“Patients who take an overdose of GHB present with a remarkably diminished level of consciousness. Hypothermia, bradycardia, vomiting, and hypotension are other manifestations. In a recent report of several patients who presented with GHB overdose, all were noted to have delirium and transient respiratory depression.
Use of physostigmine should be considered carefully because of its potential dangers. Physostigmine may exacerbate bradyarrhythmias and atrioventricular conduction delays. Seizures have been reported with rapid administration. In addition, its use may precipitate bronchospasm, vomiting, defecation, urination, and excessive salivation (cholinergic crisis).
In light of the potential toxicity of physostigmine, it should be used only in patients in whom GHB ingestion is certain, and physostigmine should be administered slowly (over 2-5 minutes) and intravenously. Physostigmine dose is 2 mg.”
— Mayo Clin Proc 2000
вторник, 25 октября 2011 г.
GHB Overdose
Who should be screened for celiac disease?
"Cortlandt Forum"
It seems that I am seeing celiac disease diagnosed more frequently. I suspect this is because the antigliadin serology is available, but I worry that this is going to become an attention deficit disorder/fibromyalgia "diagnosis du jour." How good are these tests? What are the extra-GI symptoms associated with the disease? A friend was diagnosed after a suspicion based on depression and fatigue. Should I screen all those patients for celiac disease?—Nathan W. Keever, DO, Cazenovia, N.Y.
The prevalence of celiac disease in the United States is 0.5%-1.0%. Based on consensus recommendations from NIH and the American Gastroenterological Association, screening is appropriate for patients with (1) classic symptoms of malabsorption; (2) unexplained iron deficiency anemia, transaminitis, dermatitis herpetiformis, chronic fatigue, and other atypical symptoms; (3) conditions associated with a high risk of celiac disease, such as type 1 diabetes, autoimmune endocrinopathies, and Turner syndrome; and (4) first- or second-degree relatives with celiac disease (Gastroenterology. 2006;131:1977-1980). The most efficient screening test is immunoglobulin (Ig)A tissue transglutaminase (tTG) antibody. Antigliadin antibody testing is no longer recommended except in IgA deficiency. IgA endomysial antibody (EMA) is specific but testing is more time-consuming and operator-dependent than IgA tTG, with a lower sensitivity; IgA EMA is a confirmatory test. If serology is positive or high suspicion persists despite negative serology, small bowel biopsy is the next step.—Laura G. Kehoe, MD (139-8)
It seems that I am seeing celiac disease diagnosed more frequently. I suspect this is because the antigliadin serology is available, but I worry that this is going to become an attention deficit disorder/fibromyalgia "diagnosis du jour." How good are these tests? What are the extra-GI symptoms associated with the disease? A friend was diagnosed after a suspicion based on depression and fatigue. Should I screen all those patients for celiac disease?—Nathan W. Keever, DO, Cazenovia, N.Y.
The prevalence of celiac disease in the United States is 0.5%-1.0%. Based on consensus recommendations from NIH and the American Gastroenterological Association, screening is appropriate for patients with (1) classic symptoms of malabsorption; (2) unexplained iron deficiency anemia, transaminitis, dermatitis herpetiformis, chronic fatigue, and other atypical symptoms; (3) conditions associated with a high risk of celiac disease, such as type 1 diabetes, autoimmune endocrinopathies, and Turner syndrome; and (4) first- or second-degree relatives with celiac disease (Gastroenterology. 2006;131:1977-1980). The most efficient screening test is immunoglobulin (Ig)A tissue transglutaminase (tTG) antibody. Antigliadin antibody testing is no longer recommended except in IgA deficiency. IgA endomysial antibody (EMA) is specific but testing is more time-consuming and operator-dependent than IgA tTG, with a lower sensitivity; IgA EMA is a confirmatory test. If serology is positive or high suspicion persists despite negative serology, small bowel biopsy is the next step.—Laura G. Kehoe, MD (139-8)
Подписаться на:
Сообщения (Atom)