{"id":25656,"date":"2024-05-05T04:12:00","date_gmt":"2024-05-04T20:12:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=25656"},"modified":"2024-05-05T06:43:04","modified_gmt":"2024-05-04T22:43:04","slug":"jama%e4%b8%b4%e5%ba%8a%e6%8c%91%e6%88%98%ef%bc%9a%e8%83%83%e5%86%85%e7%a1%ac%e5%b8%81%e5%bd%a2%e7%8a%b6%e7%9a%84%e4%b8%8d%e9%80%8f%e5%85%89%e7%89%a9%e5%93%81%ef%bc%88%e9%97%ae%e9%a2%98%ef%bc%89","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=25656","title":{"rendered":"[JAMA\u4e34\u5e8a\u6311\u6218]\uff1a\u80c3\u5185\u786c\u5e01\u5f62\u72b6\u7684\u4e0d\u900f\u5149\u7269\u54c1\uff08\u95ee\u9898\uff09"},"content":{"rendered":"\n

JAMA Clinical Challenge <\/p>\n\n\n\n

October 30, 2023<\/p>\n\n\n\n

Coin-Shaped Opacities in the Stomach<\/h1>\n\n\n\n

Neil Shadbeh Evans, Paul Aronowitz, Timothy E. Albertson<\/h3>\n\n\n\n

JAMA. <\/em>2023;330(20):2016-2017. doi:10.1001\/jama.2023.19032<\/h3>\n\n\n\n

Case<\/h2>\n\n\n\n

A50-year-old man with end-stage kidney disease receiving hemodialysis was admitted to the hospital for treatment of calciphylaxis and foot cellulitis. His home medications included sevelamer and hydrocodone-acetaminophen (10 mg\/325 mg) every 8 hours as needed, which was increased to every 4 hours as needed in the hospital. Hydromorphone (0.5 mg intravenously as needed) was added for breakthrough pain. He was prescribed chewable lanthanum tablets (500 mg 3 times daily) for treatment of a blood phosphate level of 8.1 mg\/dL (reference, 2.5-4.5 mg\/dL).<\/a><\/p>\n\n\n\n

On hospital day 7, the patient developed intermittent apneic episodes, during which his oxygen saturation was 80% on room air; heart rate, 86\/min; and blood pressure, 106\/45 mm Hg. Physical examination revealed bilateral rhonchi and responsiveness to verbal commands only with deep painful stimulus. A chest radiograph showed 4 radio-opaque coin-shaped opacities in the stomach (Figure<\/a>). After administration of oxygen at 2 L\/min by nasal cannula and a naloxone infusion, his oxygen saturation increased to 98% and his mental status improved. The patient reported no foreign body ingestion.<\/p>\n\n\n\n

\"\"<\/figure>\n\n\n\n

Chest radiograph showing 4 rounded objects in patient\u2019s stomach<\/p>\n\n\n\n

What Would You Do Next?<\/h2>\n\n\n\n
    \n
  1. Administer activated charcoal<\/li>\n\n\n\n
  2. Arrange endoscopy<\/li>\n\n\n\n
  3. Perform gastric lavage<\/li>\n\n\n\n
  4. Provide supportive care<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    JAMA Clinical Challenge  October 30, 2023 Coin-Sha […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[13,18],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25656"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=25656"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25656\/revisions"}],"predecessor-version":[{"id":25660,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25656\/revisions\/25660"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=25656"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=25656"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=25656"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}