Introducción: la infección generada por el nuevo coronavirus SARS-CoV-2 ha mostrado un aumento creciente en los últimos meses, presentando manifestaciones clínicas variadas desde síntomas leves hasta afectación pulmonar grave. Además, se han descrito formas clínicas atípicas, en las que predominan los síntomas extrapulmonares; entre ellas, se han notificado casos de manifestaciones neurológicas concurrentes. A partir de la identificación de coronavirus en el sistema nervioso central en el brote de SARS-CoV de 2020, se ha planteado un posible neurotropismo del SARS-CoV-2. En la literatura mundial se han descrito pocos pacientes con encefalitis aguda, eventos cerebrovasculares isquémicos y afectación de la médula espinal asociados al SARS-CoV-2. Caso clínico: varón de 57 años, con antecedentes de hipertensión controlada, acude al servicio de urgencias con ocho días de tos no productiva, asociada a un aumento subjetivo de la temperatura corporal. La exploración física al ingreso reveló taquipnea, fiebre de 38 °C, tensión arterial y frecuencia cardiaca normales; se realiza una radiografía de tórax que muestra neumonía grave, posteriormente evolucionó a insuficiencia ventilatoria que requirió manejo en unidad de cuidados intensivos para soporte con ventilación mecánica no invasiva. Infección por SARS-CoV confirmada con RT-PCR. Conclusión: en este reporte presentamos un paciente con mielitis transversal concurrente a COVID-19, revisamos la literatura y discutimos los hallazgos clínicos e imagen dados por la enfermedad.
Introduction: Lithium has been used over time in the treatment of psychiatric pathologies, mainly the bipolar spectrum, however, the narrow therapeutic range generates a high incidence of poisoning by this metal, with a very heterogeneous clinical presentation of toxicity which will depend on two factors: the time of evolution, if it is acute or chronic, and the serum levels, ranging from gastrointestinal symptoms to severe neurological compromise. As of today, there is no specific antidote for lithium, so intermittent hemodialysis is the strategy of choice for the intoxicated patient. Objectives: To describe the available and relevant literature on the management of Lithium poisoning. Methodology: A search was performed with the MeSH terms "Lithium, Renal Dialysis, Poisoning, Toxicity, Acute kidney injury" in the ClinicalKey, PubMed and Ovid databases search engines, finding 156 results, of which 47 were used to develop this manuscript. Conclusions: Lithium poisoning is frequent due to its narrow therapeutic margin, so serum lithium levels should be monitored in patients medicated with it. Today there is no specific antidote, so renal replacement therapy is the best therapeutic option for lithium poisoning, demonstrating high efficiency, especially in cases of marked neurotoxicity. It is necessary to assess the need to initiate timely management in order to achieve a rapid clearance of the drug and decrease the rate of complications and mortality.
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