Hospital Medicine Alert – December 1, 2014

December 1, 2014

• Is It Time to Rethink Lactulose for the Treatment of Acute Hepatic Encephalopathy?

  For decades, lactulose, a non-absorbable disaccharide, has been considered to be the standard-of-care, first-line therapy for acute (overt) hepatic encephalopathy. Hepatic encephalopathy (HE), a complication of decompensated liver cirrhosis, represents a spectrum of clinical manifestations ranging from mild neuropsychiatric changes to coma and is a common indication for hospital admission.

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• The Success of Cystic Fibrosis Treatment: A New Patient Population for Hospitalists

  Patients with cystic fibrosis (CF) have a dysfunctional CF transmembrane conductance regulator (CFTR) epithelial chloride channel. As a result, the channel prevents their secretions from being adequately hydrated.

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• After-Hours ICU Discharge: A Potentially Modifiable Cause of Increased Hospital Mortality

  The Australian and New Zealand Intensive Care Society Adult Patient Database prospectively records data on patients cared for in 90% of Australian and 50% of New Zealand ICUs.

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• Risk of Non-Cardiac Surgery with Severe Aortic Stenosis

  Ever since the first Goldman index, severe aortic stenosis (AS) has been known to be a risk factor for perioperative morbidity and mortality for non-cardiac surgery.

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• Dehydration Is a Poor Prognostic Sign in Acute Ischemic Stroke Patients

  Several factors have been reported to predict the outcome of acute stroke, including the modified Rankin scale, length of hospital stay, age and gender, severity of presenting deficit as measured by the initial NIH Stroke Scale, history of diabetes, and in-hospital infections.

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