A74-year-old woman with insulin-dependent diabetes was admitted to the medical high dependency unit with a 2-day history of increasing nausea and confusion. On examination she was afebrile, dehydrated and confused. Systemic examination was unremarkable. Capillary blood glucose by self-monitoring strip was 10.6 mmol/litre and urinalysis demonstrated 3+ ketones and 3+ glucose. Biochemical examination revealed plasma glucose 11.9 mmol/litre, sodium 127 mmol/litre, potassium 5.1 mmol/litre, urea 13.9 mmol/litre and creatinine 87 mmol/litre. Arterial blood gas analysis showed pH 7.30, partial pressure of carbon dioxide = 4.4 kPa, partial pressure of oxygen = 9.0 kPa, bicarbonate = 15.3 mmol/litre, base excess -9.2 mmol/litre and oxygen saturation 97%. She was treated with intravenous dextrose-saline and low dose insulin infusion. She made a good recovery and was well within 48 hours of presentation.
1 Despite demonstrable benefits in terms of symptomatic relief and improvement in prognosis, even the best treatments of heart failure currently available fall short of being ideal. We review the basis for newer approaches to the treatment of heart failure and discuss some of the agents which capitalize on current understanding of the underlying patho-physiology. 2 Several drugs, old and new, are presently being investigated by major clinical trials.We also consider some of the difficulties related to the design and conduct of such trials and suggest how drugs might be better assessed in the future.Keywords heart failure medical therapyIn recent years there have been considerable advances in the treatment of cardiac failure and in the understanding of the mechanisms underlying the syndrome. This paper reviews the salient features of the important clinical trials to date and the rationale behind the use of the drugs most recently developed for the treatment of heart failure. We shall also consider the prospects for possible new treatments and the design of future trials.
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