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Biomedical subjects

D A Blaustein

Publications and source records attributed to D A Blaustein.

5 recordsLinked to original sources

Rapid, high-dose intravenous iron sucrose therapy in 2 Jehovah's Witness patients with severe anemia, iron deficiency and chronic kidney disease.

AIMS: Two patients with chronic kidney disease presented with severe anemia and iron deficiency. Because of their religious beliefs, red blood cell transfusions were not possible, and an aggressive therapeutic regimen of iron replenishment was instituted. MATERIAL AND METHODS: The regimen included epoetin, folic acid and high-dose intravenous iron sucrose infusions over multiple successive days (total dosages of 2 and 3.5 g). RESULTS: The patients' iron stores were replenished and an erythropoietic response ensued subsequent to this aggressive and unique therapeutic regimen. There were no side effects observed which could be attributed to iron sucrose, and both patients stabilized and were discharged after 3 - 4 weeks. CONCLUSION: In patients with chronic kidney disease who are severely anemic and iron-deficient and where transfusions are not possible, an aggressive regimen of multiple high-dose iron sucrose infusions may be both safe and effective.

Aged↗

Antinuclear antibody negative systemic lupus erythematosus presenting as bilateral facial paralysis.

Cranial neuropathy, and particularly facial palsy, is a rare occurrence in patients with systemic lupus erythematosus (SLE). We describe a 16-year-old female who developed bilateral facial palsy concomitant with cutaneous bullous eruption, alopecia, mucosal ulcers, arthritis, lymphadenopathy, parotid enlargement, and proteinuria. The lack of positive antinuclear antibody (ANA) at presentation obscured the diagnosis. Her followup course clarified the diagnosis of SLE. We believe this is the first report of ANA negative SLE presenting as bilateral facial palsy.

Adolescent↗

The pharmacokinetics of acetazolamide during CAPD.

Acetazolamide is a carbonic anhydrase inhibitor commonly used to reduce intraocular pressure (IOP). We report the first pharmacokinetic study of acetazolamide in a patient undergoing continuous ambulatory peritoneal dialysis (CAPD). The patient was a Type I diabetic with end-stage renal disease (ESRD) undergoing CAPD who received acetazolamide for elevated IOP after surgery for a detached retina. Serum acetazolamide concentrations were measured prior to a 250 mg oral dose and 12 additional times during a 24-h dosing interval. All dialysate effluent was collected and assayed for acetazolamide. Serum concentrations at the beginning and end of the dosing interval were 18 and 17 mcg/mL, respectively, with a maximum concentration of 27 mcg/mL at 6.5 h (therapeutic range = 5-10 mcg/mL). The elimination half-life was prolonged, 28.5 h, compared to that seen in subjects with normal renal function (5-10 h). CAPD did not remove a clinically significant amount of drug (17.1 mg, or 6.8% of dose recovered in dialysate). The patient was very lethargic during therapy, a possible manifestation of acetazolamide toxicity. Marked reduction in acetazolamide dosage (in this case, 125 mg/day) would be required to prevent drug accumulation and toxicity.

Acetazolamide↗

Misleading acute hypercalcemia due to hyperlipidemia: a method-dependent error.

OBJECTIVE: To report a case of artifactual hypercalcemia in a patient with hyperlipidemia. METHODS: We present clinical data and laboratory findings in a 33-year-old woman with generalized fatigue, a recent 5-kg weight loss, and a papular rash on the extremities as well as a history of diabetes and hypertension. RESULTS: Physical examination revealed an obese patient with eruptive xanthomas and lipemia retinalis. Laboratory tests showed hyperlipidemia, hypercalcemia (serum calcium measured by spectrophotometry), anemia, hyperproteinemia, hyperuricemia, and hyperbilirubinemia. After 4 days of a low-fat, low-cholesterol diet and gemfibrozil therapy, the serum triglyceride level decreased, and the serum calcium concentration returned to normal. CONCLUSION: In patients with hypercalcemia without an obvious cause, a spurious measurement should be considered.

Journal Article↗