Iatrogenic causes

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

Sarvana S and Lalukotta K (2003) Myelotoxicity due to methotrexate - An iatrogenic cause. European Journal of Haematology 71 315-316. 

Many drugs used for the treatment of physical illness affect appetite. Mostly they reduce it. Thus, a possible iatrogenic cause should be considered in the management of otherwise unexplained loss of weight in the elderly. 

The transfer of intracellular K" into ECF invariably occurs in acidosis as H shifts intraceHularly and shifts outward to maintain electrical neutrality. As a general rule, K concentrations are expected to rise 0.2 to 0.7 mmol/L for every 0.1 unit drop in pH. When the underlying cause of the acidosis is treated, normokalemia will rapidly be restored. Extracellular redistribution of may also occur in (1) dehydration, (2) shock with tissue hypoxia, (3) insulin deficiency (e.g., diabetic ketoacidosis), (4) massive intravascular or extracorporeal hemolysis, (5) severe burns, (6) tumor lysis syndrome, and (7) violent muscular activity, such as that occurring in status epilepticus. Finally, important iatrogenic causes of redistribution hyperkalemia include digoxin toxicity and P adrenergic blockade, especially in patients with diabetes or on dialysis. ... 

Iatrogenic Caused by medical treatment such as drugs intended to cure disease. 

Appropriate patient work up includes consent, a brief review of current and past medical history, pertinent imaging, a limited physical exam with evaluation of the pulses, and basic laboratory parameters. Endocarditis, vasculitis, pancreatitis, prior trauma, and congenital arteriopathies such as Ehlers-Danlos are important entities to be aware of. Knowing the past surgical history and whether prior percutaneous biopsy was performed would be relevant for iatrogenic causes. Since asymptomatic patients have VAAs that are often discovered incidentally and symptomatic patients often have vague... 

Mycotic aneurysms from bacterial endocarditis were initially the most common cause of hepatic artery aneurysm [11]. However, traumatic and iatrogenic causes are likely the most common etiology today. Medial degeneration and atherosclerotic changes have also been implicated. However, atherosclerosis is more likely the result rather than the cause of the... 

Two iatrogenic causes of subclinical beriberi are known, namely that associated with diuretic treatment and one resulting from alcohol abuse. Both are of concern because the use of diuretics is introduced to manage cardiovascular disease, a condition that will deteriorate if thiamin status is impaired, and alcohol abuse can lead to Wernicke-Korsakoff syndrome, which can have many of the features of both wet and dry beriberi. 

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. 

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. 

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. 

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. 

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.

Neuroleptic malignant syndrome is an acute iatrogenic condition caused by neuroleptics, characterized by tremor, catatonia, fluctuating consciousness, hyperthermia, and cardiovascular instability. It is relatively uncommon, occuring in 1-1.5% of patients but is fatal in 11-38%, most often due to cardiovascular collapse (Jahan et al. 1992). The pathogenesis of neuroleptic malignant syndrome is poorly understood, but it is believed to result from altered dopamine and serotonin transmission in the hypothalamus, spinal cord, and striatum. Treatment includes discontinuation of neuroleptics and administration of drugs that increase dopamine transmission bromocriptine or L-dopa (Jahan etal. 1992 Baldessarini 1996). 

Vibrio spp. contaminate water (especially salt water due to the halophilic properties of bacteria), seafood, mollusks, crustaceans, and undercooked vegetables. In Asia, infections frequently accompany floods and other natural disasters. In the Far East and in Japan, V. parahaemolyticus infections are endemic. The causative factor is achlorhydria (often iatrogenic). The onset of Vibrio infection acquired via the orofecal pathway resembles dysentery due to frequent bloody stools (Butterton and Claderwood, 2001). 

Iron overload Unnecessary therapy with parenteral iron will cause excess storage of iron with consequent possibility of iatrogenic hemosiderosis. Do not administer sodium ferric gluconate complex to patients with iron overload. 

Organic factors may cause or contribute to affective illness in up to 50% of patients (Hall et al. 1981). In a patient with TRD, it is critical to rule out the presence of underlying medical disorders (Akiskal 1982 MacEwan and Remick 1988). Moreover, iatrogenic depression may result from the coadministration of medications for acute and chronic medical illnesses (Metzger and Friedman 1994). A partial list of organic causes of TRD with references is presented in Table 18-3. 

There have been no fatalities in industry attributed to bismuth and it is regarded as relatively non-toxic for a heavy metal.246 The toxic problems which have been recorded have in the main been iatrogenic illnesses. A characteristic blue-black line on the gums, the bismuth line , which may persist for years, is a feature of bismuth overdosage. Soluble salts are excreted via urine and may cause mild kidney damage. Less soluble salts may be excreted in the faeces, which may be black in colour due to the presence of bismuth sulfide. Table 31 contains some toxicity data. 

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