RESUMO
Ascertainment of the left ventricular ejection fraction is the primary reason for ordering echocardiography in the acute care setting; however, this parameter does not provide information regarding a patient's volume status. As such, it cannot be reliably used to inform decisions regarding intravenous fluid resuscitation or diuresis, particularly in undifferentiated dyspnea and hypotension. This is relevant given a national quality improvement exhortation to provide aggressive fluid resuscitation as part of a "sepsis bundle." This initiative must be tempered by the well-established increase in hospital mortality from providing intravenous fluid to patients with unrecognized heart failure, which may occur if sepsis is misdiagnosed. We describe herein, what is to our knowledge, the first description of a critically elevated Doppler ratio of mitral inflow peak E-wave velocity to the mean mitral annular velocity as a harbinger of sudden death from pulmonary edema in a patient treated with aggressive intravenous fluids as part of the "sepsis bundle." This is utilized as a springboard for proposing a clinical algorithm focused on expedited echocardiography. It emphasized the potential value of advancing markedly the diastolic assessment of filling pressure (ratio of mitral inflow peak E-wave velocity to the mean mitral annular velocity) in the acute care setting to a level of import comparable to the left ventricular ejection fraction.
Assuntos
Insuficiência Cardíaca , Sepse , Diástole , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/terapia , Humanos , Volume Sistólico , Função Ventricular EsquerdaRESUMO
IMPORTANCE: Interventions to reduce anxiety are needed for patients with anorexia nervosa (AN) and avoidant- restrictive food intake disorder (ARFID). Weighted blankets are one such intervention. OBJECTIVE: To evaluate the impact of weighted blankets on anxiety for patients with AN and ARFID. DESIGN: Randomized controlled trial conducted between November 2018 and March 2019. Patients were randomized into the control group or the intervention group. SETTING: Inpatient setting; medical stabilization unit. PARTICIPANTS: Patients (N = 23) diagnosed with AN or ARFID and experiencing moderate anxiety. The majority were female (91%), with a mean age of 26 yr (SD = 9.3), and the mean length of hospitalization was 22 days (SD = 17.3). INTERVENTIONS: Control group participants received usual care, which included occupational therapy services. Intervention group participants received a weighted blanket along with usual care. OUTCOMES AND MEASURES: Mixed-effects regression models were conducted. Primary outcomes included improvement in Beck Anxiety Inventory (BAI) scores by discharge. RESULTS: Intervention group patients had a greater, non-statistically significant decrease in BAI score over time (B = 1.16, p = .83) than control group patients. CONCLUSIONS AND RELEVANCE: Weighted blankets may be an effective tool for reducing anxiety among patients with AN or ARFID. What This Article Adds: The use of a weighted blanket, in conjunction with occupational therapy interventions, is potentially a beneficial non-pharmacological option for patients with anorexia nervosa (AN) and avoidant-restrictive food intake disorder (ARFID). The current study adds an additional modality to the multidisciplinary treatment approach for eating disorders.
Assuntos
Anorexia Nervosa , Transtorno Alimentar Restritivo Evitativo , Humanos , Feminino , Masculino , Adulto , Anorexia Nervosa/diagnóstico , Anorexia Nervosa/terapia , Estudos Retrospectivos , Ansiedade , Ingestão de AlimentosRESUMO
Bulimia nervosa, a mental illness 4 times more common than anorexia nervosa, is characterized by binge-eating followed by compensatory purging behaviors, which include self-induced vomiting, diuretic abuse, laxative abuse, and misuse of insulin. Patients with bulimia nervosa are at risk of developing medical complications that affect all body systems, especially the renal and electrolyte systems. Behavior cessation can reverse some, but not all, medical complications.
Assuntos
Anorexia Nervosa , Bulimia Nervosa , Bulimia , Bulimia Nervosa/complicações , Humanos , VômitoRESUMO
OBJECTIVE: The purpose of this study was to describe the medical complications of anorexia nervosa (AN) to enable a consult-liaison psychiatrist to be familiar with these complications when involved with the care of a hospitalized patient with AN. METHODS: Comprehensive PubMed search of English language publications of adult patients with AN was carried out using keywords, phrases, and medical subject headings of anorexia nervosa-medical complications, cardiac, osteoporosis, gastrointestinal, hematological, and endocrine. The database search was restricted by time of publication of studies from 2005 to 2020. RESULTS: Every organ system can be adversely affected by AN. Most are fully reversible with time and informed medical care. A multidisciplinary team is needed to optimally care for patients who are hospitalized as a result of the medical complications of their AN. CONCLUSIONS: Consult-liaison psychiatrists are asked to help in the care of patients with AN who are admitted to a hospital because of a medical complication of their illness. Being familiar with these complications and their treatments will optimize their hospital stays and the care provided. In addition, involving other relevant ancillary services is an important care consideration.
Assuntos
Anorexia Nervosa , Osteoporose , Adulto , Anorexia Nervosa/complicações , Anorexia Nervosa/terapia , Hospitalização , Humanos , Osteoporose/etiologia , Encaminhamento e ConsultaRESUMO
Anorexia nervosa is a mental illness characterized by self-starvation, marked weight loss, and malnutrition. As the illness worsens, numerous medical complications develop throughout the body. Some of these resolve with effective nutritional rehabilitation and weight gain, whereas others can lead to permanent damage.