Nephrology Hypertension

Nephrology Hypertension

Medical Management of the Dialysis Patient: Cognitive Function, Depression and Psychosocial Adaptation

Does this dialysis patient have delirium, dementia or depression? Delirium is an acute confusional state characterized by a recent onset of fluctuating awareness, impairment of memory and attention, and disorganized thinking that can be attributable to a medical condition, an intoxication, or medication side effects (Table I). In dialysis patients, delirium may also be caused…

Hypertension: Essential Hypertension

Does this patient have essential hypertension? Prevalence Despite recent advances in the treatment of hypertension, and increased public awareness by the introduction of several public health campaigns such as National Blood Pressure Education Program, hypertension remains a prevalent medical condition affecting ~30% of United States (US) population aged 18 years and older with no significant…

Pharmacology and Toxicology: Treatment of Poisons – Phenytoin, Carbamazapene, Valproic Acid, or Phenobarbitol Intoxication

Does this patient have phenytoin, carbamazapene, valproic acid or phenobarbitol intoxication? Phenytoin Phenytoin is a hydantoin derivate and is used to control generalized tonic clonic and complex partial seizures. The Vd is 0.5 to 0.8 L/kg but will increase somewhat with a large ingestion, liver or renal disease. It is highly protein bound at 90%…

Pharmacology and Toxicology: Treatment of Poisons – Theophylline Intoxication

Does this patient have theophylline intoxication? Descripton of the problem Theophylline is a methylxanthine bronchodilator used for obstructive airway disease. Although the number of patients using it and therefore the number of toxic exposures are declining, toxic exposure to theophylline continues to have a relatively high morbidity and mortality (Figure 1). In 2009, there were…

Pharmacology and Toxicology: Treatment of Poisons – Methanol Intoxication

Does this patient have methanol intoxication? Descripton of the problem Methanol is a highly toxic alcohol that is found in a variety of commercial products, including antifreeze, windshield wiper fluid, some racing car fuels, paint thinner, and canned solid fuel for keeping food warm. There were 10 reported deaths from 1958 exposures to methanol in…

Pharmacology and Toxicology: Treatment of Poisons – Salicylate Intoxication

Does this patient have salicylate intoxication? Description of the problem There were 19,814 reported intoxications with salicylates and 20 deaths which is approximately 1% of all exposures and 2% of all deaths reported to the Natonal Poison Data System (NPDS) in 2009 (Figure 1). Salicylates are found in many commonly used medications including aspirin and…

Pharmacology and Toxicology: Treatment of Poisons – Isopropanol Intoxication

Does this patient have isopropanol intoxication? Description of problem There were 18,051 exposures to isopropanol and 1 death reported to the National Poison Data System (NPDS) in 2009. This represents 1.4% of all exposures reported (Figure 1). It has a lower associated mortality per exposure (0.01%) as compared to methanol (0.5%) or ethylene glycol(0.3%). The…

Pharmacology and Toxicology: Treatment of Poisons – Ethylene Glycol Intoxication

Does this patient have ethylene glycol intoxication? Ethylene glycol is a sweet-tasting substance that is a common constituent of antifreeze and de-icing solutions. It can also be found in hydraulic brake fluid, many solvents and as an agent in chemical synthesis. Because of its sweet taste and its ability to intoxicate, it is sometimes used…

Pharmacology and Toxicology: Treatment of Poisons – Metformin Intoxication

Does this patient have metformin intoxication? Description of the problem Since its introduction to the US market in 1995, the biguinide, metformin has become one of the most prescribed oral hypoglycemics. It is now considered the first line agent to treat type 2 diabetes. Because of its similarity to the drug another biguinide, phenformin, there…

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