A stuttering discovery of lithium toxicity.

An 86-year-old female nursing home resident was typically described by the nursing staff as alert, pleasant, and conversant, although disoriented to time and place at times. She was frequently seen in the hallways, often breaking into song with her melodious voice. Her past medical history was significant for dementia, epilepsy, and bipolar disorder, for which she took lithium carbonate.

Heart failure in frail, older patients: we can do 'MORE'.

A comprehensive approach is necessary in managing heart failure in frail older adults. To provide optimal care, physicians need to draw on knowledge from the fields of internal medicine, geriatrics, and cardiology. The acronym "MORE" is a mnemonic for what heart failure management should include: multidisciplinary care, attention to other (ie, comorbid) diseases, restrictions (of salt, fluid, and alcohol), and discussion of end-of-life issues.

Steroid-induced hallucination following intra-articular administration: a case report and brief review.

Amidst the ubiquitous use of steroids, psychiatric side-effects are not uncommon, though the presentation may be curiously diverse. The case of an elderly lady who had 40 mg of methylprednisolone injected in each knee for treatment of suprapatellar bursitis is presented. After 3 days, she reported visual hallucinations, which resolved without treatment 6 days after the steroid injections.

Dietary supplements in primary care. Botanicals can affect surgical outcomes and follow-up.

Dietary supplements are commonly used by patients of all ages, yet few patients reveal use of these products to their medical providers. Certain dietary supplements can react or interact with frequently used surgical medications--including anesthesia--and may cause serious unforeseen consequences or complications. Arrhythmias, poor wound healing, bleeding, photosensitivity reaction, and prolonged sedation are among the serious reactions during and after surgical and diagnostic procedures that have been attributed to these products.

Cardiovascular outcomes using doxazosin vs. chlorthalidone for the treatment of hypertension in older adults with and without glucose disorders: a report from the ALLHAT study.

Insulin resistance underlies most glucose disorders in adults and is associated with an increased risk of cardiovascular disease. Alpha blockers decrease insulin resistance, whereas diuretics increase insulin resistance. The authors studied the effects of these two classes of hypertension medications (doxazosin, an a blocker, and chlorthalidone, a diuretic) on cardiovascular disease outcomes in adults aged >55 years with hypertension and glucose disorders who were participants in the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (8749 had known diabetes mellitus and 1690 had a newly diagnosed glucose disorder [fasting glucose >/=110 mg/dL]).

Blood Pressure Therapy in the Elderly: An Observation in Octogenarians.

The incidence of hypertension increases with age. Although there is ample evidence regarding the benefit of treating elderly hypertensive patients, resulting in decreases in cardiovascular morbidity and mortality, the adverse effects of treatment are also frequently reported in these often frail individuals. Therefore, it is difficult to determine the level to which blood pressure should be decreased and what type of antihypertensive medication is most effective and best tolerated.