scholarly journals The Daily Consumption of Cola Can Determine Hypocalcemia: A Case Report of Postsurgical Hypoparathyroidism-Related Hypocalcemia Refractory to Supplemental Therapy with High Doses of Oral Calcium

2017 ◽  
Vol 8 ◽  
Author(s):  
Valentina Guarnotta ◽  
Serena Riela ◽  
Marina Massaro ◽  
Sebastiano Bonventre ◽  
Angela Inviati ◽  
...  
Keyword(s):  
Case Report ◽  
Daily Consumption ◽  
Oral Calcium ◽  
High Doses ◽  
Supplemental Therapy

scholarly journals Extremely high doses of radioiodine required for treatment of Graves' hyperthyroidism: a case report

Cases Journal ◽  
2009 ◽  
Vol 2 (1) ◽  
pp. 8479 ◽  
Author(s):  
Arnaldo Moura Neto ◽  
Marcos Antonio Tambascia ◽  
Sergio Brunetto ◽  
Celso Dario Ramos ◽  
Denise Engelbrecht Zantut-Wittmann
Keyword(s):  
Case Report ◽  
High Doses

Very-low-dose ketamine for the management of pain and sedation in the ICU

2018 ◽  
Vol 4 (1) ◽  
pp. 54 ◽  
Author(s):  
Mario De Pinto, MD ◽  
Jill Jelacic, MD ◽  
William T. Edwards, PhD, MD
Keyword(s):  
Mechanical Ventilation ◽  
Case Report ◽  
Respiratory Depression ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Low Dose ◽  
Anesthetic Agent ◽  
Cardiovascular Instability ◽  
High Doses ◽  
Very High

Management of pain in critically ill patients can be very difficult. In the attempt to provide comfort with adequate levels of opioids and sedatives, respiratory depression and cardiovascular instability may become difficult to control in patients with labile hemodynamics and poor cardiopulmonary reserve. The use of medications like ketamine, an anesthetic agent that in subanesthetic doses has been reported to be effective in preventing opioidinduced tolerance and to have analgesic properties, may be of help, especially in patients who develop tolerance, leading to rapidly escalating doses of opioids and sedatives. The case report presented here shows how a very low dose of ketamine can be helpful for the management of pain and sedation in critically ill patients, especially when they are ready to be weaned from mechanical ventilation, and very high doses of opiods and sedatives do not permit it.

Perioperative dilemma: Challenges of the management of a patient on mega doses of morphine and methadone

2014 ◽  
Vol 10 (1) ◽  
pp. 69 ◽  
Author(s):  
Alan David Kaye, MD, PhD, DABA, DABPM, DABIPP ◽  
Aymen A. Alian, MD ◽  
Nalini Vadivelu, MD ◽  
Keun Sam Chung, MD
Keyword(s):  
Back Pain ◽  
Case Report ◽  
High Dose ◽  
Successful Management ◽  
Present Case Report ◽  
Opioid Induced Hyperalgesia ◽  
History Of ◽  
High Doses

High doses of opioids are often needed in the management of cancer-related pain. A discussion of a patient’s perioperative opioid management and mechanisms contributing to opioid-induced hyperalgesia (OIH) are presented. In the present case report, a patient on high doses of opioids, including morphine and methadone, with severe worsening back pain and a history of increasing opioid requirements for the last 2 months due to metastatic leiomyosarcoma to the femur, spine, and neck is described. Use of high dose opioids is associated with numerous challenges, including tolerance. The successful management of this patient was multimodal and included the use of potent analgesics, N-methyl-D-aspartatereceptor antagonists, and the α-2 agonist clonidine.

Pediatric obsessive-compulsive disorder: A case report

2011 ◽  
Vol 26 (S2) ◽  
pp. 360-360
Author(s):  
A. Tatay ◽  
C. Almonacid ◽  
A. Castillo ◽  
M. Lloret ◽  
M. Harto ◽  
...  
Keyword(s):  
Case Report ◽  
Obsessive Compulsive Disorder ◽  
Pediatric Population ◽  
Outpatient Service ◽  
Relaxation Techniques ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Pediatric Ocd ◽  
High Doses ◽  
Xix Century

IntroductionObsessive compulsive disorder (OCD) in childhood was first described by Legrand du Saulle in late XIX century, however, a systematic study in pediatric population was not made until 1986, by Rapoport. It is has been documented in scientific literature that younger patients usually hide their symptoms because of shame or that they do not find their obsessions and compulsions excessive, so that they feel them in an egosyntonic way, delaying diagnosis until several years after their first symptoms.Aims and methodologyTo highlight the specific symptoms in Pediatric OCD and review its treatment and approach through the study of a case report.ResultsA 11-year-old boy was referred by his paediatrician to a child mental outpatient service for behavioural disturbances in the last few months. For the last three years, he had been performing rituals of cleaning, order and checking, increasingly complex and with a significant impact on his life, to the point of not being able to go to school and have other members of his family involved. He also had religious and catastrophic obsessions that generated him important distress. He was treated with high doses of sertraline and low doses of risperidone, and cognitive-behavioral psychotherapy with exposure response prevention and training in relaxation techniques were associated to the treatment. The patient improved partially.ConclusionsThis case illustrates the delay in the diagnosis of Pediatric OCD itself as well as the complexity when treating this disorder.

Beneficial Effects of High Doses of Cabergoline in the Treatment of Giant Prolactinoma Resistant to Dopamine Agonists: A Case Report with a 21-Year Follow-Up

2017 ◽  
Vol 89 (1) ◽  
pp. 63-70 ◽  
Author(s):  
Lucas Faria de Castro ◽  
Maria de Fátima  Magalhães Gonzaga ◽  
Luciana Ansaneli Naves ◽  
José Luiz Mendonça ◽  
Benicio Oton de Lima ◽  
...  
Keyword(s):  
Case Report ◽  
Pituitary Gland ◽  
Prolactin Level ◽  
Dopamine Agonists ◽  
Pubertal Development ◽  
Cystic Degeneration ◽  
Childhood And Adolescence ◽  
Long Term Treatment ◽  
High Doses

Introduction: Prolactinomas are pituitary tumors with a very low prevalence in childhood and adolescence compared to adulthood. This condition is preferentially treated with dopamine agonists. Resistance to these drugs is rare. Case Report: We describe the case of a boy diagnosed with macroadenoma at the age of 9 and followed up for 21 years. He did not fully respond to treatment with dopamine agonists. His initial prolactin level was 2,400 ng/mL (in males, normal values are <16.0 ng/mL) and never normalized. At the last assessment, his prolactin level was 21.5 ng/mL, recorded after 21 years of treatment with the dopamine agonist cabergoline at a dose as high as 4.5 mg per week. Although the prolactin level remained elevated throughout the follow-up period, the patient never presented a low testosterone level and had normal pubertal development. An MRI of the sella turcica showed that the tumor became progressively cystic and disappeared, but a normal pituitary gland was observed. The pituitary gland retained its normal functions despite a partially empty sella. Discussion: Long-term treatment with high doses of cabergoline may cause cystic degeneration of a prolactinoma considered to be resistant to this treatment, but we cannot rule out the possibility that this outcome represents the natural development of the tumor.

scholarly journals A Case Report of Cardiogenic Syncope Due to Loperamide Abuse: Acute Presentation and Novel Use of Buprenorphine

2021 ◽  
Vol 2 (5) ◽  
pp. 214-217
Author(s):  
David Betting ◽  
James Chenoweth ◽  
Angela Jarman
Keyword(s):  
Case Report ◽  
Sodium Bicarbonate ◽  
Alternative Treatment ◽  
Opioid Dependence ◽  
Intestinal Tract ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Acute Presentation ◽  
Cardiogenic Syncope ◽  
High Doses

Introduction: Loperamide is a non-prescription anti-diarrheal agent targeting µ-opioid receptors in the intestinal tract. At high doses it crosses the blood-brain barrier, where µ-opioid agonism can cause euphoric effects. Misuse has been increasing for both the euphoric effects and as an alternative treatment for opioid dependence and withdrawal. Case Report: Here we report the case of a 30-year-old woman presenting with syncope, who was found to have severe myocardial conduction delays in the setting of chronic loperamide abuse. Conclusion: Treatment with sodium bicarbonate and hypertonic sodium resulted in improvement of her conduction abnormalities. Prior to discharge she was initiated on buprenorphine for her opioid use disorder.

Advantages of everolimus therapeutic drug monitoring in oncology when drug–drug interaction is suspected: A case report

2020 ◽  
Vol 26 (7) ◽  
pp. 1743-1749 ◽  
Author(s):  
Geoffrey Strobbe ◽  
Diane Pannier ◽  
Ilyes Sakji ◽  
Alexandre Villain ◽  
Frédéric Feutry ◽  
...  
Keyword(s):  
Drug Interaction ◽  
Case Report ◽  
Therapeutic Drug Monitoring ◽  
Drug Interactions ◽  
Drug Monitoring ◽  
Plasma Concentrations ◽  
Response To Treatment ◽  
Therapeutic Drug ◽  
High Doses

Introduction Drug interactions involving everolimus are fairly well known because of its common use, primarily as an immunosuppressant. Several recommendations regarding therapeutic drug monitoring are also available for the use of everolimus-based immunosuppression regimens. However, everolimus use in oncology differs substantially, particularly because of the high doses involved. Therapeutic drug monitoring, although sometimes necessary, is not recommended as a routine in oncology. Thus, it was deemed inapplicable due to the lack of clear recommendations. Case report Here, we present a case where a patient was prescribed everolimus for renal cell carcinoma. The patient benefitted from a pharmaceutical consultation prior to treatment initiation, and a drug interaction with verapamil was suspected. Management and outcome: Therapeutic drug monitoring of everolimus was proposed. Based on the everolimus values reported in the literature, trough plasma concentration in the patient was greatly increased. The patient was then diagnosed with grade 4 oral mucositis, thereby requiring temporary suspension of everolimus treatment. Management of adverse effects was performed through multiple medicated mouthwashes. Discussion Therapeutic drug monitoring for everolimus is important for potential drug interactions or the occurrence of severe adverse events. In such cases, dose adjustments should be managed according to everolimus plasma concentrations. Clear oncological recommendations regarding plasma everolimus thresholds are required for a successful follow-up of the patient’s condition and to ensure adequate response to treatment.

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