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Implementation Of Guidelines For Preprocedural Ultrasound In Neuraxial Placement For Obstetric Patients With Scoliosis, Luther Nyirenda 2025 Otterbein University

Implementation Of Guidelines For Preprocedural Ultrasound In Neuraxial Placement For Obstetric Patients With Scoliosis, Luther Nyirenda

Doctor of Nursing Practice Scholarly Projects

Neuraxial anesthesia including epidural, spinal, and combined spinal-epidural, is used with 65% of parturients in the United States for the management of pain and discomfort. Conventional landmark palpation has been the mainstay technique for neuraxial anesthesia, but unfamiliar spinal anatomy can lead to incomplete blockade or an increased incidence of complications. Scoliosis causes lateral curvature and rotation of the spine leading to arthritis and soft tissue changes that can present obscure anatomical landmarks, cause difficulty in needle passage, and result in inadequacy of local anesthetic efficacy. The literature illustrates that preprocedural ultrasound is recommended for needle placement in parturients with …


Using The Bispectral Index Monitor To Decrease The Incidence Of Unintended Intraoperative Awareness In The High-Risk Population, Bridget Hayes 2025 Otterbein University

Using The Bispectral Index Monitor To Decrease The Incidence Of Unintended Intraoperative Awareness In The High-Risk Population, Bridget Hayes

Doctor of Nursing Practice Scholarly Projects

Unintended intraoperative awareness is a traumatizing complication of general anesthesia. This negative outcome affects 0.1-0.2% of all patients undergoing general anesthesia. Patients at higher risk for this experience include those undergoing emergency surgery, traumas, cesarian sections, those on cardiopulmonary bypass, those with substance use disorder, and those undergoing total-intravenous anesthesia (TIVA). This high-risk population is affected by unintended intraoperative awareness 1% of the time. The bispectral index (BIS) monitor has been proposed as a tool to decrease the incidence of unintended intraoperative awareness. There are several large, randomized controlled trials that demonstrate that using a BIS monitor decreases the incidence …


Measurement Of Cumulative High-Sensitivity C-Reactive Protein And Monocyte To High-Density Lipoprotein Ratio In The Risk Prediction Of Type 2 Diabetes: A Prospective Cohort Study, Dan Wu, Genyuan Chen, Yulong Lan, Shuohua Chen, Xiong Ding, Chiju Wei, Lois Balmer, Wei Wang, Shouling Wu, Wencan Xu 2024 Edith Cowan University

Measurement Of Cumulative High-Sensitivity C-Reactive Protein And Monocyte To High-Density Lipoprotein Ratio In The Risk Prediction Of Type 2 Diabetes: A Prospective Cohort Study, Dan Wu, Genyuan Chen, Yulong Lan, Shuohua Chen, Xiong Ding, Chiju Wei, Lois Balmer, Wei Wang, Shouling Wu, Wencan Xu

Research outputs 2022 to 2026

Background: Converging data have suggested that monocytic inflammation and C-reactive protein (CRP) are biologically intertwined processes and are involved in diabetogenesis. This study aimed to investigate the association between systemic inflammation assessed by joint cumulative high-sensitivity C-reactive protein (CumCRP) and monocyte to high-density lipoprotein ratio (CumMHR) and incident type 2 diabetes (T2D) and their predictive value for T2D in a general population. Methods: A total of 40,813 nondiabetic participants from a prospective real-life cohort (Kailuan Study, China) were followed biennially from 2010/2011 until December 31, 2020. Multivariable Cox regression analyses were conducted to evaluate the adjusted hazard ratios (aHRs) of …


Exploring Treatment Burden In People With Type 2 Diabetes Mellitus: A Thematic Analysis In China's Primary Care Settings, Kai Lin, Mi Yao, Lesley Andrew, Rouyan Li, Yilin Chen, Jacques Oosthuizen, Moira Sim, Yongsong Chen 2024 Edith Cowan University

Exploring Treatment Burden In People With Type 2 Diabetes Mellitus: A Thematic Analysis In China's Primary Care Settings, Kai Lin, Mi Yao, Lesley Andrew, Rouyan Li, Yilin Chen, Jacques Oosthuizen, Moira Sim, Yongsong Chen

Research outputs 2022 to 2026

Background: Understanding treatment burden is a critical element to the effective management of Type 2 Diabetes Mellitus (T2DM). The current study aims to address the knowledge gap surrounding treatment burden of T2DM from the patient’s perspective in China’s primary care settings. Methods: A narrative review informed the creation of an a priori coding structure to identify aspects of T2DM treatment burden. Focus groups were conducted, employing a maximum variation sampling strategy to select participants from diverse sociodemographic backgrounds across urban, suburban, rural, and remote areas in China. Participants included adults with T2DM care in primary care settings for over a …


Reclaiming Healing Spaces: A Phenomenological Study On The Transformative Power Of Outdoor Therapy From The Lived Experiences Of Black Clinicians Working With Black Clients, Lynn Murphy 2024 National Louis University

Reclaiming Healing Spaces: A Phenomenological Study On The Transformative Power Of Outdoor Therapy From The Lived Experiences Of Black Clinicians Working With Black Clients, Lynn Murphy

Dissertations

This phenomenological study involved assessing the experiences of Black therapists who engaged Black clients in outdoor therapeutic contexts. The study was founded on the existing literature that shows the quality of the therapeutic relationship is pivotal for client retention and the Western standards that have historically favored treatment within indoor environments. To contextualize this research, a comprehensive literature review was commenced, covering topics such as the decolonization of therapy, the historical and present-day relationship between Blacks and the outdoors in the United States, sedentary lifestyles, the psychological benefits of time spent in nature, various types of outdoor therapy, and the …


Characteristics And Treatment Of Acute Myeloid Neoplasms With Cutaneous Involvement In Infants Up To 6 Months Of Age: A Retrospective Study., Juliette Renaud, Bianca F. Goemans, Franco Locatelli, Martina Pigazzi, Shelagh Redmond, Claudia E. Kuehni, Alice Destaillats, Todd A. Alonzo, Robert B. Gerbing, Alan S. Gamis, Richard Aplenc, Raffaele Renella, Todd Cooper, Francesco Ceppi 2024 Children's Mercy Hospital

Characteristics And Treatment Of Acute Myeloid Neoplasms With Cutaneous Involvement In Infants Up To 6 Months Of Age: A Retrospective Study., Juliette Renaud, Bianca F. Goemans, Franco Locatelli, Martina Pigazzi, Shelagh Redmond, Claudia E. Kuehni, Alice Destaillats, Todd A. Alonzo, Robert B. Gerbing, Alan S. Gamis, Richard Aplenc, Raffaele Renella, Todd Cooper, Francesco Ceppi

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Myeloid neoplasms account for 50% of cases of pediatric leukemias in infants. Approximately 25%-50% of patients with newborn leukemia have cutaneous extramedullary disease (EMD). In less than 10% of patients, aleukemic leukemia cutis or isolated extramedullary disease with cutaneous involvement (cEMD) occurs when skin lesions appear prior to bone marrow involvement and systemic symptoms. Interestingly, in acute myeloid leukemia with cutaneous EMD (AML-cEMD) and cEMD, spontaneous remissions have been reported.

METHOD: This is a multicentric retrospective cohort study aiming to describe characteristics, treatment, and outcome of infants with either cEMD or presence of cutaneous disease with involvement of the …


Use Of Clearguard Hd Caps In Pediatric Hemodialysis Patients., Amy E. Nau, Troy Richardson, Diana Cardwell, Jennifer Ehrlich, Jyothsna Gattineni, Melisha Hanna, Mahima Keswani, Emily Neibauer, Kelly Nitz, Raymond Quigley, Michelle Rheault, Rebekah Sims, Mayna Woo, Bradley A. Warady 2024 Children's Mercy Hospital

Use Of Clearguard Hd Caps In Pediatric Hemodialysis Patients., Amy E. Nau, Troy Richardson, Diana Cardwell, Jennifer Ehrlich, Jyothsna Gattineni, Melisha Hanna, Mahima Keswani, Emily Neibauer, Kelly Nitz, Raymond Quigley, Michelle Rheault, Rebekah Sims, Mayna Woo, Bradley A. Warady

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Bloodstream infections (BSIs) are a leading cause of hospitalizations and mortality among patients receiving hemodialysis (HD) therapy, especially those with a central venous catheter (CVC) for dialysis access. The use of chlorhexidine impregnated catheter caps (ClearGuard) has been associated with a decrease in the rate of HD catheter-related BSIs (CA-BSIs) in adults; similar data have not been published for children.

METHODS: We compared CA-BSI data from participating centers within the Standardizing Care to Improve Outcomes in Pediatric Endstage Kidney Disease (SCOPE) collaborative based on the center's use of ClearGuard caps for patients with HD catheter access. Centers were characterized …


Concepts In Animal Parasitology, Scott L. Gardner, Sue Ann Gardner 2024 University of Nebraska-Lincoln

Concepts In Animal Parasitology, Scott L. Gardner, Sue Ann Gardner

Zea E-Books Collection

This is a textbook covering concepts in animal parasitology. It is meant to be used by students, teachers, professors, researchers, and members of the public who are interested in learning about animal parasite biology, systematics, taxonomy, zoogeography, and ecology. The primary intended audience is upper-level undergraduate or graduate university students who have knowledge of basic biology and, particularly, basic animal biology. (863 pages, illustrated)

One of the most fascinating things that a person can experience in the complex realm of biology is the discovery of an animal living inside another animal. If this discovery takes place at an early enough …


Early Outcomes Of Transcatheter Aortic Valve Implantation With Next-Generation Balloon-Expandable Myval Transcatheter Heart Valve: Single-Center Experience From Iraq, Khalid Ibrahim Amber, Ammar Jabbar Majeed 2024 Al-Najaf Centre for Cardiac Surgery and Transcatheter Therapy

Early Outcomes Of Transcatheter Aortic Valve Implantation With Next-Generation Balloon-Expandable Myval Transcatheter Heart Valve: Single-Center Experience From Iraq, Khalid Ibrahim Amber, Ammar Jabbar Majeed

Journal of the Saudi Heart Association

Objectives: Transcatheter aortic valve implantation (TAVI) is a minimally invasive percutaneous procedure for the treatment of elderly patients with symptomatic severe aortic stenosis. The study aimed to determine immediate (in-hospital) and short-term (30-day) outcomes of TAVI with next-generation balloon-expandable Myval transcatheter heart valve (THV) at a single-centre in Iraq. Methods: During January 2019 to January 2024, a total of 100 symptomatic severe aortic stenosis patients who underwent TAVI using Myval THV at Al-Najaf Cardiac Center, Iraq were enrolled. The procedure was done under local anesthesia and conscious sedation via transfemoral approach, using balloon-expandable Myval THV. All patients were followed-up at …


Postoperative Bioactive Adrenomedullin Is Associated With The Onset Of Ards And Adverse Outcomes In Patients Undergoing Open Thoracoabdominal Aortic Surgery, Panagiotis Doukas, Oliver Hartmann, Jelle Frankort, Birte Arlt, Hanif Krabbe, Michael Johan Jacobs, Andreas Greiner, Jan Paul Frese, Alexander Gombert 2024 The Texas Medical Center Library

Postoperative Bioactive Adrenomedullin Is Associated With The Onset Of Ards And Adverse Outcomes In Patients Undergoing Open Thoracoabdominal Aortic Surgery, Panagiotis Doukas, Oliver Hartmann, Jelle Frankort, Birte Arlt, Hanif Krabbe, Michael Johan Jacobs, Andreas Greiner, Jan Paul Frese, Alexander Gombert

Journal Articles

Cytokine-mediated systemic inflammation after open thoracoabdominal aortic aneurysm (TAAA) repairs plays a pivotal role in disrupting circulatory homeostasis, potentially leading to organ dysfunction. The bioactive form of adrenomedullin (bio-ADM) is a peptide hormone with immunomodulatory and vasomotor effects, making it a potential diagnostic agent in these cases. This retrospective, bicentric study, conducted between January 2019 and December 2022, recruited 36 elective open TAAA repair patients in two German centres. Serum and plasma samples were collected at multiple time points to measure bio-ADM levels. The primary objective was to evaluate the association of bio-ADM levels with the onset of acute respiratory …


A “Fishy” Situation, Rare Pathogen And Presentation In Prosthetic Valve Infective Endocarditis, Nichole Schtupak, Patrick Kennedy, Darko Pucar, Linda Godinez, Jodi-Ann Chin, Kristen Selema, Dipan Uppa, Antonio Lewis, Marcelo Helguera 2024 A.T. Still University and Cleveland Clinic Florida

A “Fishy” Situation, Rare Pathogen And Presentation In Prosthetic Valve Infective Endocarditis, Nichole Schtupak, Patrick Kennedy, Darko Pucar, Linda Godinez, Jodi-Ann Chin, Kristen Selema, Dipan Uppa, Antonio Lewis, Marcelo Helguera

DMSc Student Publications

Lactococcus garviae (L. garviae) is a gram-positive coccus belonging to the Streptococcaceae family. While primarily a pathogen in fish farms causing hemorrhagic sepsis, it can act as a rare opportunistic pathogen in humans. A 2021 case report by Bravo et al. documented less than 30 cases of infective endocarditis caused by L. garviae worldwide at that time. This case report describes the 27th documented case globally and 7th documented case in the USA of L. garviae causing infective endocarditis of a prosthetic valve.
L. garviae is found in unpasteurized dairy products, raw fish, and meat (pork, beef, and …


Delays To Antibiotics In The Emergency Department And Risk Of Mortality In Children With Sepsis., Roni D. Lane, Troy Richardson, Halden F. Scott, Raina M. Paul, Fran Balamuth, Matthew A. Eisenberg, Ruth Riggs, W Charles Huskins, Christopher M. Horvat, Grant E. Keeney, Leslie Hueschen, Justin M. Lockwood, Vishal Gunnala, Bryan P. McKee, Nikhil Patankar, Venessa Lynn Pinto, Amanda M. Sebring, Matthew P. Sharron, Jennifer Treseler, Jennifer J. Wilkes, Jennifer K. Workman 2024 Children's Mercy Hospital

Delays To Antibiotics In The Emergency Department And Risk Of Mortality In Children With Sepsis., Roni D. Lane, Troy Richardson, Halden F. Scott, Raina M. Paul, Fran Balamuth, Matthew A. Eisenberg, Ruth Riggs, W Charles Huskins, Christopher M. Horvat, Grant E. Keeney, Leslie Hueschen, Justin M. Lockwood, Vishal Gunnala, Bryan P. Mckee, Nikhil Patankar, Venessa Lynn Pinto, Amanda M. Sebring, Matthew P. Sharron, Jennifer Treseler, Jennifer J. Wilkes, Jennifer K. Workman

Manuscripts, Articles, Book Chapters and Other Papers

IMPORTANCE: Pediatric consensus guidelines recommend antibiotic administration within 1 hour for septic shock and within 3 hours for sepsis without shock. Limited studies exist identifying a specific time past which delays in antibiotic administration are associated with worse outcomes.

OBJECTIVE: To determine a time point for antibiotic administration that is associated with increased risk of mortality among pediatric patients with sepsis.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used data from 51 US children's hospitals in the Improving Pediatric Sepsis Outcomes collaborative. Participants included patients aged 29 days to less than 18 years with sepsis recognized within 1 hour …


A Case-Based Implementation Of Heart Failure Therapies, A Consensus Pathway By The Saudi Heart Failure Working Group, Abeer Bakhsh, Ibrahim Jelaidan, Ammar Gulzar Chaudhary, Sahar Al Amro, Kamal Alghalayini, Osama Almogbel, Maryam Alqaseer, Hanan B. Albackr, Fayez Elshaer, Fakhr Al Ayoubi 2024 Heart Function Unit, Prince Sultan Cardiac Centre, Riyadh, Saudi Arabia

A Case-Based Implementation Of Heart Failure Therapies, A Consensus Pathway By The Saudi Heart Failure Working Group, Abeer Bakhsh, Ibrahim Jelaidan, Ammar Gulzar Chaudhary, Sahar Al Amro, Kamal Alghalayini, Osama Almogbel, Maryam Alqaseer, Hanan B. Albackr, Fayez Elshaer, Fakhr Al Ayoubi

Journal of the Saudi Heart Association

The implementation of guideline-directed medical therapy (GDMT) in heart failure (HF) has many challenges in real-world clinical practice. The consensus document is written considering the variability of the clinical presentation of HF patients. HF medical therapies need frequent dose adjustment during hospital admission or when patients develop electrolyte imbalance, acute kidney injury, and other acute illnesses. The paper describes clinical scenarios and graphs that will aid the managing physicians in decision-making for HF therapy optimization.


Statin Utilization And Cardiovascular Outcomes In A Real-World Primary Prevention Cohort Of Older Adults, Aaron J. Walker, Jianhui Zhu, Floyd Thoma, Oscar Marroquin, Amber Makani, Martha Gulati, Eugenia Gianos, Salim S. Virani, Fatima Rodriguez, Steven E. Reis, Christie Ballantyne 2024 Florida State University College of Medicine, United States

Statin Utilization And Cardiovascular Outcomes In A Real-World Primary Prevention Cohort Of Older Adults, Aaron J. Walker, Jianhui Zhu, Floyd Thoma, Oscar Marroquin, Amber Makani, Martha Gulati, Eugenia Gianos, Salim S. Virani, Fatima Rodriguez, Steven E. Reis, Christie Ballantyne

Office of the Provost

Background: Statins are a cost-effective therapy for prevention of atherosclerotic cardiovascular disease (ASCVD). Guidelines on statins for primary prevention are unclear for older adults (>75 years).
Objective: Investigate statin utility in older adults without ASCVD events, by risk stratifying in a large healthcare network.
Methods: We included 8,114 older adults, without CAD, PVD or ischemic stroke. Statin utilization based on ACC/AHA 10-year ASCVD risk calculation, was evaluated in intermediate (7.5%-19.9%) and high-risk patients (≥ 20%); and categorized using low and 'moderate or high' intensity statins with a follow up period of ∼7 years. Cox regression models were used to …


Man With Chest Pain, Fever, And Surprising Finding On Bedside Ultrasound, Omoyeni O Clement, Benjamin L Cooper 2024 The Texas Medical Center Library

Man With Chest Pain, Fever, And Surprising Finding On Bedside Ultrasound, Omoyeni O Clement, Benjamin L Cooper

Journal Articles

No abstract provided.


A Rapid Host-Protein Test For Differentiating Bacterial From Viral Infection: Apollo Diagnostic Accuracy Study, Richard G Bachur, Sheldon L Kaplan, Cesar A Arias, Natasha Ballard, Karen C Carroll, Andrea T Cruz, Richard Gordon, Salim Halabi, Jeffrey D Harris, Kristina G Hulten, Theresa Jacob, Mark D Kellogg, Adi Klein, Pninit Shaked Mishan, Sergey M Motov, Octavia M Peck-Palmer, Leticia M Ryan, Ma'anit Shapira, George S Suits, Henry E Wang, Alexandra Weissman, Richard E Rothman 2024 The Texas Medical Center Library

A Rapid Host-Protein Test For Differentiating Bacterial From Viral Infection: Apollo Diagnostic Accuracy Study, Richard G Bachur, Sheldon L Kaplan, Cesar A Arias, Natasha Ballard, Karen C Carroll, Andrea T Cruz, Richard Gordon, Salim Halabi, Jeffrey D Harris, Kristina G Hulten, Theresa Jacob, Mark D Kellogg, Adi Klein, Pninit Shaked Mishan, Sergey M Motov, Octavia M Peck-Palmer, Leticia M Ryan, Ma'anit Shapira, George S Suits, Henry E Wang, Alexandra Weissman, Richard E Rothman

Journal Articles

OBJECTIVES: To determine the diagnostic accuracy of a rapid host-protein test for differentiating bacterial from viral infections in patients who presented to the emergency department (ED) or urgent care center (UCC).

METHODS: This was a prospective multicenter, blinded study. MeMed BV (MMBV), a test based on tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), interferon gamma-inducible protein-10 (IP-10), and C-reactive protein (CRP), was measured using a rapid measurement platform. Patients were enrolled from 9 EDs and 3 UCCs in the United States and Israel. Patients >3 months of age presenting with fever and clinical suspicion of acute infection were considered eligible. MMBV …


Contemporary Analysis Of Reexcision And Conversion To Mastectomy Rates And Associated Healthcare Costs For Women Undergoing Breast-Conserving Surgery, Youngran Kim, Cecilia Ganduglia-Cazaban, Nina Tamirisa, Anthony Lucci, Trudy Millard Krause 2024 The Texas Medical Center Library

Contemporary Analysis Of Reexcision And Conversion To Mastectomy Rates And Associated Healthcare Costs For Women Undergoing Breast-Conserving Surgery, Youngran Kim, Cecilia Ganduglia-Cazaban, Nina Tamirisa, Anthony Lucci, Trudy Millard Krause

Journal Articles

PURPOSE: This study was designed to provide a comprehensive and up-to-date understanding of population-level reoperation rates and incremental healthcare costs associated with reoperation for patients who underwent breast-conserving surgery (BCS).

METHODS: This is a retrospective cohort study using Merative™ MarketScan

RESULTS: The commercial cohort included 17,129 women with a median age of 55 (interquartile range [IQR] 49-59) years, and the Medicare cohort included 6977 women with a median age of 73 (IQR 69-78) years. Overall reoperation rates were 21.1% (95% confidence interval [CI] 20.5-21.8%) for the commercial cohort and 14.9% (95% CI 14.1-15.7%) for the Medicare cohort. In both cohorts, …


Efficacy And Safety Of Tepotinib In Asian Patients With Advanced Nsclc With Met Exon 14 Skipping Enrolled In Vision, Terufumi Kato, James Chih-Hsin Yang, Myung-Ju Ahn, Hiroshi Sakai, Masahiro Morise, Yuh-Min Chen, Ji-Youn Han, Jin-Ji Yang, Jun Zhao, Te-Chun Hsia, Karin Berghoff, Rolf Bruns, Helene Vioix, Simone Lang, Andreas Johne, Xiuning Le, Paul K Paik 2024 The Texas Medical Center Library

Efficacy And Safety Of Tepotinib In Asian Patients With Advanced Nsclc With Met Exon 14 Skipping Enrolled In Vision, Terufumi Kato, James Chih-Hsin Yang, Myung-Ju Ahn, Hiroshi Sakai, Masahiro Morise, Yuh-Min Chen, Ji-Youn Han, Jin-Ji Yang, Jun Zhao, Te-Chun Hsia, Karin Berghoff, Rolf Bruns, Helene Vioix, Simone Lang, Andreas Johne, Xiuning Le, Paul K Paik

Journal Articles

BACKGROUND: Tepotinib, a MET inhibitor approved for the treatment of MET exon 14 (METex14) skipping NSCLC, demonstrated durable clinical activity in VISION (Cohort A + C; N = 313): objective response rate (ORR) 51.4% (95% CI: 45.8, 57.1); median duration of response (mDOR) 18.0 months (95% CI: 12.4, 46.4). We report outcomes in Asian patients from VISION (Cohort A + C) (cut-off: November 20, 2022).

METHODS: Patients with advanced METex14 skipping NSCLC, detected by liquid or tissue biopsy, received tepotinib 500 mg (450 mg active moiety) once daily.

PRIMARY ENDPOINT: objective response (RECIST 1.1) by independent review. Secondary endpoints included: …


Rhabdomyolysis As A Cause Of Pth Independent Hypocalcemia In A Child With Acute Influenza Infection, Samhita Bhattarai, Kelsee Halpin 2024 Children's Mercy Kansas City

Rhabdomyolysis As A Cause Of Pth Independent Hypocalcemia In A Child With Acute Influenza Infection, Samhita Bhattarai, Kelsee Halpin

Posters

INTRODUCTION Hypocalcemia is characterized by abnormally low level of calcium in the blood. Normal reference range for calcium for children between 12- 19-year-old is 8.5-10.6 mg/dl . Severe hypocalcemia is considered as serum calcium level of <7 mg/dl and can present with tetany, seizures, and life-threatening cardiac arrhythmias. Etiology of hypocalcemia varies but hypoparathyroidism, pseudohypoparathyroidism and Vitamin D deficiency are some of the most common causes encountered by pediatrician endocrinologists. Association of rhabdomyolysis with hypocalcemia and elevated PTH is a rare presentation that should be considered, particularly for those children presenting with acute viral illness. We present a rare case of rhabdomyolysis associated with hypocalcemia not related to hypoparathyroidism. CASE A 12-year-old female presented to the emergency department with body ache, decreased oral intake and vomiting. She was found to be influenza positive. Electrolytes showed hypocalcemia (4.8 mg/dl). She subsequently had an undetectable 25-OH vitamin D level (<5 ng/ml) and elevated iPTH level (609 pg/ml). We discussed the possibility of her etiology of hypocalcemia to be Vitamin D deficiency although her presentation was atypical at an older age with a negative imaging for rickets, hyperphosphatemia (6.0 mg/dl), and normal alkaline phosphatase (334 unit/L). She also did not have any phenotypic features of Albright’s hereditary osteodystrophy and renal function was within normal limits. She was identified to have elevated creatinine kinase (4829 U/L) supporting rhabdomyolysis secondary to acute influenza as a cause of her hypocalcemia. Rhabdomyolysis, a known complication of influenza infection, causes cell membrane destruction which impairs the normal function of Na-K-ATPase channel. This leads to increase in intracellular sodium activating Na/Ca exchanger which in turn causes influx of calcium intracellularly causing hypocalcemia. Additionally, any injury or infection leads to high phosphorus release from cells due to cell lysis. High phosphorus is also caused by reduced oxidative metabolism in muscles impairing phosphate use. This excess of phosphate then combines with calcium and causes calcium-phosphate complex in soft tissues. Hyperphosphatemia also additionally inhibits 1 alpha hydroxylase limiting formation of calcitriol leading to hypocalcemia. CONCLUSION Our patient had severe hypocalcemia due to influenza-related rhabdomyolysis. Rhabdomyolysis is an important consideration as a cause of hypocalcemia in children, especially with acute viral illness. Accordingly, it is also important to obtain serum electrolytes in patients presenting with rhabdomyolysis as hypocalcemia may lead to complications like seizures and cardiac arrhythmia if not appropriately recognized and treated.


The Internist's Post V.1 N.4, The University of Texas Rio Grande Valley. School of Medicine, Jian Garcia Cruz, Diana Othon Martinez, Edgar Dorsey Trevino, Eunbee Cho, Barbara Malaga-Espinoza, Roque Mifuji, Martha Solis, Cesar Gutierrez 2024 Internal Medicine, Knapp Medical Center, The University of Texas Rio Grande Valley School of Medicine

The Internist's Post V.1 N.4, The University Of Texas Rio Grande Valley. School Of Medicine, Jian Garcia Cruz, Diana Othon Martinez, Edgar Dorsey Trevino, Eunbee Cho, Barbara Malaga-Espinoza, Roque Mifuji, Martha Solis, Cesar Gutierrez

School of Medicine Publications and Presentations

Newsletter of the University of Texas Rio Grande Valley School of Medicine - Internal Medicine Residency Program.


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