Secondary failures

Patients with asymptomatic left ventricular systolic dysfunction and hypertension should be treated with P-blockers and ACE inhibitors. Those with heart failure secondary to left ventricular dysfunction and hypertension should be treated with drugs proven to also reduce the morbidity and mortality of heart failure, including P-blockers, ACE inhibitors, ARBs, aldosterone antagonists, and diuretics for symptom control as well as antihypertensive effect. In African-Americans with heart failure and left ventricular systolic dysfunction, combination therapy with nitrates and hydralazine not only affords a morbidity and mortality benefit, but may also be useful as antihypertensive therapy if needed.66 The dihydropyridine calcium channel blockers amlodipine or felodipine may also be used in patients with heart failure and left ventricular systolic dysfunction for uncontrolled blood pressure, although they have no effect on heart failure morbidity and mortality in these patients.49 For patients with heart failure and preserved ejection fraction, antihypertensive therapies that should be considered include P-blockers, ACE inhibitors, ARBs, calcium channel blockers (including nondihydropyridine agents), diuretics, and others as needed to control blood pressure.2,49... 

CD occurs in approximately 4.56 per 100,000 pediatric patients, and UC occurs in about 2.14 cases per 100,000.43 A major issue in children with IBD is the risk of growth failure secondary to inadequate nutritional intake. Failure to thrive may be an initial presentation of IBD in this population. Aggressive nutritional interventions may be required to facilitate adequate caloric intake. Chronic corticosteroid therapy may also be associated with reductions in growth. 

Pituitary failure (secondary hypothyroidism) is an uncommon cause resulting from pituitary tumors, surgical therapy, external pituitary radiation, postpartum pituitary necrosis, metastatic tumors, tuberculosis, histiocytosis, and autoimmune mechanisms. 

Most patients with pituitary failure (secondary hypothyroidism) have clinical signs of generalized pituitary insufficiency such as abnormal menses and decreased libido, or evidence of a pituitary adenoma such as visual field defects, galactorrhea, or acromegaloid features. 

Pituitary failure (secondary hypothyroidism) should be suspected in a patient with decreased levels of T4 and inappropriately normal or low TSH levels. 

Hart L, Cobaugh D, Sean B, et al. 1991. Successful use of extracorporeal membrane oxygenation ecmo in the treatment of refractory respiratory failure secondary to hydrocarbon. Vet Hum Toxicol 33(4) 361. 

Human deaths after inhalation exposure have been attributed to respiratory failure secondary to central nervous system depression and to cardiac arrhythmias. Lethal arrhythmias may result from sensitization of the heart to epinephrine. 

IR concentrated oral solution and tablets/suppositories - Respiratory insufficiency or depression severe CNS depression attack of bronchial asthma heart failure secondary to chronic lung disease cardiac arrhythmias increased intracranial or CSF pressure head injuries brain tumor acute alcoholism delirium tremens convulsive disorders after biliary tract surgery suspected surgical abdomen surgical anastomosis concomitantly with MAOIs or within 14 days of such treatment paralytic ileus. 

Gold MR, Shorofsky SR, Metcalf MD, Feliciano Z, Fisher ML, Gottlieb SS. The acute hemodynamic effects of right ventricular septal pacing in patients with congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. Am. J. Cardiol. 1997 79 679-81. 

Cook, B. A., Sinnhuber, J. R., Thomas, R J., Olson, T. A., Silverman, T. A., Jones, R., Whitehead, V. M., and Ruymann, R B. (1983). Hepatic failure secondary to indicine N-oxide toxicity. A Pediatric Oncology Group Study. Cancer 52 61-63. 

Acute renal failure secondary to ischemia-reperfusion or nephro-toxins represents a major cause of morbidity and mortality in hospitalized patients, particularly in the intensive care unit setting. The proximal tubule region of the nephron suffers the most damage in acute renal injury and is therefore the target site of therapeutic interventions. While several experimental therapies have been attempted to prevent or hasten recovery from acute renal injury,... 

Mangano FA, Zaontz M, Pahira JJ, Clark LR, Jaffe MH, Choyke PL, Zeman RK (1985) Computed tomography of acute renal failure secondary to rhabdomyolysis. J Comput Assist Tomogr 9 777-779... 

Simvastatin, like other inhibitors of HMG-CoA reductase, occasionally causes myopathy manifested as muscle pain, tenderness or weakness with creatine kinase (CK) 10 times above the upper limit of normal (ULN). Myopathy sometimes takes the form of rhabdomyolysis with or without acute renal failure secondary to myoglobinuria, and very rare fatalities have occurred. 

A 40-year-old man with cough, shortness of breath, and fever progressed to respiratory failure. He had smoked cocaine for the previous 17 years. His tobacco history was not known. His medical history included recurrent respiratory tract infections. A chest X-ray and CT scan showed findings consistent with bilateral bullous emphysema with a right lung abscess. He was ventilated and given antibiotics but died from respiratory failure secondary to pneumonia. Sputum cultures... 

Shi, Y.F., He, XL., Chen, S.B., Zhang, L.L., Yang, X.L., Wang, Z.H., Wang, M.M. MARS optimistic therapy method in fulminant hepatic failure secondary to cytotoxic mushroom poisoning. A case report. Liver 2002 22 (Suppl. 2) 78-80... 

Shlbayama, Y. The role of hepatic venous congestion and endotoxi-nemia in the production of fuhiiinant hepatic failure secondary to congestive heart failure. J. Pathol. 1987 151 133-138... 

Luyckx VA, Ballantine R, Claeys M, Cuycketrs F, Van den Heuvel H, Cimanga RK, Vhetinck AJ, De Broe ME, Katz U. Herbal remedy-associated acute renal failure secondary to Cape aloes. Am J Kidney Dis 2002 39(3) E13. 

Fernandez Lucas M, Liano F, Navarro JF, Sastre JL, Quereda C, Ortuno J. Acute renal failure secondary to antifibrinolytic therapy. Nephron 1995 69(4) 478-9. 

De Labarthe A, Jacobs F, Blot F, Glotz D. Acute renal failure secondary to hydroxyethylstarch administration in a surgical patient. Am J Med 2001 lll(5) 417-8. 

A 45-year-old woman with protracted cryptococcal meningoencephalitis developed fulminant hepatic failure secondary to high fluconazole serum concentrations, possibly precipitated by renal dysfunction induced by concomitant amphotericin therapy or concomitant therapy with lisinopril, atenolol, or amlodipine (49). Four days after the withdrawal of fluconazole 400 mg/day the serum concentration of fluconazole was 40 pg/ml. 

Hootkins R, Fenves AZ, Stephens MK. Acute renal failure secondary to oral ciprofloxacin therapy a presentation of three cases and a review of the literature. Chn Nephrol 1989 32(2) 75-8. 

Chaudary S, Song SY, Jaski BE. Profound, yet reversible, heart failure secondary to 5-fluorouracil. Am J Med 1988 85(3) 454-6. 

Grinstead WC, Francis MJ, Marks GF, Tawa CB, Zoghbi WA, Young JB. Discontinuation of chronic diuretic therapy in stable congestive heart failure secondary to coronary artery disease or to idiopathic dilated cardiomyopathy. Am J Cardiol 1994 73(12) 881-6. 

Rovira I, Fita G, Suarez S, Gomar C, Cartana R. Effects of inhaled nitric oxide in a patient with pulmonary hypertension and left heart failure secondary to a giant left atrial myxoma. J Cardiothorac Vase Anesth 1999 13(6) 726-8. 

Hricik DE, Goldsmith GH. Uric acid nephrolithiasis and acute renal failure secondary to streptozotocin nephrotoxicity. Am J Med 1988 84(l) 153-6. 

A 70-year-old man developed heart failure secondary to ischemic heart disease and severe aortic stenosis (1). Furosemide 20 mg/day was replaced by torasemide 5 mg/day. After the second dose he developed oliguria and an erythematous morbilliform rash with palpable violet petechial lesions on the legs. Chest X-ray showed bilateral alveolar infiltrates. Serum creatinine and potassium were raised (212 pmol/1 and 6.7 mmol/1 respectively). Skin biopsy showed leukocytoclastic vasculitis. After withdrawal of torasemide, his renal function improved (serum creatinine 97 pmol/1) and the skin lesions resolved (leaving residual pigmented areas) within 8 days. 

Jennette JC, Falk RJ Acute renal failure secondary to leukocyte-mediated acute glomerular injury. Ren Fail. 14 395-399,1992... 

However, appropriate hydration and the sulfhydryl compound mesna are effective in decreasing the urotox-icity of ifosfamide [100, 101]. Less frequently asymptomatic renal functional abnormalities are reported following treatment with ifosfamide when used at a dose below 1.5 gr/m body skin surface [102, 103]. Acute renal failure secondary to tubular necrosis has been described when high-dose therapy [>5 gr/ m2] is administered, especially if patients were treated previously with cisplatin [104,105]. With escalating doses of a 96 hours infusion of ifosfamide, renal toxicity is dose limiting at 18 gr/ m2 [106]. 

Skeletal muscle Cases of rhabdomyolysis (muscle fiber breakdown), leading to acute renal failure secondary to myoglobinuria, have been reported with cerivastatin and other drugs in this class. Myopathy, defined as muscle aching or muscle weakness, associated with increases in plasma creatine kinase values to greater than 10 times the upper limit of normal, was seen in 0.4% of patients in US cerivastatin clini cal trials. 

Congestive heart failure, secondary heart block, cardiogenic shock, bronchial asthma, bronchospasm. Use with caution in patients with renal or liver problems. 

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