Neurological disorders/difficulties

Liquids and Suspensions. Most liquid formulations are not packaged in unit-dosage form. Therefore, before administration, the proper amount of medication to be taken for each dose must be measured. This additional requirement may compound any difficulties a patient may have in following a prescribed schedule. Patients suffering from visual impairment, arthritis, or tremors associated with neurological disorders are particularly likely to become frustrated with this type of formulation. Visual impairments make it difficult, if not impossible, for many elderly patients to measure the prescribed amounts of medication accurately. Impaired dexterity, owing to tremors or arthritis, may have effects on a patient s ability to hold both a spoon and a bottle at the same time while pouring out the desired amount of liquid. 

The authors discussed the difficulty of the differential diagnosis between lithium intoxication and other neurological disorders, such as strokes. What they did not discuss was the possibility that the presentation was caused by sinus node dysfunction, which has been reported as a complication of lithium treatment. 

The decision to initiate EN is based on a variety of factors as outlined in Eig. 136-1 in Chap. 136. Suitable candidates are those who cannot or will not eat a sufficient amount to meet nutritional requirements, those who exhibit a sufficient functioning GI tract to allow the absorption of nutrients, and those in whom a method of enteral access can be safely obtained. Enteral nutrition may be indicated in a variety of conditions or disease states (Table 138-4). For example, patients who have certain neurologic disorders, such as following a cerebrovascular accident, and have difficulty swallowing... 

Molybdenum-deficient animals are especially susceptible to the toxic effects of bisulfite, which is both a food additive and a product of the metabolism of sulfur-containing amino acids. Bisulfite toxicity is characterized by breathing difficulties and neurological disorders. 

This test first appeared in 1938 and is said to be suitable for children aged 5 years and above. Children are asked to look at a design and reproduce it. children with neurological disorders, learning difficulties and behaviour problems perform less adequately than normal children. In this study we used a more recent, detailed, objective scoring system (Schlange et al, 1972). 

The most serious side effects of efavirenz are psychiatric symptoms, rash and nervous symptoms. The psychiatric symptoms include suicide thoughts, depression, paranoia, manic disorders and aggressive behavior the rashes include macu-lopapular skin eruptions and life-threatening Stevens-Johnson syndrome has also been reported. The neurological symptoms are difficulty in concentration, insomnia, dizziness, confusion, agitation, hallucinations and amnesia. Additional side effect may include an increase in cholesterol and hepatic transaminase levels. 

The objective of this chapter is to put into perspective some of the current knowledge with respect to trace metals and their health implications. Potential adverse health effects of occupational exposures to trace metals are dis cussed cancer (arsenic, beryllium chromium nickel, and perhaps cadmium) chronic lung disease (beryllium and cadmium) neurologic and reproductive disorders (lead and mercury) and kidney disorders (lead and cadmium). Also discussed are the National Institute for Occupational Safety and Health (NIOSH) recommended standards for occupational exposure to several trace metals, the difficulty of establishing safe levels of exposure (particularly for carcinogens), and problems involved in identifying toxic components of trade name products. Special attention is given to the role of chemists to help protect the public health. 

Neurologic and neuropsychologic symptoms reported included difficulty concentrating, memory loss, numbness in the face or extremities, shaking, tremors, headache, and sleep disorders. Industrial hygiene evaluation... 

Treatment is generally palliative or nonexistent. Enzyme replacement therapy has proved useful in some of these disorders. Because the exogenous enzymes are unable to cross the blood-brain barrier, their efficacy in the glycosphingolipidoses that have neurological involvement is doubtful. Attempts to modify the enzymes to overcome this difficulty offer some hope. 

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