RESUMEN
An important cause of hypertriglyceridemia in psychiatric patients is the administration of antipsychotics. Mildly elevated levels of triglycerides are seen most often, occurring shortly after treatment inception. Whether hypertriglyceridemia may be caused by alcohol use has not been fully elucidated. We describe the case of a 38-year-old woman suffering from schizophrenia who had been prescribed quetiapine for five years and consumed two glasses of alcohol daily. Upon presentation with stomach pain, lab results showed alarming triglyceride levels (8348 mg/dl). She rapidly developed both a severe pancreatitis and thrombotic thrombocytopenic purpura (ttp). We discuss how this most severe case of pancreatitis and ttp in a patient on an antipsychotic described in the literature to date should encourage prevention and early management of hypertriglyceridemia in psychiatric patients.
Asunto(s)
Antipsicóticos/efectos adversos , Hipertrigliceridemia/inducido químicamente , Pancreatitis/diagnóstico , Púrpura Trombocitopénica Trombótica/diagnóstico , Fumarato de Quetiapina/efectos adversos , Adulto , Antipsicóticos/uso terapéutico , Femenino , Humanos , Hipertrigliceridemia/complicaciones , Pancreatitis/etiología , Púrpura Trombocitopénica Trombótica/etiología , Fumarato de Quetiapina/uso terapéutico , Esquizofrenia/tratamiento farmacológicoRESUMEN
The hospital costs and the effects on speech are compared for tracheoesophageal (TE) speech and esophageal (E) speech in laryngectomy patients. TE-speech is more intelligible and the rehabilitation is faster (four versus nine months), but it is more expensive for the hospital. E-speech needs more speech rehabilitation sessions (average of 23,422 BF/patient) than TE-speech (7,157 BF). TE-speech involves primary (6,192 BF) or secondary placement (25,357 BF), replacement (average of 19,443 BF/patient/year) and in about ten percent closure of the fistula (39,135 BF/patient) and switching over to E-speech. On the basis of these data the expected average costs per patient can be calculated. These are definitely higher for the TE-speech than for E-speech.