Flugtauglichkeit und Höhenkrankheit

The greatest problem for healthy individuals and those with pre-existing diseases at middle and high altitudes is oxygen deficiency through hypobaric hypoxia. Hypoxia can lead to typical altitude sickness, acute mountain sickness, altitude cerebral edema and altitude pulmonary edema. The occurrence of this disease is avoidable by adequate acclimatization. If it occurs despite acclimatization improvement can be achieved by rapid descent, oxygen inhalation or medicinal therapy. Patients with pre-existing pulmonary diseases are endangered even at low altitudes and this also holds true for air flights because cabin pressure heights up to 2,438 m can be reached. Only patients with good pulmonary function and sufficient oxygenation tolerate these conditions without problems. Especially endangered are patients with limited hyperventilation or diffusion capacity and high pulmonary pressure. This article presents pre-flight possibilities to recognize those patients who would possibly profit from additional oxygen inhalation during the flight using lung function, blood gases and oxygen saturation.     

Formen der Insulintherapie

Rigid algorithms providing identical glycemic treatment goals and intervention thresholds for all patients with both type 1 and type 2 diabetes are obsolete. In patients with type 1 diabetes, intensive insulin therapy using short-acting and long-lasting basal analog insulins are superior compared to normal or intermediate human insulins with respect to the risks of hypoglycemia, quality of glycemic control and quality of life. If correctly indicated, insulin pump therapy with continuous subcutaneous insulin infusion (CSII) offers superior glycemic control compared to intensive insulin treatment. In patients with type 2 diabetes, individualized and patient-centered treatment strategies tailored to the respective phase of the chronic progressive disease are warranted. The best point in time to start insulin therapy depends on the extent of hyperglycemia and comorbidities taking into account the state of the disease, safety aspects (e.g. hypoglycemia, adverse effects and body weight gain) and the preferences of the patient. In patients with severe (skeletal muscle) insulin resistance and poor glycemic control, very high doses of insulin with the aim to override insulin resistance do not seem prudent as muscle insulin resistance also serves as a protective mechanism preventing further nutrient drainage into the muscle tissue. Instead, strategies to improve insulin sensitivity by reducing nutrient load, such as calorie restriction, increase of physical activity as well as administration of metformin, incretin-based treatment and sodium-glucose-linked transporter-2 (SGLT-2) inhibitors should form the basis for therapy in such patients. Transient, short-term treatment with insulin, often started at manifestation of the disease -if plasma glucose values are high, quickly removes the negative effects of glucotoxicity and may offer beneficial metabolic long-term effects.     

Maximale Blutalkoholkonzentration nach forciertem Konsum von alkoholfreiem Bier

In recent years sales of non-alcoholic beer have constantly increased. In Germany, so-called non-alcoholic beer may still have an ethanol content of up to 0.5% (by volume). This marginal amount of ethanol might have negative implications for certain groups of persons such as novice drivers. So far no reliable data regarding the blood ethanol concentration after consumption of non-alcoholic beer have been published. Therefore, a drinking experiment was performed as follows: after 5 days of abstinence from ethanol 78 test persons were asked to drink 1.5?l of non-alcoholic beer (ethanol content 0.41–0.42%) within 1?h. Blood samples were taken on a regular basis and analyzed for ethanol by headspace gas chromatography-flame ionization detection (HS-GC-FID). A total of 67 data sets could be interpreted and in 20 test persons ethanol was detected in blood with a limit of detection (LOD) of 0.0005?g/l. The maximum blood ethanol concentration was 0.0056‰. The results of the study suggest that even after consumption of unrealistically high amounts of non-alcoholic beer negative forensic implications are not to be expected.