Diathesis

In 1956 selenium was identified (123) as an essential micronutrient iu nutrition. In conjunction with vitamin E, selenium is effective iu the prevention of muscular dystrophy iu animals. Sodium selenite is adrninistered to prevent exudative diathesis iu chicks, a condition iu which fluid leaks out of the tissues white muscle disease iu sheep and infertility iu ewes (see Eeed ADDITIVES). Selenium lessens the iacidence of pneumonia iu lambs and of premature, weak, and stillborn calves controls hepatosis dietetica iu pigs and decreases muscular inflammation iu horses. White muscle disease, widespread iu sheep and cattle of the selenium-deficient areas of New Zealand and the United States, is insignificant iu high selenium soil areas. The supplementation of animal feeds with selenium was approved by the U.S. EDA iu 1974 (see Eeed additives). Much of selenium s metaboHc activity results from its involvement iu the selenoproteia enzyme, glutathione peroxidase. 

The hemorrhagic diathesis in patients with coagulation disorders is because of either an abnormaUty of one or more plasma proteins and/or platelets necessary for normal blood coagulation or the spontaneous presence of a circulating anticoagulant. Specific laboratory techniques are required for the precise identification of these disorders. 

Known bleeding diathesis (includes renal and hepatic insufficiency) ... 

Contraindicated if patient has a bleeding diathesis, has hydrostatic pulmonary edema, or is anuric. Cautious use if patient is thrombocytopenic, has liver disease, or has a history of corn allergy... 

Known bleeding diathesis, including but not limited to (1) platelet count less than 100 x 1 0 /mm3 (100 x 109/L) (2) heparin within 48 hours with an elevated aPTT or (3) current oral anticoagulant use (e.g., warfarin) or recent use with an elevated PT (greater than... 

Pathological findings frequently observed in organs of patients who have died of sepsis include disseminated intravascular coagulation (DIC), manifested as diffuse thrombotic occlusions in the entire microvascular system, associated with alterations in the hemostatic mechanism and clinical signs of hemorrhagic diathesis. Many observations indicate that DIC contributes to the major symptoms of the systemic inflammatory response syndrome (SIRS), which frequently complicate sepsis (HI, H2, H3, T6). 

Adverse drug reactions and the diathesis stress model... 

Diathesis stress model A multifactorial model of pathogenesis suggesting that schizophrenia is due to the complex interaction between a number of internal and external factors. 

Homocystinuria Usually a failure of cystathionine synthase (Fig. 40-2 reaction 6). Rarely associated with aberrant vitamin B12 metabolism (Fig. 40-2) Thromboembolic diathesis, marfanoid habitus, ectopia lentis. Mental retardation is frequent. Diet low in methionine Vitamin B6 in pyridoxine-responsive syndromes Vitamin B12 in responsive syndromes Anticlotting agents... 

A newer therapeutic approach is the administration of betaine (6-12 g daily), which lowers homocysteine levels by favoring remethylation [33], A theoretical hazard of betaine treatment is increasing the blood methionine, sometimes to an extravagant degree ( 1 mmol/1). Experience to date indicates that betaine administration is safe, with no major side effects except for a fishy odor to the urine. Other therapeutic approaches have included the administration of salicylate to ameliorate the thromboembolic diathesis. Patients also have been treated with dietary supplements of L-cystine, since the block of the transsulfura-tion pathway in theory could diminish the synthesis of this amino acid. 

A thromboembolic diathesis is not unusual and strokes have been reported. Other pathological changes have included microgyri, demyelination, gliosis and brain atrophy. Lipid-laden macrophages have been described. 

The reason most likely lies in genetic and developmental effects having created a neurobiological diathesis for recurrent episodes of major depression or mania. It is of note that the clinical picture of major depression varies greatly... 

Known bleeding diathesis, including but not limited to platelet count <100,000/mm3... 

The net effect of these events is the development of bleeding diathesis. 

In patients with anemia secondary to blood loss (hemorrhagic diathesis or long-term dialysis) ... 

Adverse effects, which include gastritis, peptic ulcer, hypertension, kidney failure, delirium, bleeding diathesis and oedema of the lower extremities, are not uncommon. Most cases of knee arthritis can improve with the right kind of exercise of the thigh muscles, better personally adjusted walking aids and shoe implants can also be of help. 

But as frustrating as Haig s inattention to these frequent scoldings could be, uric acid critics were more bothered by the naivete of rank and file physicians, so many of whom, it was charged, had allowed themselves to be conditioned to reflexly diagnose "uric acid diathesis" if any uric acid were found in the patient s urine. That the compound had been able to acquire what one commentator described as a "fixed hold" on the medical profession should not, however, have caused much surprise. (40)... 

The most important side effects of the thiazide diuretics, chlorthalidone, furosemide, ethacrynic acid and metolazone are potassium losses with resultant hypokalemia, and hyperuricemia. Hyperuricemia may result in acute attacks of gouty arthritis in individuals with a gouty diathesis. 

Special risk Use with care in patients with a bleeding diathesis, uncontrolled arterial hypertension, or a history of recent Gl ulceration or bleeding, diabetic retinopathy, hemorrhage, and severe liver or kidney insufficiency. 

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