Furosemide ELISA Kit

A 48-year-old man was brought to our emergency room with acute abdominal pain and systemic edema, indicating acute circulatory failure with lactic acidosis. Furosemide treatment paradoxically worsened the systemic edema and induced confusion. He had no drinking history but hardly ate legumes or meats containing thiamine. Administration of fursultiamine dramatically improved the symptoms and subsequently caused pulmonary edema. Thiamine deficiency may occur in nondrinkers with an unbalanced diet. In this condition, diuretic therapy can worsen the symptoms before thiamine supplementation by promoting the flushing of water-soluble vitamins but is needed for the management of secondary pulmonary edema after thiamine replenishment.

BACKGROUND: Cardiac rhabdomyoma has a postnatal incidence of 1 in 40,000 and comprises 45-75% of tumors that are detected at the prenatal stage, with 70 to 80% of them associated with the tuberous sclerosis complex. CLINICAL CASE: Male fetus with a mass located over the wall of the left ventricle identified at 18 weeks of gestation, after birth developed tachycardia and respiratory distress; treatment with digoxin and furosemide was initiated. Cardiac rhabdomyoma was suspected; brain magnetic resonance showed multiple cortical tubers, left parietal linear marginal dysplasia and subependymal nodules, tuberous sclerosis complex diagnosis was made without confirmatory genetic testing. Everolimus was started; one-month later reduction of the tumor was observed with clinical improvement. After five-month the mass shrink and heart failure disappeared, and furosemide and digoxin were stopped. At 10 months he started with epilepsy, at 2 years the echocardiography and the neurodevelopment was normal, he continues with antiepileptic drugs and Everolimus without side effects. CONCLUSIONS: Everolimus is an alternative for the treatment of cardiac rhabdomyomas in patients with tuberous sclerosis with large tumors or surgically unreachable locations.