tailieunhanh - Manual of neurologic therapeutics - part 9

1. Furosemide 40 to 240 mg IV over 30 minutes 2. Ethacrynic acid 50 to 100 mg IV over 30 minutes 3. Bumetanide 1 to 8 mg IV over 30 minutes Copyright ©2004 Lippincott Williams & Wilkins Samuels, Martin A. Manual of Neurologic Therapeutics, 7th Edition VITAMIN DEFICIENCY, DEPENDENCY, AND TOXICITY Part of "16 - Toxic and Metabolic Disorders" VITAMIN A BACKGROUND 1. Vitamin A deficiency is an important cause of blindness in large parts of the world but is rare in economically developed countries. 2. Vitamin A intoxication is seen in people who engage in megavitamin therapy. PATHOPHYSIOLOGY In many developing countries, general malnutrition is the major. | 1. Furosemide 40 to 240 mg IV over 30 minutes 2. Ethacrynic acid 50 to 100 mg IV over 30 minutes 3. Bumetanide 1 to 8 mg IV over 30 minutes Copyright 2004 Lippincott Williams Wilkins Samuels Martin A. Manual of Neurologic Therapeutics 7th Edition VITAMIN DEFICIENCY DEPENDENCY AND TOXICITY Part of 16 - Toxic and Metabolic Disorders VITAMIN A BACKGROUND 1. Vitamin A deficiency is an important cause of blindness in large parts of the world but is rare in economically developed countries. 2. Vitamin A intoxication is seen in people who engage in megavitamin therapy. PATHOPHYSIOLOGY In many developing countries general malnutrition is the major cause of vitamin A deficiency whereas in developed countries it is usually related to malabsorption or an unconventional diet. PROGNOSIS 1. If treated early the neurologic manifestations are usually completely reversible. 2. Once blindness has occurred little can be done to reverse the visual loss. DIAGNOSIS 1. Night blindness and dry eyes are probably the earliest symptoms of vitamin A deficiency. 2. Dry pruritic skin is also an early symptom of this deficiency. TREATMENT 1. Vitamin A 1 000 units daily for 6 months and restoration of a normal diet for early disease. 2. Vitamin A up to 100 000 units daily for 6 months with restoration of a normal diet may be needed for moderate or advanced symptoms. Long-term use of vitamin A is not advisable as it may produce hypercoagulable state with consequent increased intracranial pressure ICP pseudotumor cerebri possibly caused by cerebral venous thrombosis. Treatment consists of discontinuation of the vitamin A. VITAMIN B1 THIAMINE DEFICIENCY BACKGROUND 1. Vitamin B1 thiamine deficiency occurs in parts of the world where polished rice is a major dietary staple or in people who are malnourished for any reason. 2. In developed countries it is strongly linked to alcoholism. PATHOPHYSIOLOGY Thiamine is the coenzyme in thiamine pyrophosphate catalysis of decarboxylation of pyruvic acid .