読者です 読者をやめる 読者になる 読者になる

函館稜北病院総合診療科抄読会B面

毎週木曜日5:30PMから30分間、Clinical Problem-Solvingを素材にクリニカル・パールを拾い集めます。

第50回:"Wasting Away"

今回の "Wasting Away" というタイトルは、「衰弱する」と「浪費する」という2つの意味を掛けたタイトルでした。その意味を汲めば、難しい日本語だが、「枯槁憔悴(ここうしょうすい)」という訳にでもなりましょうか。

Word Count:3224語 (Time:  16'06'', 200 wpm)

参加人数:4名

引用箇所:

  • The administration of calcitriol is also indicated to increase phosphate levels through several mechanisms. This approach was successful in our patient, with resolution of her pain, muscle weakness and wasting, and electrolyte abnormalities and amelioration of the bone loss caused by urinary electrolyte wasting.
  • Phosphate redistribution into bone occurs in the “hungry bone” syndrome, in which the decrease in parathyroid hormone levels after parathyroidectomy for primary hyperparathyroidism leads to the rapid deposition of calcium and phosphate (in the form of hydroxyapatite) into undermineralized bone within an expanded remodeling space.
  • Her HBV infection increases her risk of polyarteritis nodosa, which could explain the fatigue, weight loss, weakness, and abdominal pain.
  • The clinical manifestations of hypophosphatemia are rarely apparent until phosphate levels fall below 1 mg per deciliter. Common symptoms and signs include fatigue, proximal myopathy, dysphagia, ileus, and impaired cardiac contractility. There may be involvement of the central nervous system, which can result in irritability, delirium, or coma. Hemolysis and impaired granulocyte function have also been described. Finally, chronically low serum phosphate levels lead to a reduction in bone-mineral deposition, which can lead to rickets in childhood and osteomalacia in adulthood. Rickets is associated with stunted linear growth and bone deformities. In adulthood, bone deformities are rare, but widespread bone pain may occur. Gait abnormalities attributable to pain with weight-bearing ambulation are common.