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Re-feeding syndrome and alcoholic cardiomyopathy: A case of interacting diagnoses.

ABSTRACT: Re-feeding syndrome is an uncommon clinical entity of fluid and electrolyte disorders that typically occurs after re-initiation of enteral nutrition following prolonged fasting. This disorder can be complicated by left ventricular (LV) dysfunction, arrhythmias, and death. Alcohol abuse and anorexia nervosa are independently associated with similar complications. The interaction between these diagnoses can result in significant, but reversible, LV dysfunction. We present the case of a 69-year-old woman with a history of significant alcohol abuse and anorexia nervosa. The patient was admitted to hospital for the management of re-feeding syndrome, which was complicated by significant LV dysfunction. Her LV function normalized following a combination of electrolyte replacement, re-institution of feeding, and abstinence from alcohol. Re-feeding syndrome, anorexia nervosa, and alcohol abuse are conditions that commonly co-exist. These conditions may have a synergistic relationship, potentially resulting in a profound cardiomyopathy. Careful monitoring and aggressive electrolyte replacement may be helpful in identifying this complication and minimizing its potential harm. .

SUBMITTER: Miller RJH

PROVIDER: S-EPMC6282927 | biostudies-literature | 2016 Sep

REPOSITORIES: biostudies-literature

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Re-feeding syndrome and alcoholic cardiomyopathy: A case of interacting diagnoses.

Miller Robert J H RJH Chew Derek D

Journal of cardiology cases 20160603 3

Re-feeding syndrome is an uncommon clinical entity of fluid and electrolyte disorders that typically occurs after re-initiation of enteral nutrition following prolonged fasting. This disorder can be complicated by left ventricular (LV) dysfunction, arrhythmias, and death. Alcohol abuse and anorexia nervosa are independently associated with similar complications. The interaction between these diagnoses can result in significant, but reversible, LV dysfunction. We present the case of a 69-year-old ...[more]

PMID: 30546674

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Project description:BackgroundIn order to provide reliable tissue material for malignant mesothelioma (MM) studies, we re-evaluated biopsies and autopsy material from 61 patients with a diagnosis of MM from the period of 1980-2002.MethodsBasic positive (Calretinin, EMA, Podoplanin, Mesothelin) and negative (CEA, Ber-Ep4) immunohistochemical (IHC) marker reactions were determined. If needed, more markers were used. Histological diagnoses were made by three pathologists. Survival data were calculated.Results49 cases (80%) were considered being MM by a high degree of likelihood, five more cases possible MM. Of the remaining seven cases, three were diagnosed as adenocarcinoma, three as pleomorphic lung carcinoma, in one peritoneal case a clear entity diagnosis could not be given. One of the possible MM cases and two of the lung carcinoma cases had this already as primary diagnoses, but were registered as MM.With a sensitivity of 100%, Calretinin and CEA were the most reliable single markers. The amount of MM cells with positive immunoreactivity (IR) for Podoplanin and Mesothelin showed most reliable inverse relation to the degree of atypia.In the confirmed MM cases, there had been applied either no IHC or between one and 18 markers.The cases not confirmed by us had either lacked IHC (n = 1), non-specific markers were used (n = 4), IR was different (n = 1), or specific markers had not shown positive IR in the right part of the tumour cells (n = 3).46 of the 49 confirmed and three of the not confirmed cases had been diagnosed by us as most likely MM before IHC was carried out.ConclusionsIn order to use archival tissue material with an earlier MM diagnosis for studies, histopathological re-evaluation is important. In possible sarcomatous MM cases without any positive IR for positive MM markers, radiology and clinical picture are essential parts of diagnostics. IHC based on a panel of two positive and two negative MM markers has to be adapted to the differential diagnostic needs in each single case. New diagnostic tools and techniques are desirable for cases where IHC and other established methods cannot provide a clear entity diagnosis, and in order to improve MM treatment.

Project description:AimHospital discharges with a diagnosis of cardiomyopathy have more than doubled in Sweden since 1987. We validated the cardiomyopathy diagnoses over this time period to investigate that the increase was real and not a result of improved recognition of the diagnosis and better diagnostic methods.Methods and resultsEvery fifth year from 1989 to 2009, records for all patients with a cardiomyopathy diagnosis were identified by searching the local registers in three hospitals in Västra Götaland, Sweden. The diagnoses were validated according to criteria defined by the European Society of Cardiology from 2008. The population comprised 611 cases with cardiomyopathy diagnoses [mean age 58.9 (SD 15.5) years, 68.2% male], divided into three major groups: dilated, hypertrophic, and other cardiomyopathies. Hypertrophic cardiomyopathy and hypertrophic obstructive cardiomyopathy were analysed as a group. Cardiomyopathies for which there were few cases, such as restrictive, arrhythmogenic right ventricular, left ventricular non-compaction, takotsubo, and peripartum cardiomyopathies, were analysed together and defined as 'other cardiomyopathies'. Relevant co-morbidities were registered. The use of echocardiography was 99.7%, of which 94.6% was complete echocardiography reports. The accuracy rates of the diagnoses dilated cardiomyopathy, hypertrophic cardiomyopathy, and other cardiomyopathies were 85.5%, 87.5%, and 100%, respectively, with no differences between the three hospitals or years studied; nor did the prevalence of co-morbidities differ.ConclusionsThe accuracy rate of the cardiomyopathy diagnoses from in-hospital records from >600 patients in western Sweden during a 20 year period was 86.6%, with no significant trend over time, strengthening epidemiological findings that this is likely due to an actual increase in cardiomyopathy diagnoses rather than changes in coding practices. The use of echocardiography was high, and there was no significant difference in co-morbidities during the study period. The accuracy rate of the cardiomyopathy diagnoses during the 20 year period was high. The use of diagnostic tools did not increase under the study period, and once cardiomyopathy diagnoses were suspected, echocardiography was performed in almost all cases. In this study, the occurrence of cardiomyopathy was increasing over time without significant increase of co-morbidity, supporting that an actual increase of cardiomyopathy has occurred.

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Re-feeding syndrome and alcoholic cardiomyopathy: A case of interacting diagnoses.

Publications

Re-feeding syndrome and alcoholic cardiomyopathy: A case of interacting diagnoses.

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