parasitária mais comum de diarreia prolongada, associada à perda de peso acentuada, podendo evoluir com grave desidratação e distúrbio eletrolítico.(1,2). Veja grátis o arquivo disturbios eletroliticos enviado para a disciplina de Semiologia Categoria: Anotações – 7 – enwiki Electrolyte imbalance; eswiki Trastorno hidroelectrolítico; hrwiki Poremećaji ravnoteže elektrolita; kowiki 수분-전해질 불균형; ptwiki Distúrbio eletrolítico.
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ABSTRACT – We reviewed the laboratorycards of analysis elettolitico cerebrospinal fluid CSF performed to evaluate acute alterations of eletorlitico in adult patients attended in a neurological emergency room. The most common clinical data were infective and neurologic. The CSF was abnormal in There were some statistically ditsurbio correlations between CSF syndromes and clinical data: We classified the abnormal results in two groups: The former group was found in In patients attending to neurologic emergency rooms with acute alterations of consciousness, the examination of the CSF frequently could contribute to an etiologic diagnosis.
It must be performed after a rigorous clinical evaluation of the patient. Patients with consciousness impairment are frequently seen in the emergency room. In this setting, a detailed medical history, concerning mode of onset, previous diseases, associated symptoms, history of medications, drug exposure or abuse is essential, but not ever obtainable. So, the diagnosis may become based upon physical examination and sometimes extensive laboratorial and image tests, such as computed tomography CT scan, electroencephalogram and cerebrospinal elerrolitico CSF examination.
In order to study the frequence in which the CSF findings contribute for the evaluation of patients presenting to eletroliitco neurologic emergency setting with acute conciousness compromise, we reviewed six year results of CSF analysis performed with this indication. Patients were attended at the neurological emergency room from January, up to April, All the tests were performed during the evaluation of patients presenting an acute disturbance of consciousness.
There was no history of recent neurosurgery or craniocerebral trauma and only patients older than 12 were included.
Clinical data were obtained from laboratory records. Because this eletroliticco a retrospective study, we preferred not to divide the patients between those presenting an acute confusional state, or deliriumand those presenting somnolence or coma. We included only the results of the initial evaluation. Among thesewe randomly choose 30 hospital filecards to check the inclusion criteria. To perform a statistical analysis, we divided the abnormal results in two groups: The groups were composed of the following syndromes: The four age groups were: The CSF results were correlated to clinical data using Epi-info, version 5.
Alterações na concentração de eletrólitos: implicações cardi by Bruna Federizzi on Prezi
The mean time of consciousness alteration until the first CSF analysis was 3 days. The most common clinical data were: We found abnormal CSF analysis Fifty-five were from the sufficient group: Table 1 shows eletrolifico CSF syndromes.
The association eletrokitico clinical data and the syndromes is shown in Table 2. Our results disclose diseases usually encountered and some interesting associations. To interpret these results, we shall consider the circumstances in which the CSF analysis were solicited: Many of the syndromes found, as well as their frequency, are related to these strict selection criteria 1. The prevalence of neurological and infectious clinical data eletroligico clearly related to our inclusion criteria and to the syndromes found 2.
Patients with obvious systemic causes disturbii their clinical state are evaluated in the clinical – not in the neurological – emergency room. The association of the age between 12 and 25 with nonspecific results may be related to the predominance of diseases of the sufficient group in older ages: As an example, young diabetic patients present more frequently with diabetic keto-acidosis and are infrequently submitted to CSF analysis, except in the suspicion of bacterial meningitis 3.
These patients would not be included because they are seen in the clinical emergency room. It results in extravasation of plasma proteins and in hyperproteinorrachia 4. The predominance of compressive syndromes, besides indicating an insult to the CNS, partially reflect our selection criteria.
The highest CSF protein levels are seen in tumors or inflammatory processes of the brain or spinal cord and in hydrocephalus 5. These diagnoses, except for neurotuberculosis, were not included in this series. Other causes of BBB breakdown usually lead to lower protein levels.
The mean protein level we found was Some grade of chronic eletrllitico suffering, frequently present in the older male population, may lead to moderate elevations of protein 5. In our study, moderate elevations of CSF protein were associated with the male gender and older age. Even so, we consider the finding eletroliticl a moderate elevation of the CSF protein level as indicative of a significant insult to the CNS.
It is not specific enough to point out a diagnosis but we suggest that these patients might need a closer vigilance of their clinical state. Marked elevations of CSF protein levels were associated to headache, fever, meningeal signs and vomiting, reflecting its association to septic and to hemorrhagic syndromes. High CSF protein levels, in patients with bacterial meningitis, is associated to a higher risk of subdural effusion and abcess formation 6. This relatively high frequency of other diagnosis compared with infections of the CNS may be explained by the fact that the typical or mild cases of meningitis were not included by our criteria.
Certainly, a great part of the patients that had a CSF eletrokitico, due to a hypothesis of meningitis, were not cisturbio because they had no consciousness compromise.
The syndrome of “viral” meningitis is usually thought as essentially benign. Nevertheless, we found 17 cases that eldtrolitico acute consciousness compromise. It may be related to the many possible diaturbio, including fungi and protozoa 1.
To evaluate the hypothesis of a subarachnoid hemorrhage, we perform a CT scan of the head 7,8. If no blood is seen, one can perform a CSF analysis to evaluate the presence of minor bleeding. Francisco found that spontaneous subarachnoid hemorrhage with less than So, the relatively high frequency of the CSF diagnosis of a CNS hemorrhage may be explained by the relatively low red cells count mean: The 3 cases with neoplastic infiltration had no previous diagnosis.
Even rare, the finding of neoplastic cells in the CSF is a striking diagnosis and a prognostic information in any individual patient 2,5,9.
Moderate hypotension may reflect systemic dehydration just as moderate hyperglycorrachia may be considered an unspecific consequence of a stressful situation eletrloitico. Qualitative alteration of proteins QAPreflected in the posititivity of the Pandy, Nonne or Weichbrodt reactions, may be caused by diseases like syphilis or multiple sclerosis.
May also be secondary to elevation of the CSF protein 1,5. All the patients with compressive syndrome also had QAP and 3 of the 4 patients with QAP as the sole abnormality had a borderline protein level mean: Severe hyperglycorrachia is an example of a sufficient CSF result secondary to a systemic metabolic disturbance. A more careful clinical evaluation prior to the CSF analysis might had made it unnecessary.
The association of seizures to hydroelectrolytic disturbances in the CSF was very interesting. It is well known that systemic electrolytic changes are reflected in the CSF and that they can predispose patients to seizures 5, It is a demonstration that metabolic dysfunction must always be carefully sought in critical ill neurological dissturbio.
We found an elevated frequency of syndromes considered sufficient for an immediate clinical decision or a diagnosis It may be explained by a thorough previous evaluation, before performing the puncture, but may also reflect our strict selection criteria. Both contributed to exclude patients with obvious secondary neurological compromise.
By evaluating deliriumin a neurological emergency setting, Neves found eoetrolitico the CSF analysis confirmed an initial diagnostic hypothesis in In the patients we studied, were included not only delirium but also patients who were somnolent or comatose. Even that the etiologies may be similar, the clinical situation in which the CSF analysis was performed is quite different. Many of our patients had a CSF analysis only after the initial diagnosis that seemed more probable were excluded.
In the neurological emergency setting, it must be emphasized the urge to evaluate the patient as a whole, carefully trying to differentiate primary and secondary neurological involvement.
When the primary clinical suspicion is meningitis, CSF analysis almost always is the first exam to be performed. Many systemic causes of acute consciousness compromise are reversible and need urgent evaluation and treatment.
In these cases, performing and waiting the results of a CSF analysis may be not worthwhile. So, it was possible to obtain a so high contribution of the CSF analysis mainly because of carefully selecting patients that would benefit from it, based on reasonable clinical judgment. The CSF examination may significantly contribute for the evaluation of patients who show an acute compromise of the CNS.
A high frequency of results considered “sufficient” can be expected if the patients are reasonably selected. A CSF analysis may reveal uncommon diseases, but usually it reveals unsuspected usual diseases.
Given the high probability of a “sufficient” elerolitico in the CSF examination, we suggest that it must be reasonably considered in the evaluation of patients presenting acute confusional status or somnolence not only if the primary suspicion is meningitis or SAH. Adams RD, Victor M. Principles of neurology Disturbances of cerebrospinal fluid circulation, including hydrocephalus and meningeal reactions.
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