Biomedical subjects
Publications and source records attributed to M W Pearson.
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We report three cases of peripheral neuropathy in patients with sickle cell disease. All had a history of frequent painful crises and regular attendance at our Accident and Emergency department where nitrous oxide analgesia was administered for prolonged periods. All three patients (one male and two females) presented with difficulty in walking associated with paraesthesiae, and neurological examination revealed signs compatible with a peripheral sensorimotor neuropathy, later confirmed by nerve conduction studies. Serum vitamin B12 levels were mildly reduced in two patients and very low in one patient (< 10 ng/l). Haemoglobin levels in all the patients were unchanged compared with their steady-state levels but one had developed a macrocytosis (103 fl). Schilling tests were normal in two patients, and two patients had negative gastric parietal antibodies. All three patients were given intramuscular vitamin B12 in addition to avoiding further exposure to nitrous oxide, and their neurological symptoms improved completely. As nitrous oxide is known to cause a neuropathy similar to that seen in pernicious anaemia, we postulate that nitrous oxide analgesia combined with low B12 levels was the cause of the marked neuropathy in these patients. As a result of our observations and the probable association, we now do not use nitrous oxide analgesia in the management of patients with sickle cell disease.
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The use of routine calcium estimations has led to a marked increase in the number of cases of hyperparathyroidism diagnosed, especially in the elderly. The results of surgery in the elderly are reviewed, as are some studies on the natural history of untreated hyperparathyroidism, and on this basis it is recommended that in the asymptomatic elderly patient observation is the appropriate management.
Previous workers have suggested that hepatic enzyme induction by drugs does not occur in the elderly. We have studied the effect of a potent enzyme inducer--glutethimide--on a group of nine patients over the age of 70 years, using antipyrine clearance as a measure of hepatic drug metabolism. After six days treatment with glutethimide, antipyrine clearance rose from 22.8 +/- 4.5 ml/min to 38.3 +/- 7.6 ml/min (P less than 0.001). The results suggest that the elderly are at risk for the full range of drug interactions due to hepatic microsomal enzyme induction.
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