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Biomedical subjects

Philippe Chassagne

Publications and source records attributed to Philippe Chassagne.

6 recordsLinked to original sources
PubMed2006

Clinical presentation of hypernatremia in elderly patients: a case control study.

OBJECTIVES: To assess early clinical signs and their prognostic value in elderly patients with hypernatremia. DESIGN: Prospective, case control study of 150 patients with hypernatremia matched to 300 controls. SETTING: Multicenter study including seven short- and long-term geriatric care facilities. MEASUREMENTS: Clinical assessment of hydration status at bedside, such as abnormal skin turgor or dry oral mucosa. SECONDARY OUTCOME MEASURES: 30-day mortality rate and clinical indicators (assessed at the peak of natremia) associated with mortality. RESULTS: Patients and controls were comparable in terms of drugs and underlying diseases, except for history of dementia, which was more frequent in patients than in controls. Patients were significantly more likely than controls to have low blood pressure, tachycardia, dry oral mucosa, abnormal skin turgor, and recent change of consciousness. Only three clinical findings were found in at least 60% of patients with hypernatremia: orthostatic blood pressure and abnormal subclavicular and forearm skin turgor. The latter two signs were significantly more frequent in patients with hypernatremia. Four other signs (tachycardia, abnormal subclavicular skin turgor, dry oral mucosa, and recent change of consciousness) had a specificity of greater than 79%. Using logistic regression, four signs were significantly and independently associated with hypernatremia: abnormal subclavicular and thigh skin turgor, dry oral mucosa, and recent change of consciousness. The mortality rate was 41.5% and was significantly higher in patients with hypernatremia. The status of consciousness when hypernatremia was diagnosed was the single prognostic indicator associated with mortality (odds ratio=2.3, 95% confidence interval=1.01-5.2). CONCLUSION: Most of the classical signs of dehydration are irregularly present in patients with hypernatremia. Caregivers should carefully screen any variations in consciousness, because they may reveal severe hypernatremia.

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PubMed2005

[Mental confusion in the elderly].

The prevalence of delirium in hospitalized patients aged 80 years or older ranges from 35 to 50%. Its onset is acute, recovery is erratic, and the principal differential diagnosis is dementia. Hypoactive confusion is a clinical form that should not be ignored. Prognosis is severe with impairments in activities of daily living and high mortality. Risk factors are age (older than 80 years), dementia, sensory impairments, dehydration, sleep deprivation and immobility. Initial treatment must focus on identifying the cause of the delirium. Primary nonpharmacological prevention in subjects at risk is possible and effective.

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PubMedDate not supplied

[Are the prescriptions of anticholinesterasic drugs adapted to the associated diseases and/or drugs in the Alzheimer's dementia?].

The aim of this study was to evaluate if the prescriptions of anticholinesterase drugs took into account some diseases and drugs which could interfere with them, in 58 inpatients (82 years old). The anticholinesterase drugs were respectively at admission and discharge: donepezil (n = 27 and 34), galantamine (n = 12 and 19) and rivastigmine (n = 3 and 1). Nineteen patients received a combination of anticholinesterase drug with an anticholinergic drug (muscarinic antipsychotic 15 times). Twelve patients had a medical history which interfered with the anticholinesterase drug: uretroprostatic obstacle, chronic renal failure and auriculo-ventricular block. Thirty-five adverse drug reactions, mainly in digestive track, were recorded in 26 patients. The treatment with anticholinesterase drug was modified only in 18 patients and the combination of anticholinesterase drug and antipsychotic agent was stopped in 5 patients. In conclusion, inappropriated prescriptions of anticholinesterase drugs seem frequent, with a more important prevalence of adverse drug reactions than in prospective studies. These results incite to develop studies of evaluation of prescriptions of anticholinesterase drugs.

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