Ugeskrift for laeger最新文献

Polypharmacy is common among the elderly. This case report details the experience of an 85-year-old man whose notable polypharmacy and additional over-the-counter medicines led to anemia and acute kidney injury. These issues were traced to an unintended »triple-whammy« effect due to the interaction of diuretics, ACE inhibitors, and NSAIDs, and concurrent treatment with an anticoagulant. Highlighting the role of systematic medication reviews, this case illustrates how targeted interventions can prevent severe health outcomes and underscores the importance of medication monitoring in elderly patients.

Polypharmacy with anticholinergic and sedative effects is a major contributor to cognitive decline in older adults. This case study of an 80yearold man with mild cognitive impairment illustrates how systematic deprescribing resulted in improved cognition, mood, and functional capacity. The intervention emphasises the value of regular medication review to uncover reversible contributors to decline and promote quality of life even amid neurodegenerative progression.

This case report describes a 69-year-old woman on long-term pantoprazole therapy, initially prescribed for nonspecific upper gastrointestinal symptoms. Despite resistance to discontinuation due to rebound symptoms, a gradual dose reduction combined with patient education and use of antacids led to successful cessation. The case highlights the importance of regular medication review, patient involvement, and awareness of rebound acid hypersecretion in facilitating rational PPI use and deprescribing efforts.

A woman with complex psychiatric illness and substance use disorder presented with nausea, vomiting, and episodes of oculogyric crisis. A medication review suggested drug-induced acute dystonia, likely triggered by metoclopramide. Other symptoms were possibly related to cumulative anticholinergic effects. Fluoxetine, a potent CYP2D6 inhibitor, may have increased exposure to metoclopramide and promethazine. This case report demonstrates that pharmacological insight and deprescribing can improve symptoms and support rational pharmacotherapy in vulnerable psychiatric patients.

In this case report, a 60-year-old patient was referred to a multidisciplinary pain clinic to discontinue methadone. Before referral, a self-managed dose reduction from 40 to 15 mg had led to loss of function due to withdrawal symptoms. After referral, methadone was successfully deprescribed over three months. Withdrawal symptoms were managed through an individually tailored plan, supportive consultations with a nurse, and the use of clonidine. The patient regained function after deprescribing methadone. Deprescribing opioids can be managed through a patient-centered approach and close monitoring.

Iodine-based contrast agents are routinely used for contrast-enhanced CT. However, CT contrast has been associated with acute kidney injury (CA-AKI) and thus international guidelines recommend prior screening of kidney function using eGFR. However, eGFR screening is resource-consuming, and current evidence suggests that the risk of CA-AKI is very low. This review examines the evidence, recommendations, and current practices of eGFR screening in Danish radiology departments. Following a Choosing Wisely-strategy, we recommend minimising eGFR screening before contrast-enhanced CT scans.

Phenibut (β-phenyl-γ-aminobutyric acid) is a GABA-B agonist associated with sedation, dependency, and withdrawal. In this case report, a young man was admitted unconscious with partial brainstem areflexia. Based on clinical findings, a container of phenibut found on him, and his later statement of ingestion, phenibut intoxication was suspected, and he was admitted to the ICU. He later developed withdrawal symptoms, treated effectively with baclofen. This highlights phenibut as a potential cause of coma and the role of baclofen in withdrawal treatment.

Hypersensitivity reactions during hemodialysis remain a clinical concern despite advances in materials and techniques. A reaction should prompt swift interruption of treatment, identification of possible triggers, and thorough documentation. Filter change is recommended before the next treatment. Current handling varies across centers, underlining the need for national guidelines to standardize treatment and improve patient safety, as argued in this review.