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病例15-2018——一名有恶心、呕吐和意识错乱的83岁女性
Case 15-2018 — An 83-Year-Old Woman with Nausea, Vomiting, and Confusion


Melissa L.P. Mattison ... 心脑血管疾病 • 2018.05.17

病历陈述


Andrew S. Hoekzema医师(内科):一名83岁女性因恶心、呕吐、腹泻和意识错乱,在冬季入住本院。

入院前一周,患者出现鼻漏、咽喉痛和干咳。患者感到发热,但没有在家中测量体温。家人或最近接触的人员均未生病。入院前两日,患者出现了恶心、呕吐和腹泻。入院前一日,患者问女儿重复的问题,似乎认不出家人。在入院当日,患者报告全身无力,由女儿带到本院急诊科进行评估。





作者信息

Melissa L.P. Mattison, M.D., Victorine V. Muse, M.D., Leigh H. Simmons, M.D., Christopher Newton-Cheh, M.D., M.P.H., and Rory K. Crotty, M.B., B.Ch., B.A.O.
From the Departments of Medicine (M.L.P.M., L.H.S.), Radiology (V.V.M.), Cardiology (C.N.-C.), and Pathology (R.K.C.), Massachusetts General Hospital, and the Departments of Medicine (M.L.P.M., L.H.S.), Radiology (V.V.M.), Cardiology (C.N.-C.), and Pathology (R.K.C.), Harvard Medical School — both in Boston.

 

参考文献

1. Gilmore EJ, Gaspard N, Choi HA, et al. Acute brain failure in severe sepsis: a prospective study in the medical intensive care unit utilizing continuous EEG monitoring. Intensive Care Med 2015;41:686-694.

2. Maldonado JR. Acute brain failure: pathophysiology, diagnosis, management, and sequelae of delirium. Crit Care Clin 2017;33:461-519.

3. Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method: a new method for detection of delirium. Ann Intern Med 1990;113:941-948.

4. Russo A, Falcone M, Venditti M. Early identification of severe community-onset pneumonia in “frail elderly patient.” Intern Emerg Med 2014;9:119-120.

5. Silva TJ, Jerussalmy CS, Farfel JM, Curiati JAE, Jacob-Filho W. Predictors of in-hospital mortality among older patients. Clinics (Sao Paulo) 2009;64:613-618.

6. McCusker J, Cole M, Abrahamowicz M, Primeau F, Belzile E. Delirium predicts 12-month mortality. Arch Intern Med 2002;162:457-463.

7. Marcantonio ER. Delirium in hospitalized older adults. N Engl J Med 2017;377:1456-1466.

8. Centers for Disease Control and Prevention. About adult BMI. August 29, 2017 (https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html).

9. Coresh J, Astor BC, Greene T, Eknoyan G, Levey AS. Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey. Am J Kidney Dis 2003;41:1-12.

10. Frequently asked questions about GFR estimates. New York: National Kidney Foundation, 2014.

11. Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA 1998;279:1200-1205.

12. Pardo Cabello AJ, González Contreras LG, Manzano Gamero MV, Gómez Jiménez FJ, Puche Cañas E. Prevalence of fatal adverse drug reactions in hospitalized patients. Int J Clin Pharmacol Ther 2009;47:596-602.

13. Toxicology Data Network. Spironolactone. September 17, 2007 (https://toxnet.nlm.nih.gov/cgi-bin/sis/search/a?dbs+hsdb:@term+@DOCNO+3184).

14. Dasgupta A. Therapeutic drug monitoring of digoxin: impact of endogenous and exogenous digoxin-like immunoreactive substances. Toxicol Rev 2006;25:273-281.

15. Withering W. An account of the foxglove, and some of its medical uses: with practical remarks on dropsy and other diseases. Birmingham, England: M. Swinney, 1785.

16. Digitalis Investigation Group. The effect of digoxin on mortality and morbidity in patients with heart failure. N Engl J Med 1997;336:525-533.

17. Antman EM, Wenger TL, Butler VP Jr, Haber E, Smith TW. Treatment of 150 cases of life-threatening digitalis intoxication with digoxin-specific Fab antibody fragments: final report of a multicenter study. Circulation 1990;81:1744-1752.

18. Sommers BD, Gawande AA, Baicker K. Health insurance coverage and health — what the recent evidence tells us. N Engl J Med 2017;377:586-593.

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