez prethodno opisanih predisponirajuÄih Äimbenika za razvoj ove teÅ”ke bolesti, smatramo ovaj prikaz kliniÄki važnim za rano prepoznavanje i Å”to ranije agresivno lijeÄenje ove teÅ”ke bolesti
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