1/14. Mucous fistula refeeding in neonates with short bowel syndrome.BACKGROUND/PURPOSE: Neonates with enterostomies commonly suffer from a functional short bowel syndrome (SBS) and have a greater risk of electrolyte and fluid loss with poor weight gain. The authors describe their experience with refeeding stoma effluent into the mucous fistula in neonates. methods: A 5-year (1993 to 1997) chart review of neonates with stoma effluent refeeding was undertaken. Demographics, medical history, surgical procedures, timing, and duration of refeedings were reviewed. Enteral and total parenteral nutritional (TPN) requirements, electrolyte, and acid-base disturbances were recorded. RESULTS: Six neonates (gestational ages of 27 to 38 weeks, birth weights of 533 to 3400 g) were identified with nutritional or electrolyte complications before the commencement of refeeding. enterostomy indications included necrotizing enterocolitis (n = 2), intestinal atresia type 3b (n = 1), complications from ruptured omphalocoele (n = 1), congenital adhesive band obstruction (n = 1), and midgut volvulus after congenital diaphragmatic hernia repair (n = 1). weight gain during refeeding ranged from 5 to 25 g/kg/d with duration of refeeding lasting 16 to 169 days (two neonates were refed at home) until reanastomoses were done 6 to 44 weeks after the original surgery. There were no complications, and TPN requirements were diminished or eliminated. CONCLUSION: This technique represents a simple and safe method, which lessens the need for TPN and electrolyte supplementation in neonates with enterostomies and SBS before reanastomosis.- - - - - - - - - - ranking = 1keywords = short bowel syndrome, short bowel, bowel syndrome, bowel, short (Clic here for more details about this article) |
2/14. Acute renal failure and metabolic disturbances in the short bowel syndrome.BACKGROUND: short bowel syndrome (SBS) describes a malabsorptive state caused by extensive loss of small intestinal length. AIM: To improve understanding of the metabolic complications of SBS. DESIGN: observational study of five patients with SBS who presented with acute renal failure. RESULTS: Acute renal failure in our patients was predominantly due to salt and fluid depletion, and sepsis. Electrolyte imbalance was a major cause of morbidity. Metabolic acidosis was seen in three patients, and may arise from excessive gastrointestinal bicarbonate loss, compounded by impaired renal homeostasis. Our patients also manifested disturbances of calcium and magnesium homeostasis. DISCUSSION: patients with SBS are at high risk of renal failure. Prevention of this complication requires close monitoring and the maintenance of sodium homeostasis through increased intake and measures to reduce loss (e.g. anti-motility agents and large bowel re-anastomosis), and calcium, magnesium and vitamin d supplementation.- - - - - - - - - - ranking = 0.82039579044949keywords = short bowel syndrome, short bowel, bowel syndrome, bowel, short (Clic here for more details about this article) |
3/14. Misdiagnosis of congenital chloride-losing diarrhea.Congenital chloride-losing diarrhea is a recessively inherited disorder due to the absence of chloride-bicarbonate exchange in the small bowel. Malabsorption of chloride leads to osmotic diarrhea, electrolyte abnormalities, and dehydration. If left untreated, the infants fail to thrive and have a very high mortality. Clinically, affected patients develop secretory diarrhea in utero resulting in distended bowel loops and polyhydramnios. At birth these infants have profuse watery diarrhea that may be confused with urine. Thus, the correct diagnosis is often missed, and they may be subjected to unnecessary interventions. If diagnosed early, the electrolyte abnormalities are easily corrected and the prognosis is good. We report two patients who were initially evaluated for other conditions but later proved to have congenital chloride-losing diarrhea. The cases emphasize the importance of having a high index of suspicion in patients with a history of polyhydramnios, prematurity, and watery stools.- - - - - - - - - - ranking = 6.1276150711571E-5keywords = bowel (Clic here for more details about this article) |
4/14. Use of clonidine to decrease intestinal fluid losses in patients with high-output short-bowel syndrome.BACKGROUND: Some patients who have short bowel syndrome (SBS) have high intestinal outputs, which increases the risk of dehydration and fluid-electrolyte abnormalities and impairs quality of life. methods: We evaluated the use of clonidine, an alpha2-adrenergic receptor agonist, in 2 patients with SBS and high intestinal outputs, who were refractory to conventional therapy with antidiarrheal and antisecretory agents (loperamide, belladonna, opiates, somatostatin, histamine2 receptor antagonists and proton pump inhibitors). The first patient (case 1) was a 29-year-old woman who had 175 cm of small bowel anastamosed to 8 cm of descending colon, ending in a colostomy. The second patient (case 2) was a 22-year-old man who had 30 cm of jejunum anastomosed to 30 cm of sigmoid colon and rectum. RESULTS: The addition of clonidine, 0.1 mg per os (PO) 2 times per day, to the treatment regimen of case 1 decreased her ostomy output from approximately 4 L/day to approximately 1 L/day, eliminating the need for parenteral nutrition and fluids and decreasing the need for opiate therapy. The addition of clonidine, 0.2 mg PO 2 times per day in case 2 resulted in decreased rectal outputs from approximately 4 L/day to approximately 1.5 L/day. CONCLUSIONS: These results demonstrate that clonidine can effectively reduce intestinal fluid and electrolyte losses and should be considered as an additional treatment option in patients with SBS and high intestinal outputs.- - - - - - - - - - ranking = 0.28150851500198keywords = short bowel syndrome, short bowel, bowel syndrome, bowel, short (Clic here for more details about this article) |
5/14. Rare case of rhabdomyolysis with therapeutic doses of phendimetrazine tartrate.Phendimetrazine tartrate is a newer drug that acts as a central stimulant and indirectly acting sympathomimetic with a host of uses similar to the class amphetamines. Its main use is as an anorectic in the short-term treatment of obesity, although stimulants are no longer indicated for this purpose. This drug appeals to the younger American population for immediate weight loss through decreased appetite and early satiety. The european union markets have already withdrawn this medication as well as other countries, but phendimetrazine is still used within the united states. rhabdomyolysis is a potentially life-threatening complication reported with higher doses of amphetamines. We present a case of rhabdomyolysis and myoglobinuria developing in a 23-year-old patient after oral administration of phendimetrazine tartrate for 3 days in suggested therapeutic doses. The medication was taken for short-term treatment of obesity, and patient did not have any predisposing factors to precipitate rhabdomyolysis. rhabdomyolysis resolved within 5 days. To our knowledge, this is the first reported case of rhabdomyolysis from administration of therapeutic amounts of phendimetrazine tartrate. The purpose of this case report is to create an awareness among physicians about the potentially life-threatening complications associated with phendimetrazine use as an anorectic even in suggested therapeutic doses as was the case in our patient. Additional awareness is needed to educate their patients about the side effects associated with these drugs and to strongly discourage their unsupervised use.- - - - - - - - - - ranking = 8.6337150509548E-6keywords = short (Clic here for more details about this article) |
6/14. Fatal rotavirus gastroenteritis: an analysis of 21 cases.During the period of May 1972 to March 1977, twenty-one fatal cases of rotavirus acute gastroenteritis were recorded in the city of Toronto. The mean age of these subjects was approximately 1 year. Boys outnumbered girls by 12 to 9. death occurred within three days of onset of symptoms in all cases. Sixteen of the subjects were profoundly dehydrated and had sodium levels (serum or vitreous humor) in excess of 150 mEq/liter. In 11 subjects, sodium values were greater than 160 mEq/liter. Although a physician was contacted in 16 instances, these infants still perished. We suggest that both language difficulties and the rapid rate of fluid depletion contributed significantly to the fatal outcome. At autopsy the bowel was often dilated and filled with fluid. Postmortem autolysis precluded an accurate histological assessment of the small bowel mucosa.- - - - - - - - - - ranking = 6.1276150711571E-5keywords = bowel (Clic here for more details about this article) |
7/14. Enteral glucose-polymer-electrolyte solution in the treatment of chronic fluid and electrolyte depletion in short-bowel syndrome.A 55-year-old woman with extensive small-bowel resection and total colectomy complicated by chronic fluid and electrolyte depletion, achieved fluid and electrolyte homeostasis using a glucose-polymer-electrolyte solution. This is probably due to a solvent drag mechanism in the jejunum, in which nutrients such as glucose or aminoacids promote the passive absorption of electrolytes and water.- - - - - - - - - - ranking = 0.081508515001978keywords = bowel syndrome, bowel, short (Clic here for more details about this article) |
8/14. Enteral therapy in the management of massive gut resection complicated by chronic fluid and electrolyte depletion.Following combined resection of small and large bowel, fluid and electrolyte depletion may necessitate chronic intravenous therapy. We report two such patients who were dependent upon thrice weekly intravenous electrolyte infusions to maintain body weight and urine output. The patients were maintained on a diet aimed at minimizing intestinal fluid losses but nevertheless were in severe negative sodium and water balance. Metabolic studies were performed to evaluate the efficacy of oral glucose electrolyte therapy in reversing negative sodium and water balance. Fluid and electrolyte homeostasis was achieved with isotonic glucose, or glucose polymer, electrolyte sipping solutions which enabled both patients to become independent of parenteral therapy.- - - - - - - - - - ranking = 3.0638075355786E-5keywords = bowel (Clic here for more details about this article) |
9/14. Torsade de pointes complicating the treatment of bleeding esophageal varices: association with neuroleptics, vasopressin, and electrolyte imbalance.Torsade de pointes is an unusual life-threatening ventricular arrhythmia that has been associated with vasopressin, neuroleptic drugs, and electrolyte imbalances, including hypokalemia and hypomagnesemia. Over a 9-month period, we observed torsade de pointes in three patients with cirrhosis and bleeding esophageal varices who did not have prior cardiac disease. All had received endoscopic sclerotherapy and continuous infusions of vasopressin and nitroglycerin. For sedation, two patients received haloperidol and one droperidol. In addition, two patients had either hypokalemia or hypomagnesemia. In all three patients, there was prolongation of the electrocardiographic QT interval and a "long-short" initiating sequence followed by ventricular tachycardia with torsade de pointes morphology. All were successfully cardioverted; there was one late death due to aspiration and septicemia. We conclude that cirrhotics with variceal hemorrhage may be at increased risk of developing this arrhythmia in the setting of treatment with vasopressin, sedation with neuroleptic drugs, and electrolyte abnormalities. We urge close monitoring of these patients for cardiac arrhythmia and recommend that neuroleptics be used cautiously, if at all.- - - - - - - - - - ranking = 4.3168575254774E-6keywords = short (Clic here for more details about this article) |
10/14. Colonic infusion in the management of the short bowel syndrome.Two cases are presented of short bowel syndrome. Both had had the colon or part of the colon bypassed as part of prior surgical management in addition to having had extensive resection of the small bowel. Despite various medical regimens, both patients remained in negative fluid and electrolyte balance thus requiring intravenous fluid supplementation. In an effort to maintain positive fluid balance without intravenous therapy, colonic infusion of fluids was initiated. This modification of management proved effective in maintenance of adequate plasma volume and normal renal function. It is concluded that this type of therapy can be of great benefit in the management of patients with the short bowel syndrome.- - - - - - - - - - ranking = 1.2000306380754keywords = short bowel syndrome, short bowel, bowel syndrome, bowel, short (Clic here for more details about this article) |
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