A Grande

Elisha Hospital

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Document Type

Co-Authors

Salvatore Amico

Agenzia Regionale Sanitaria della Puglia

C. Le Moli

Azienda Ospedaliera S.Maria

G Narbone

Jerónimo Farré

Hospital Universitario Fundación Jiménez Díaz

Clemente Giuffrida

Centro Neurolesi Bonino Pulejo

V Giustolisi

Sapienza University of Rome

Antonio Burgio

Elisha Hospital

Francisca M. Marti

The Christie NHS Foundation Trust

D Malara

Enel (Italy)

Albó Ps

Cooperative Institutions

Azienda Ospedaliera S.Maria

Elisha Hospital

University of Messina

University of Milan

Azienda Ospedaliera Universitaria Policlinico "G. Martino"

University of Catania

Hospital Universitario Fundación Jiménez Díaz

University of Turin

Istituti di Ricovero e Cura a Carattere Scientifico

University of Palermo

Author Statistics

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Citation

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Early repolarization syndrome and Brugada syndrome: Is there any linkage?

European Journal of Internal Medicine (2008)

A Grande Vincenzo Tabita Maria Maddalena Lizzio Clemente Giuffrida Ignazio Bellanuova

Benign early repolarization

J wave

Bundle branch block

10.1016/j.ejim.2007.06.013

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Citations (13)

Management of sodium-channel blocker poisoning: the role of hypertonic sodium salts.

PubMed (2010)

A Grande Clemente Giuffrida G Narbone C. Le Moli Fiammetta Nigro

Sodium-channel blockers act by slowing sodium influx into myocytes through voltage gated channels. Many substances have sodium-channel blocking properties and many others show this effect when taken in overdose. Sodium-channel blocker poisoning, associated with a high death rate, is characterized by a variety of clinical presentation, depending on the pharmaceutical agent involved. Sodium bicarbonate or lactate, increasing serum pH and extracellular concentration of the ion, displace the drug from its receptor sites and can be used for the treatment of cardiac toxicity in the setting of sodium-channel blocker poisoning. In spite of this theoretical assumption, the role played by hypertonic sodium salts is not well elucidated and conflicting results have been reported. Authors review the pathophysiologic mechanisms of sodium-channel blocker poisoning and the evidences in literature concerning the efficacy of hypertonic sodium salts in the treatment of the related toxicity.

Sodium channel blocker

Sodium bicarbonate

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Citations (16)

Metformin-induced lactic acidosis in a type 2 diabetic patient with acute renal failure.

PubMed (2008)

A Grande Federico Vancheri V Giustolisi Clemente Giuffrida G Narbone

Metformin is a biguanide commonly used in type 2 diabetes mellitus (DM). Lactic acidosis, a potentially life-threatening metabolic disorder, may be due to a number of different causes, including metformin therapy. We present a case of a severe metformin-induced lactic acidosis in a patient with type 2 DM, admitted to the emergency department with a history of dehydration due to diarrhoea and complicated by acute renal failure. Patient complained malaise and severe weakness and was tachypneic (Kussmaul's respiration), agitated and confused, with a Glasgow Coma Scale score of 13/15. Heart rate was 75 b/min and blood pressure 110/80 mmHg. The pH was 6.87, HCO3- 3 mmol/l, lactate 15 mmol/l, potassium 6.9 mEq/l. The renal function was markedly impaired with a creatinine of 9.75 mg/dl, and pancreatic enzymes, amylase and lipase, were also increased in absence of abdominal pain. Patient was treated with intravenous fluids, bicarbonate infusion and haemodialysis with bicarbonate buffered replacement fluid. Clinical conditions improved rapidly, with a progressive normalization of the acid-base balance and the other laboratory data. Authors discuss the pathophysiologic mechanisms of these alterations with particular regard to the role played by metformin as potential cause of lactic acidosis.

Lactic acidosis

Biguanide

Diabetic ketoacidosis

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Citations (10)

Arrhythmogenic effects of antiarrhythmic drugs in patients with an old myocardial infarction and asymptomatic ventricular ectopic activity as studied by programmed electrical stimulation

European Heart Journal (1987)

Jerónimo Farré A Grande P. S. Albo Ferran Esquilache Martí Pedro Martínez-Romero

In 22 patients with a previous myocardial infarction and documented Lown class II to IV asymptomatic ventricular arrhythmias, the arrhythmogenic effect of mexiletine (18 patients) and propafenone (10 patients) has been assessed by programmed electrical stimulation. Ventricular arrhythmias induced during the basal study were: repetitive ventricular responses (RVR) (11/22, 50%), nonsustained ventricular tachycardia (VT) (3/22, 14%), sustained VT (7/22, 32%) and ventricular fibrillation (VF) (1/22, 4%). The induction of sustained VT or VF increased to 50% after mexiletine and to 80% following propafenone. An arrhythmogenic effect was found in 7/11 patients (64%) without VT at the control study (P = 0.004). One patient of this group spontaneously developed sustained VT both after mexiletine and propafenone. Only 1/8 patients (13%) with sustained VT/VF at the basal study had RVR after drug administration. The R-R interval of sustained VT at the basal state tended to be faster than that after the drugs (260 +/- 60 ms vs 293 +/- 56 and 332 +/- 77 ms for mexiletine and propafenone, respectively) (P = 0.052). Statistical significance was only reached in the propafenone group (P = 0.03). Facilitation of VT induction after antiarrhythmic drugs is most likely due to a modest lengthening of refractoriness in contrast with a more evident reduction in conduction velocity within the reentry pathway. Our study illustrates that treating asymptomatic ventricular ectopic activity in patients with an old myocardial infarction may be dangerous and that antiarrhythmic drugs show a significant arrhythmogenic potential at least in the laboratory setting.

10.1093/eurheartj/8.suppl_a.113

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Citations (6)

[Automatic implantable defibrillator-cardioverter. A therapeutic alternative for patients with potentially fatal ventricular tachyarrythmias].

PubMed (1985)

Jerónimo Farré Gregorio Rábago A Grande J. Martinell Albó Ps

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Citations (2)

Brugada-like electrocardiographic pattern: A challenge for the clinician

European Journal of Internal Medicine (2005)

A Grande Valerio Tomaselli Laura Massarelli Salvatore Amico Ignazio Bellanuova

Bundle branch block

10.1016/j.ejim.2005.07.010

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Citations (6)

Hypokalemic rhabdomyolysis in a patient with a laparoscopic adjustable gastric banding.

PubMed (2008)

A Grande V Giustolisi V Tabita Clemente Giuffrida S Riccobene

Rhabdomyolysis is an acute skeletal muscle disorder characterized by altered integrity of the cell membranes of muscle fiber cells. It can be related to a variety of factors: muscular trauma, muscle enzyme deficiencies, infections, drugs, toxins, alcohol ingestion, endocrinopathies and electrolyte imbalances such as hypokalemia. We report the case of a 46-year-old woman admitted to the Emergency Department for frequent episodes of vomiting associated with food intake in the last two weeks, general muscular weakness and myalgia. Physical examination on admission was unremarkable, except for a symmetrical and dominantly proximal muscular weakness of all four extremities. Blood pressure was 116/70 mmHg with a sinus bradycardia (53 beats/min) on the electrocardiogram. Laboratory tests showed a metabolic alkalosis with marked hypokalemia (K+= 1.9 mEq/l) and elevation of muscular enzymes (myglobin= 993 ng/ml, troponin T= 0,10 ng/ml e CK= 1113 U/l). No symptoms of recurrent rhabdomyolysis were reported, patient denied alcohol consumption and there was not clinical evidence of hyperthyroidism. A iatrogenic etiology could not be excluded for certain because patient was in therapy with lansoprazole (Naranjo algorithm 3/13) but, revealing medical history that she underwent a laparoscopic adjustable gastric banding for the treatment of a severe obesity, we focused our attention on hypokalemia, due to persistent vomiting. Fasting, administration of metoclopramide and infusion of potassium chloride resulted in steady improvement of clinical conditions and normalization of electrolyte imbalance. At the clinical follow-up of three months, after partial deflation of the gastric banding, the patient was asymptomatic with muscular enzymes and potassium levels in the normal range. Authors discuss the pathophysiologic mechanisms of these alterations.

Muscle cramp

myalgia

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Citations (3)

[New electrocardiographic observations in the differential diagnosis of tachycardia with wide QRS complex. Role of electrophysiologic studies in the re-evaluation of the diagnostic potential of the surface ECG].

PubMed (1984)

Jerónimo Farré Rosa Marı́a Hernández A Grande Mirta Mesquita Francisca M. Marti

Electrophysiologic study

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Citations (4)

Spontaneous spinal epidural haematoma: when magnetic resonance imaging is an unavoidable choice in an emergency department

Internal and Emergency Medicine (2007)

A Grande V Giustolisi C. Groppuso Salvatore Amico C. Le Moli

10.1007/s11739-007-0050-x

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Citations (3)

Characterization and preventability of adverse drug events as cause of emergency department visits: a prospective 1-year observational study

BMC Pharmacology and Toxicology (2019)

Ivan Lo Giudice Eleonora Mocciaro Claudia Giardina María Antonietta Barbieri Giuseppe Cicala

Adverse drug events (ADEs) are a significant cause of emergency department (ED) visits, with a major impact on healthcare resource utilization. A multicentre observational study, aimed to describe frequency, seriousness and preventability of ADEs reported in four EDs, was performed in Sicily (Italy) over a 1-year period.

10.1186/s40360-019-0297-7

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Citations (24)