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Barbarini S, Martella V, Ferramosca E, Ria P, Zito A, Lefons ML, Carbonara MC, Fontò G, Protopapa P, De Pascalis A, Napoli M. Efficacy of sustained low-efficiency dialysis in the management of topiramate intoxication: case report. G Ital Nefrol 2023; 40:40-02-2023-04. [PMID: 37179476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Guidelines on the use of dialysis treatment in patients with chronic kidney disease (CKD) and TPM (Topiramate) intoxication are controversial. A 51-year-old man with epilepsy and CKD was carried to our emergency department for dysuria and sickness. He chronically assumed TPM 100 mg 3/day. Creatinine level was 2.1 mg/dL, blood urea nitrogen 70 mg/dL, and inflammation indexes were increased. We started empirical antibiotic therapy and rehydration. The day two he had diarrhea and an acute insurgence of dizziness, confusion, and bicarbonate levels reduction. Brain CT resulted negative for acute events. During the night his mental status worsened, and urinary output results were about 200 mL in 12h. EEG showed desynchronized brain bioelectric activity. Thereafter, there was an episode of seizure and then anuria, hemodynamic instability, and loss of consciousness. Creatinine value was 5.39 mg/dL with a serious metabolic acidosis non-anion gap. We decided to start 6-hours Sustained Low Efficiency Hemo-Dia-Filtration (SLE-HDF). We assisted in the recovery of consciousness and later in the improvement of kidney function after 4 hours of treatment. TPM levels before SLE-HDF resulted in 123.1 µg/mL. At the end of treatment resulted in 30 µg/mL. To our knowledge, this is the first report of TPM involuntary intoxication in a patient affected by CKD who survived such a high TPM concentration treated with renal replacement therapy. SLE-HDF resulted in moderate elimination of TPM and acidemia resolution, continuous monitoring patient's vital parameters in relation to his hemodynamic instability, since blood flow and dialysate flow are lower than conventional hemodialysis.
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Affiliation(s)
- Silvia Barbarini
- Ospedale Vito Fazzi, Lecce, Italia. Dipartimento di nefrologia, dialisi e trapianto
| | - Vilma Martella
- Ospedale Vito Fazzi, Lecce, Italia. Dipartimento di nefrologia, dialisi e trapianto
| | - Emiliana Ferramosca
- Ospedale Vito Fazzi, Lecce, Italia. Dipartimento di nefrologia, dialisi e trapianto
| | - Paolo Ria
- Ospedale Vito Fazzi, Lecce, Italia. Dipartimento di nefrologia, dialisi e trapianto
| | - Anna Zito
- Ospedale Vito Fazzi, Lecce, Italia. Dipartimento di nefrologia, dialisi e trapianto
| | - M Luisa Lefons
- Ospedale Vito Fazzi, Lecce, Italia. Dipartimento di nefrologia, dialisi e trapianto
| | | | - Giulia Fontò
- Ospedale Vito Fazzi, Lecce, Italia. Dipartimento di nefrologia, dialisi e trapianto
| | - Paolo Protopapa
- Ospedale Vito Fazzi, Lecce, Italia. Dipartimento di nefrologia, dialisi e trapianto
| | - Antonio De Pascalis
- Ospedale Vito Fazzi, Lecce, Italia. Dipartimento di nefrologia, dialisi e trapianto
| | - Marcello Napoli
- Ospedale Vito Fazzi, Lecce, Italia. Dipartimento di nefrologia, dialisi e trapianto
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Cotesta D, Petramala L, Zinnamosca L, Marinelli C, Serafini MC, Lefons ML, Ciardi A, Cavallaro G, De Toma G, Letizia C. Adrenal ganglioneuroma incidentally discovered in a patient with dysuria: a case report. Eur Rev Med Pharmacol Sci 2011; 15:1222-1226. [PMID: 22165687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A case of adrenal ganglioneuroma incidentally discovered during an abdominal ultrasound examination in a 26 year-old woman patient with recurrent episodes of dysuria. After a diagnostic work-up with laboratory and abdomen CT scan, the patient uderwent a laparotomic removal of the adrenal lesion. Histopathological examination of the adrenal mass confirmed the diagnosis.
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Affiliation(s)
- D Cotesta
- Department of Internal Medicine and Medical Specialities, "Sapienza" University, Rome, Italy
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