急性百草枯农药中毒并发低钾血症临床分析

探讨急性百草枯农药中毒患者低钾血症的发生及其与预后的关系。对沧州市人民医院重症医学科2010年8月-2013年12月收治的急性百草枯农药中毒患者124例进行回顾性分析,常规方法测定血钾离子浓度,根据入院时血钾水平分为低钾血症组(3.5mmol/L)与血钾正常组(≥3.5mmol/L)。比较两组患者入院时临床情况及预后。结果显示,低钾血症组患者在服毒量、入院时白细胞(WBC)数量、肌酐(CR)、丙氨酸转氨酶(ALT)水平等方面均高于血钾正常组,pH值低于血钾正常组,差异均有统计学意义(P0.05);低钾血症组死亡45例,病死率为86.5%;血钾正常组死亡15例,病死率为20.8%,两组比较,差异有统计学意义(χ2=52.195,P0.01)。提示,百草枯农药中毒早期出现低钾血症的患者病情重,预后差,早期监测血清中钾离子水平能客观地评估病情程度及预后。     

神经性厌食营养干预的疗效分析

神经性厌食是以厌食和体重减轻为主要特点的疾病。神经性厌食的治疗主要包括两个方面:心理治疗和饮食治疗。本研究观察了营养干预对10例神经性厌食患者的临床疗效。对象和方法对象:10例女性神经性厌食患者,年龄15~25岁(平均17.5岁)。发病前的体重指数(BMI)为(20.9±2.18)kg/m2,治疗前的BMI为(12.36±1.05)kg/m2,治疗前的白蛋白水平为(28.50±3.69)g/L。重度消瘦10例,闭经10例,记忆力减退5例,腹胀4例。4例患者由于自行限制饮食,使摄入明显减少;6例患者由于呕吐、腹泻,使丢失明显增加;8例患者由于腹胀,大便干燥,消化吸收功能减弱。营养干预…     

微量泵输注高浓度氯化钾在心力衰竭合并低钾血症中的应用及护理

目的：探讨微量泵输注高浓度氯化钾在心力衰竭合并低钾血症中的应用及护理.方法：随机选取2013年3月至2014年10月我院收治的82例重度心力衰竭合并低钾血症患者,依据随机数字表法将这些患者分为两组,即观察组和对照组,每组41例.观察组运用静脉留置针补钾,对照组运用留置针或静脉穿刺补钾,然后对治疗前后两组患者的血钾水平进行统计分析.结果：治疗前两组患者的血钾水平之间的差异不显著（P〉0.05）;治疗后1d、2d观察组患者的血钾水平均明显比对照组高（P〈0.05）,但治疗后3d、4d两组患者的血钾水平之间的差异均不显著（P〉0.05）.结论：微量泵输注高浓度氯化钾在心力衰竭合并低钾血症中的应用效果良好,临床应积极给予患者有针对性的护理.     

急性心肌梗死早期血钾水平监测的必要性临床分析

目的:探讨急性心肌梗死早期血钾水平异常所致各种心律失常发生情况及其临床意义。方法:对156例急性心肌梗死患者于入院时即抽血化验血钾水平,根据血钾水平分为两组,A组:血钾3.5mmol/l,B组:血钾3.5~5.5mmol/l。观察2组发生心律失常(室性早搏、室性心动过速、室颤、房颤)情况及患者预后情况。结果:低钾血症总发生率35.4%,发病3小时内低钾血症发生率?%,高于发病时间3小时的患者,且低钾血症组各种心律失常及严重不良事件发生率32.9%高于正常血钾组。结论:早期监测血钾很重要,及时纠正血钾异常对各种心律失常及改善患者预后有积极临床意义。     

低钾血症的内科急诊疗效及临床观察

目的:探讨低钾血症的内科急诊疗效及临床观察。方法:对2015年12月-2016年12月我院收治的60例低钾血症患者根据其血清钾浓度情况分类治疗,轻度缺钾者给予进食含钾丰富的饮食,对于中重度缺钾患者静脉滴注10%氯化钾15-30m L,比较患者治疗前后的血清钾浓度。结果:治疗前患者的血钾浓度为(2.10±0.32)mmol/L;治疗12h后,患者的血钾浓度为(3.29±0.22)mmol/L。与治疗前血钾浓度相比P0.05,具有统计学差异。所有患者治疗过程中无严重并发症,未发生肾功能下降与高钾血症。有2例患者在治疗过程中产生局部疼痛,2例心率失常,总不良反应发生率为6.7%。结论:根据患者血清钾浓度选择合适的治疗方法,可有效提高临床治疗率,减少不良反应发生率。     

神经性厌食患者入院治疗效果及影响因素分析

目的了解住院治疗的神经性厌食症患者流行趋势及住院治疗前后体重的变化及影响神经性厌食症患者住院治疗效果的影响因素,为神经性厌食症患者的治疗提供新思路。方法纳入2012—2017年期间首次于上海市交通大学医学院附属精神卫生中心进行治疗的神经性厌食患者,进行一般情况调查,收集并观察出入院时的体重变化。结果 2012—2017年期间本院共收治87名神经性厌食症患者,女性为84人,60.9%为初高中学生。出院时平均体重为(42.1±8.1)kg,显著高于住院时(39.4±8.4)kg(P0.05),78人(89.7%)住院治疗后体重有所上升。出院时平均BMI为(15.9±2.6)kg/m~2,显著高于住院时的(14.9±2.7)kg/m~2(P0.05),上升了6.7%。多元线性回归分析显示,学历高、入院年份越靠近2017年和住院天数多是神经性厌食人群的保护因素。讨论住院治疗可有效改善厌食症患者体重偏低的状况,厌食症患者在治疗的过程中需考虑患者学历,首次住院治疗需保证充足的住院时间。     

老年心血管病患者肺部感染合并重度低钾血症的临床治疗研究

目的探讨老年心血管疾病住院患者肺部感染合并重度低钾血症的临床救治措施,以提高诊治水平。方法调查2011年1月-2014年1月的68例老年心血管疾病肺部感染合并重度低钾血症患者临床资料,将其随机分为对照组与观察组,每组各34例,观察组给予深静脉置管微量泵注射氯化钾溶液补钾治疗,对照组采用普通静脉滴注0.3%氯化钾溶液补钾治疗,比较两组患者治疗后的临床疗效、肺部感染改善及血钾水平。结果观察组治疗有效率为88.24%,显著高于对照组的67.65%,差异有统计学意义(P<0.05);观察组治疗前、后血钾水平分别为(2.18±0.13)、(3.98±0.42)mmol/L;对照组治疗前、后血钾水平分别为(2.46±0.15)、(3.51±0.38)mmol/L,显著高于对照组,差异有统计学意义(P<0.05)。结论深静脉置管补钾治疗和锁骨下静脉穿刺注射氯化钾溶液治疗,可提高老年心血管疾病住院患者肺部感染合并重度低钾血症的治疗有效率,提升患者生命质量,可于临床推广与应用。     

神经性厌食症患者入院治疗效果及影响因素分析

目的了解住院治疗的神经性厌食症患者流行趋势及住院治疗前后体重的变化及影响神经性厌食症患者住院治疗效果的影响因素,为神经性厌食症患者的治疗提供新思路。方法纳入2012—2017年期间首次于上海市交通大学医学院附属精神卫生中心进行治疗的神经性厌食患者,进行一般情况调查,收集并观察出入院时的体重变化。结果 2012—2017年期间本院共收治87名神经性厌食症患者,女性为84人,60.9%为初高中学生。出院时平均体重为(42.1±8.1)kg,显著高于住院时(39.4±8.4)kg(P0.05),78人(89.7%)住院治疗后体重有所上升。出院时平均BMI为(15.9±2.6)kg/m~2,显著高于住院时的(14.9±2.7)kg/m~2(P0.05),上升了6.7%。多元线性回归分析显示,学历高、入院年份越靠近2017年和住院天数多是神经性厌食人群的保护因素。讨论住院治疗可有效改善厌食症患者体重偏低的状况,厌食症患者在治疗的过程中需考虑患者学历,首次住院治疗需保证充足的住院时间。     

儿童布氏杆菌病102例研究

作者对1984年1月～1987年12月确诊的102例布氏杆菌病儿童患者进行了研究。诊断以临床征象和布氏杆菌凝集试验≥1:160及/或血培养和组织培养阳性为依据。研究对象年龄≤14岁,且均为首次感染。每例均详细询问病史并全面查体。实验室查血细胞计数、血沉、肝肾功能、布氏凝集试验、肥达氏反应,并作血培养及尿液分析。根据患者的年龄、病情轻重、对药物的耐受性、血培养结果和药敏试验选择抗生素:复方新诺明(TMP-SMX)每日10/50mg/kg,分2次口服;四环素每日40mg/kg,分4次     

急救护理重症低钾血症的临床效果观察

目的探讨急诊快速静脉补钾并配合有效的护理干预治疗重症低钾血症临床效果及安全性。方法对2012-04/2014-09宿迁市第一人民医院急诊科收治的94例重症低钾血症患者采用快速静脉补钾治疗,同时进行有效的护理干预,分析临床资料。结果通过急诊快速静脉补钾治疗及有效的护理干预后24 h,94例重症低钾血症血钾浓度恢复至正常水平,焦虑情绪基本缓解,肌力趋于正常或正常,与入院治疗前比较,差异有统计学意义(P0.05),特异性心电图(ECG)恢复正常时间为(12.52±4.21)h。结论急诊重症低钾血症患者通过快速静脉补钾治疗并配合有效的护理干预后,均可以达到较好的临床效果。     

Body composition in adolescents with anorexia nervosa.

BACKGROUND: Malnourished patients with anorexia nervosa have altered body composition characterized by depletion of fat and fat-free mass. OBJECTIVES: The objectives of this study were to assess the body composition of adolescents with anorexia nervosa compared with that of control subjects and to investigate the relation between simple anthropometric measures and reference techniques for measuring body composition. DESIGN: Twenty-three adolescent females with anorexia nervosa aged 15.46 +/- 1.34 y (x +/- SD) were studied. Body composition was measured by anthropometry, dual-energy X-ray absorptiometry (DXA) (for body fat), and prompt gamma in vivo neutron activation analysis [for total body nitrogen (TBN)]. Twenty-five female subjects provided the control DXA data. TBN measurements were compared with prediction equations based on sex, height, age, and weight. RESULTS: Anorexia nervosa patients had significantly lower weight (40.2 +/- 4.6 kg), body mass index (in kg/m(2): 15.3 +/- 1.2), percentage of body fat (DXA) (13.8 +/- 5.8%), percentage of TBN predicted for age (73 +/- 10%), trunk fat (2.1 +/- 1.0 kg), leg fat (2.6 +/- 1.1 kg), and trunk-to-leg fat ratio than did control subjects (P < 0.05). In anorexia nervosa patients, significant correlations were found between triceps skinfold thickness and percentage of body fat (r = 0.83), body mass index and percentage of body fat (r = 0.46), and body weight and TBN (r = 0.84, P < 0.05). CONCLUSIONS: Hospitalized adolescent females with anorexia nervosa are depleted of total body fat and protein. We identified 3 simple anthropometric measures (triceps skinfold thickness, BMI, and body weight) that can be used to assess body composition and nutritional status in malnourished adolescents with anorexia nervosa.     

Body mass index and agreement between bioimpedance and anthropometry estimates of body compartments in anorexia nervosa

BACKGROUND: In 74 women with anorexia nervosa (body mass index [BMI] 10-17.5 kg/m(2)), a progressive disagreement between anthropometry and bioelectrical impedance analysis (BIA) estimates of fat (FM) and fat-free mass (FFM) was documented with a BMI <15 kg/m(2). Below this threshold, an abnormal body composition was detected with vector BIA independent on body weight (useful tool at the bedside). Both anthropometry and BIA are used for body composition assessment. We evaluated the agreement between their estimates of FFM and FM in extremely lean subjects with anorexia nervosa. METHODS: Observational study in 74 women (age 15-45 years; BMI 10.0-17.5 kg/m(2)) with anorexia nervosa. Anthropometry FM and FFM were estimated by skinfold thicknesses. Whole-body impedance vector components, resistance (R) and reactance (X(c)), were measured at the same time (BIA-101 analyzer, 50-kHz frequency; Akern/RJL Systems, Clinton Twp., MI). BIA estimates of FFM and FM were obtained with Sun's equations (BMI 14-39 kg/m(2)). Vector BIA was performed with the RXc graph method. The frequency of disagreement between anthropometry and BIA was evaluated as a function of increasing BMI (receiver operating characteristic curve). RESULTS: The correlation coefficient between methods was 0.80-0.90. The BMI cutoff value of 15 kg/m(2) predicted disagreement of FM and FFM in patients with a BMI <15 kg/m(2). In the RXc graph, the distribution of vectors from patients with disagreement was significantly shifted out of the right border of the reference tolerance ellipses. CONCLUSIONS: Anthropometry and BIA equations should not be used in anorexic patients with a BMI <15 kg/m(2). The distribution of vectors from patients with disagreement of methods was shifted out of the right border of the reference tolerance ellipses and was superposed to vectors from patients with a BMI <15 kg/m(2). The identified impedance pattern for anorexia could be useful for feedback in individual patient refeeding (vector back into the 75% reference ellipse).     

Is glycyrrhizin sensitivity increased in anorexia nervosa and should licorice be avoided? Case report and review of the literature

ObjectiveHypokalemia is a potentially life-threatening electrolyte disturbance in anorexia nervosa and is most frequently caused by purging behavior. We report a case of severe hypokalemia in anorexia nervosa induced by daily ingestion of approximately 20 g of licorice.MethodsTo confirm the diagnosis of licorice-induced pseudohyperaldosteronism, a re-exposure trial was performed.ResultsCessation of the licorice intake normalized plasma potassium, renin, and aldosterone levels and the urine cortisol/cortisone ratio. Re-exposure confirmed the diagnosis. The pronounced response to a relatively low daily dose of licorice suggests high glycyrrhizin sensitivity.ConclusionPatients with anorexia nervosa not only have decreased food intake but also selective and sometimes bizarre eating habits that, in association with increased sensitivity to glycyrrhizin, may cause severe hypokalemia.     

Bone resorption in anorexia nervosa and rehabilitated patients

OBJECTIVE: To assess the impact of anorexia nervosa and that of nutritional rehabilitation on bone resorption. DESIGN: Cross-sectional, observational study. SETTING: Rome, Italy SUBJECTS: Twenty-eight female patients affected by anorexia nervosa (AN, BMIor=18.5 kg/m(2)) and 34 age- and sex-matched healthy controls (CO, BMI >or=18.5 kg/m(2)). Among AN patients, 16 were affected by the 'restrictive' (ANr) and 12 by the 'purging' type (ANp) of anorexia nervosa. METHOD: Body weight, height and skeletal diameters were measured on each individual. The skeletal mass (SKM) was predicted from the skeletal diameters of the elbow, wrist, knee and ankle, using the equation of Martin. Twenty-four-hour urinary excretion of pyridinium crosslinks of collagen (pyridinoline (Pyd) and deoxypyridinoline (Dpd)) and creatinine was assessed by reversed-phase HPLC with fluorimetric detection after solid-phase extraction and by the Jaffé-method with deproteinization, respectively. RESULTS: Twenty-four-hour urinary output of Pyd and Dpd was not significantly different between AN and CO when expressed in absolute values, but AN showed higher bone resorption than CO when Pyd and Dpd excretion was adjusted by either creatinine (P<0.0000) or the SKM (P<0.05). Within the AN group, urinary excretion of both cross-links was significantly and consistently higher in ANp compared with ANr (P<0.05). However, these differences disappeared when crosslink output was adjusted either by urinary creatinine or SKM. RE subjects showed no differences in bone resorption with the AN group despite weight gain, being crosslink excretion consistently elevated compared to controls (Pyd: P<0.01 by creatinine and P<0.05 by SKM; Dpd: P<0.01 by creatinine and P<0.05 by SKM). CONCLUSION: Bone resorption is elevated in anorexia nervosa and different strategies for low-weight maintenance do not seem to have a differential impact. Increased bone resorption persists in subjects with past diagnosis of anorexia nervosa despite rehabilitation lasting more than 6 months. This finding indicates that bone mass and turnover should be monitored in anorexia nervosa patients and ex-patients well beyond recovery of normal body mass. Further investigation is warranted to examine the long-term effect of such prolonged increase in bone turnover at a young age.     

Severe acute liver damage in anorexia nervosa: two case reports

OBJECTIVE: Two female patients (18 and 30 y old, body mass indexes 14.1 and 13.2 kg/m2) with severe, restrictive anorexia nervosa developed sudden severe liver damage. In addition to overt protein-energy malnutrition, they showed marked hypotension, bradycardia, dry skin, acrocyanosis, and hypothermia. Most common causes of liver failure, such as hepatotropic viruses, hepatotoxic drugs, alcohol, cannabis, and cocaine abuse, were excluded. METHODS: Therapeutic intervention consisted of immediate plasma volume support, progressive parenteral or oral nutritional rehabilitation, and parenteral potassium and phosphorus supplements to avoid the refeeding syndrome. RESULTS AND CONCLUSION: Improvement of initial clinical symptoms and rapid recovery of liver enzymes after this type of treatment suggest that severe liver damage in anorexia nervosa may be secondary to acute hypoperfusion.     

Suicide and attempted suicide in anorexia nervosa and bulimia nervosa

Suicide in anorexia nervosa and bulimia nervosa is a major cause of death. Risk factors for suicide and attempted suicide (which in many cases results in successful suicide) in anorexia nervosa include: purging type, chronic disease, and during treatment, obsessive symptoms and drug abuse, major depression, and for anorexia nervosa low body mass index (BMI) at presentation. In anorexia nervosa suicide has been considered the first cause of death and attempted suicide is a serious threat to these individuals. Data concerning suicide in bulimia nervosa has still scarce whereas attempted suicides are easily found in clinical histories of patients. No doubt suicidal behavior is underestimated amongst patients with anorexia nervosa and bulimia nervosa. An effort to reconcile with subject of suicide and a better evaluation of these patients' psychopathology should improve suicide prevention strategies amongst these individuals.     

Reduced hemodynamic load and cardiac hypotrophy in patients with anorexia nervosa

BACKGROUND: Anorexia nervosa is associated with lower left ventricular mass (LVM) and systolic dysfunction. Whether these abnormalities reflect chronic protein-energy malnutrition or are primarily related to lower cardiac workload is unclear. OBJECTIVE: The objective of the study was to verify whether low LVM in anorexia nervosa is explained by low hemodynamic load. DESIGN: Ninety-one women with anorexia nervosa [macro x +/- SD age: 20.5 +/- 6.1 y; body mass index (in kg/m(2)): 15.6 +/- 1.9; group 1] and 62 normal-weight female control subjects (age: 22.5 +/- 5.5 y; body mass index: 20.9 +/- 1.2; group 2) underwent Doppler echocardiography. LVM was evaluated as the percentage predicted by body height, sex, and stroke work (systolic blood pressure x stroke volume). RESULTS: The left ventricular chamber dimension was smaller and the chamber walls were thinner in group 1 than in group 2, which resulted in significantly lower LVM and LVM indexes (P < 0.0001). Ejection fraction, heart rate, stroke volume, and cardiac output were significantly (P < 0.007) lower in group 1, but peripheral resistance was substantially higher (P < 0.0001). The deviation of LVM from predicted values was lower and the proportion of subjects with inadequate LVM was significantly higher in group 1 than in group 2 (P < 0.0001). This difference was attenuated after adjustment for body weight and heart rate. There were no relations between LVM and laboratory tests in group 1. CONCLUSIONS: Anorexia nervosa is a condition of low hemodynamic load that leads to low LVM. Even with adjustment for stroke work, however, LVM is lower than would be predicted by height, because of the effect of body weight reduction (ie, wasting of lean body mass).     

A case of anorexia nervosa with severe hyperlipoproteinemia

OBJECTIVE: The complication of severe hyperlipoproteinemia with anorexia nervosa is very rare. We investigated the mechanisms of severe hyperlipoproteinemia in a patient with anorexia nervosa. METHODS: The measurement of plasma levels of lipids, apolipoproteins (Apo), lipoprotein subfractions, free T3, and estrogen, apo (lipoprotein) E phenotyping, and the assay of lymphocyte low-density lipoprotein (LDL)-receptor activity were accomplished in a 40-year-old female patient with anorexia nervosa. RESULTS: Her body mass index was 10.3 kg/m2. Her plasma levels of total cholesterol (C), triglyceride (TG), apoB, apoE, very-low-density lipoprotein (VLDL)-C, and intermediate-density lipoprotein (IDL)-C were 757 mg/dl, 526 mg/dl, 288 mg/dl, 13.6 mg/dl, 133 mg/dl, and 99 mg/dl, respectively. VLDL was cholesterol rich (C/TG ratio = 0.68; normal value = 0.2). The plasma LDL was high and skewed to less dense fractions. Her apoE phenotype was E 3/2. Her lymphocyte LDL-receptor activity was 79% of normal subjects. The plasma level of estradiol was low and that of free T3 was subnormal. DISCUSSION: We concluded that the plasma lipoprotein abnormality of this anorexia nervosa patient was induced by the impaired removal of TG-rich lipoprotein remnants and less dense LDL due to apoE phenotype E 3/2, subnormal LDL-receptor activity, subnormal plasma level of free T3, and diminished secretion of estrogen.     

Severe neutropenia with gelatinous bone marrow transformation in anorexia nervosa: a case report

A 28-year-old woman with a history of anorexia nervosa was admitted with excessive weight loss, edema, and amenorrhea. She had lost 34% of her previous body weight within 2 years, and her body mass index was 12.3 kg/m(2). The leukocyte count on admission was 2150/microl and gradually decreased to 980/microl (neutrophils; 276/microl). Bone marrow biopsy disclosed gelatinous transformation with hypocellularity. After the patient was treated with intravenous nutritional support, the severe neutropenia improved to the level on admission. Hematological abnormalities seem to be common in anorexia nervosa, but severe neutropenia with gelatinous bone marrow transformation has rarely been reported.     

神经性厌食儿童青少年出院后1～5年的随访研究

目的随访出院神经性厌食儿童青少年的临床结局,了解其短期预后情况及其影响因素。方法选取2008-2012年首次住院治疗、符合国际疾病分类第10版神经性厌食诊断标准、年龄≤18岁的病例,采用自编的随访调查问卷从首次住院病历中提取既往病情等相关资料,并通过电话联系进行随访。结果符合入组标准的患者共59例,共随访到45例,随访时年龄(16.56±2.52)岁,随访距出院时间(2.39±1.01)年,随访时体质指数9.21~28.40(18.47±3.54)kg/m2,28例患者体质指数恢复正常范围,25例患者存在怕胖心理,5例患者存在体像障碍,25例患者存在异常进食行为,4例患者存在过度运动,19例(57.58%)女性患者月经正常。38例患者在正常上学或工作。客观评定痊愈13例,好转28例,迁延不愈4例;主观评定疗效好25例,中等13例,差7例;主观评定结果优于客观评定结果(Kappa=0.214)。以客观结局做分析,男性性别与预后呈正相关(r=0.311,P=0.037),病前性格中的"好强"特点与预后呈负相关(r=-0.317,P=0.034)。结论神经性厌食儿童青少年住院治疗后1~5年总体预后较好,男性患者的预后优于女性患者,病前性格好强的患者预后相对更差。