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Uniphyline-Induced Hypophosphatemia: A Rare Etiology of Severe Respiratory Failure

Health 2023年第7期15卷 810-813页

作者： Hassan Mohammed Ismael Mohammed Farooq Ahmad mohamed abdalrahman Ghazy mohamed Gastroenterology/Medicine Department United Lincolnshire Hospitals NHS Trust Grantham Hospital Grantham UK Diabetes and Endocrinology Department United Lincolnshire Hospitals NHS Trust Grantham Hospital Grantham UK Acute Medicine Department United Lincolnshire Hospitals NHS Trust Grantham Hospital Grantham UK University Hospital Coventry NHS Trust Coventry UK

Hypophosphataemia is defined as low level of phosphate in the blood (normal range 0.8 - 1.4 mmol/l), which can be drug-induced such as uniphyline. We present a case of elderly female patient with known chronic obstructive pulmonary disease, admitted with acute respiratory failure and low serum phosphate level, her clinical signs and serum phosphate level did not improve with conventional therapy and intravenous phosphate replacement, until her recently commenced uniphyline was discontinued. This highlights the importance of awareness amongst the clinicians about this rare but potential side effect of uniphyline. We suggest monitoring phosphate levels in patients admitted with acute respiratory failure especially those on extended bronchodilator therapy.

关键词： Hypophosphatemia Acute Respiratory Failure Chronic Obstructive Pulmonary Disease Uniphyline Theophyline Bronchodilator Therapy

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Gastrointestinal Symptoms—A Rare Complication of Untreated CPA Tumor

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Health 2023年第8期15卷 839-844页

作者： Hassan Mohammed Ismael Mohammed Farooq Ahmad mohamed abdalrahman Raoof Hagag Ghazy mohamed Abdelgani Abdlegani Ngwira Joseph Gastroenterology/Medicine Department United Lincolnshire Hospitals NHS Trust Grantham Hospital Grantham UK Internal Medicine Department United Lincolnshire Hospitals NHS Trust Grantham Hospital Grantham UK Acute medicine Department United Lincolnshire Hospitals NHS Trust Grantham Hospital Grantham UK Intensive Care Department Medicine University Hospital Coventry NHS Trust Coventry UK Cardiology Department Scarborough General Hospital Scarborough UK Bank Consultant Internal Medicine Department United Lincolnshire Hospitals NHS Trust Grantham Hospital Grantham UK

Cerebellopontine angle (CPA) lesions account for up to 10% of all intracranial tumors. Most CPA tumors are benign, but can cause nerve damage or compress the surrounding structures if left untreated. The typical presentation is with adult-onset sensorineural hearing loss or non-pulsatile tinnitus. In some patients, this goes unnoticed, and presentation is delayed until the lesion is much larger and presents with symptoms related to mass effect. We present the case study of 63 years old gentleman, who had suspected left CPA lesion on CT head done few years ago for dizziness and left-sided facial numbness. MRI could not be done at that time due to his MRI incompatible pacemaker leading to delay in his management eventually causing loss of patient to the follow up. He later developed progressive difficulty in walking which was initially attributed to as secondary to vasovagal syncope and postural hypotension. He eventually presented to us with intractable nausea and vomiting, worsening headache and ataxia. He had an urgent CT head which showed significant growth in the lesion with compression of the surrounding structures and obstructive hydrocephalus. He was given steroids which improved his nausea and vomiting, followed by undergoing surgery in regional center leading to significant improvement in his gait within few days of surgery. He unfortunately continued to have a degree of ataxia and facial numbness. This case illustrates a rare presentation of CPA tumor with symptoms of nausea and vomiting as a result of mass effect of the growing tumor. In addition, this review also shows the importance of regularly following up the patients with suspected CPA lesions on initial scans which will help with identifying the increase in size of lesion promptly and potentially preventing advanced complications of CPA tumors. We suggest regular monitoring of these patients to timely manage the lesion and avoid the potential life-threatening complications.

关键词： Cerebellopontine Angle (CPA) Vestibulocohlear Nerve (CNV111) Vestibular Schwannoma (VS) Sensorineural Hearing Loss Facial Nerve (CN VII) Vagus Nerve Microsurgery Gamma Knife Surgery (GKS Hydrocephalus)

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