Iatrogenic

Syndrome of inappropriate antidiuretic hormone is defined by water retention, dilutional hyponatraemia and decreased volume of highly concentrated urine. There are several causes which can result in SIADH, neoplasms ectopic secreting AVP, ectopic release of AVP by various diseases or drugs, exogenous administration of AVP, desmopressin, lysipressin or large doses of OT (iatrogenic SLADH). 

Proximal tubule cells are exquisitely sensitive to vasculat disturbances and acute tubular necrosis (ATN) can occur naturally in areas of poor perfusion resulting from falling blood pressure, or vasospasm of renal vessels or arterioles. In other words hypoxia associated with partial ischaemia can cause severe damage. It is not then surprising that anoxia associated with iatrogenic, surgically induced total ischaemia produces irreversible damage within a short time unless steps are taken to prevent it. 

Iatrogenic warm ischaemia (WI) may be induced vvhen (1) the renal vessels are clamped in situ for exploratory or reconstructive surgery of the kidney (2) when the organ is removed from the donor, reconstructed invito and then replanted orthotopically and (3) when a kidney is harvested from a donor for transplantation. 

This isotonic volume expander contains sodium, potassium, chloride, and lactate that approximates the fluid and electrolyte composition of the blood. Ringer s lactate (also known as lactated Ringer s or LR) provides ECF replacement and is most often used in the perioperative setting, and for patients with lower GI fluid losses, burns, or dehydration. The lactate component of LR works as a buffer to increase the pH. Large volumes of LR may cause metabolic alkalosis. Because patients with significant liver disease are unable to metabolize lactate sufficiently, Ringer s lactate administration in this population may lead to accumulation of lactate with iatrogenic lactic acidosis. The lactate is not metabolized to bicarbonate in the presence of liver disease and lactic acid can result. 

Avascular necrosis (more common in iatrogenic cases)... 

Plasma cell disorders Plasma cell disorders Inflammation-associated, familial Mediterranean fever Familial amyloidotic neuropathy, systemic senile amyloidosis Dialysis-associated amyloidosis Familial amyloidotic neuropathy, aortic amyloidosis Familial systemic amyloidosis Familial systemic amyloidosis Familial systemic amyloidosis Familial cerebral hemorrhage with amyloidosis Sporadic and familial Alzheimer s disease, familial cerebral hemorrhage with amyloidosis Spongiform encephalopathies C-cell thyroid tumors Insulinoma, type II diabetes Atrial amyloidosis Prolactinomas pituitary amyloidosis Iatrogenic amyloidosis Corneal amyloidosis ... 

Iatrogenic causes long-term non-indicated (parenteral) iron therapy... 

Collinge, J., Palmer, M. S. and Dryden, A. J. Genetic predisposition to iatrogenic Creutzfeldt-Jakob disease. Lancet 337 1441-1442,1991. 

Subclinical or carrier states of prion disease have major implications for public health, most notably iatrogenic transmission from apparently healthy individuals. The existence of subclinical prion infections also raise the possibility that other species (such as sheep, pigs and poultry), exposed to BSE prions by contaminated feed, might be able to develop subclinical carrier states. Given that BSE prions are pathogenic in a wide variety of species, and that the strain characteristics of BSE prions are retained upon transmission to new species, it must be considered possible, if not probable, that BSE in animals other than cattle will retain pathogenicity for humans. 

Brown, P. et al. Iatrogenic Creutzfeldt-Jakob disease at the millennium. Neurology 55 1075-1081, 2000. 

The vast majority of hypothyroid patients have thyroid gland failure (primary hypothyroidism). The causes include chronic autoimmune thyroiditis (Hashimoto s disease), iatrogenic hypothyroidism, iodine deficiency, enzyme defects, thyroid hypoplasia, and goitrogens. 

Blunt abdominal trauma with rupture of intestine Penetrating abdominal trauma Iatrogenic intestinal perforation (endoscopy)... 

Bowel injuries caused by penetrating, blunt, or iatrogenic trauma that are repaired within 12 hours and intraoperative contamination of the operative field by enteric contents under other circumstances should be treated with antibiotics 24 hours. 

Special mention must be accorded to iatrogenic effects, where the usefulness of novel synthetic drugs is impaired by untoward side effects of obscure etiology. In some, if not many of them, these side effects may find their explanation in the inhibitory action of the drug upon a vitamin, as in the case of primidone vs. folic acid (B3a). These relationships appear to be fortuitous until the structural chemical kinship of drug and vitamin is recognized. 

Fig. 3. Classification of human prion diseases. Sporadic the transformation from PrPc (circle) to PrPSc (square) occurs without apparent cause. Familial a point mutation ( ) is thought to facilitate the transformation. Infectious the transformation arises via PrPSc which acts as a template. The kinetic equations are defined by Eigen (1996). The infectious form includes kuru, iatrogenic CJD (iCJD), variant CJD (vCJD first reported in 1996), bovine spongiform encephalopathy (BSE first reported in 1985), and scrapie. In the nucleation-dependent model, monomeric PrPc and PrPSc are in chemical equilibrium.

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