sodium-bicarbonate and Puerperal-Disorders

To compare two postpartum laxative regimens in women who have undergone primary repair of obstetric anal sphincter injury.. Randomised controlled trial.. National Maternity Hospital, Dublin.. A total of 147 postpartum women who had sustained anal sphincter injury at vaginal birth.. Women were randomised to receive either lactulose alone thrice daily for the first three postpartum days followed by sufficient lactulose to maintain a soft stool over the following 10 days (lactulose group, n = 77) or the lactulose regimen combined with a sachet of ispaghula husk daily for the first 10 postpartum days (Fybogel group, n = 70). All patients kept a diary of bowel habit for the first 10 postpartum days and were invited to return for review at 3 months postpartum.. Patient discomfort with first postpartum bowel motion, incidence of postnatal constipation and incontinence and incontinence score in postnatal period.. Pain scores were similar in the two treatment groups; but incontinence in the immediate postnatal period was more frequent with the two preparations compared with lactulose alone (32.86% versus 18.18%, P = 0.03).. This study does not support routine prescribing of a stool-bulking agent in addition to a laxative in the immediate postnatal period for women who have sustained anal sphincter injury at vaginal delivery.

Topics: Adult; Anal Canal; Cathartics; Citric Acid; Constipation; Drug Combinations; Drug Therapy, Combination; Female; Gastrointestinal Agents; Humans; Lactulose; Obstetric Labor Complications; Plant Extracts; Pregnancy; Puerperal Disorders; Sodium Bicarbonate; Treatment Outcome

Ketoacidosis is a potential complication of type 1 diabetes. Severe ketoacidosis with a blood pH below 7.0 is only rarely seen in other diseases.Three weeks after delivery, a young woman was admitted because of tachypnoe and tachycardia. Blood gas analysis showed a severe metabolic acidosis with a high anion gap. Further workup revealed the presence of ketone bodies in the urine with normal blood glucose and no history of diabetes. The patient reported that she had not eaten for days because of abdominal pain. After initial treatment in the ICU and immediate re-feeding, the patient's condition rapidly improved.While under normal circumstances fasting causes at most only mild acidosis, it can be dangerous during lactation. Prolonged fasting in combination with different forms of stress puts breast feeding women at risk for starvation ketoacidosis and should therefore be avoided.

Topics: Adult; Fasting; Female; Glucose; Humans; Hyperventilation; Ketone Bodies; Ketosis; Lactation; Phosphates; Potassium; Puerperal Disorders; Sodium Bicarbonate; Sodium Chloride; Tachycardia; Tachypnea

Serious complications from tricyclic antidepressant (TCA) overdose are uncommon. We present a case of massive imipramine overdose complicated by ventricular fibrillation and a prolonged period of cardiovascular collapse. A total of 400 mmol of sodium bicarbonate, 5 mg of adrenaline and 80 mg of sotalol were given during 50 minutes of cardiac arrest. The patient made a full recovery with no apparent neurological sequelae. The highest TCA plasma level we could find in the published literature was 4873 ng/ml4; our patient's peak TCA level was 6000 ng/ml. Tricyclic antidepressant overdose is a common cause of intensive care unit admission. It has a low mortality rate.

Topics: Adrenergic Agonists; Adult; Anti-Arrhythmia Agents; Antidepressive Agents, Tricyclic; Critical Care; Depression; Drug Overdose; Electric Countershock; Epilepsy, Tonic-Clonic; Epinephrine; Female; Heart Arrest; Humans; Imipramine; Puerperal Disorders; Shock; Sodium Bicarbonate; Sotalol; Ventricular Fibrillation