244 / 290
Conclusions:
This case brings MALA to attention, underlining the need
for thoughtful metformin use and details the seriousness of MALA in a
very elderly patient, focusing on the need of high clinical suspicion to
improve outcomes.
P-791
Cancer: one of the most prevalent diseases in geriatric population
M. Semedo
1,2
, R. Mendes
1
, E. Cunha
1
.
1
Hospital de São João, Porto,
Portugal;
2
Departamento de Medicina Molecular, Universidade de
Santiago de Compostela, Santiago de Compostela, Spain
Introduction:
Heavy metals and cancer are a subject widely spoken
and studied given to their level of exposure by the entire population,
mainly people of an advanced age. Despite being awell-known theme,
we still do not know the mechanisms related to cancer presence
and contact with heavy metals. For this reason, we investigated the
possibility of the presence of heavy metals in samples from renal
carcinoma tissue and renal adjacent tissue, in patients that do radical
or partial nephrectomy. This study was approved by the local ethics
committee of Centro Hospitalar de S. João, E.P.E. and patient consent
was obtained from all participants.
Methods:
The collected samples were processed and observed by
using Scanning ElectronMicroscopy coupledwith X-RayMicroanalysis
(SEM-XRM), with the aim of comparing qualitatively and semi-
quantitatively the existence of heavy metals.
Results:
The results obtained in this study showed there was a
significant difference between the amount of heavy metals present in
samples of tumor tissue and adjacent tissue, used as a control. The
tumor tissue was found to have a sequestering of some types of metal,
contrary to what happened with control tissue.
Conclusions:
With these results, we can suggest that heavy metals
play a role in the oncogenic pathway of renal cell carcinoma. It is
necessary to question if the presence of heavy metals in tumor tissue is
a cause or a consequence of carcinogenesis phenomenon or if these
metals can be used as biomarkers with a diagnosis or prognosis
interest for geriatric population.
P-792
Use of central nervous system active medications in patients with
Parkinson
’
s disease or Parkinsonism
J. Barnes
1
, A. Michael
2
.
1
Neurology Specialist Pharmacist, Dudley CCG,
NHS, Dudley,
2
Consultant Geriatrician, Russells Hall Hospital, Dudley, UK
Introduction:
Patients with Parkinson
’
s disease (PD) are frequently
prescribed CNS active drugs, many of which have side effects and
wide spectrum of drug interactions. Antimuscarinics can lead to
confusion. Tricyclic and related antidepressants have varying degrees
of antimuscarinic side effects and cardiotoxicity. There is increased
CNS toxicity when SSRIs or Tricyclic Antidepressants are given
concomitantly with Selegiline or Rasagiline. There is risk of extrapyr-
amidal side effects when antipsychotics are given with amantadine.
Opioids can cause Confusion, hallucinations and muscle rigidity. And
Antipsychotics antagonize the effect of PD dopaminergic drugs. Most
CNS active drugs also increase the risk of falling.
Aim:
To study the use of CNS active drugs in patients with PD or
Parkinsonism.
Method:
Prospective study of CNS active drugs
’
use in 200 consecutive
patients attending PD clinic in a UK teaching hospital. Patients
’
notes
and electronic records were reviewed. Data were collected on excel
and descriptive statistics were used.
Results:
200 patients were included; 115 males and 85 females with
mean age of 73 and 72 years respectively. 88% of patients had PD, 10%
had secondary Parkinsonism and 2% had Parkinson
’
s plus syndrome.
33% of patients had 1 or 2 falls in the previous 6 months, 18% had 3 or
more falls.
28% of patients were on Antimuscarinics, 20% were on antidepres-
sants, 11% on opioids, 5% on sedatives and 3% on antipsychotics .
Conclusion:
Many patients with PD or Parkinsonism are on many CNS
active drugs. Patient
–
drug and drug
–
drug interactions should be
meticulously considered before prescribing. The indication, dose and
risk/benefit should be regularly reviewed and dose adjusted or the
drug stopped.
P-793
Resistant hypocalcemia with denosumab therapy
C. Michael, A. McGrath.
The Christie NHS Foundation Trust, Dudley Group
of Hospitals Foundation Trust
Case report:
A 73-year old patient had non-traumatic right hip
fracture while being on alendronate and daily calcium 1200 mg and
colecalciferol 800 units. Her past medical history includes auto-
immune pancreatitis, ileojejunostomy, biliary stricture and chronic
kidney disease. She also had L1 vertebral fracture. Shewas onwarfarin,
bisoprolol, amlodipine, citalopram, creon, and ferrous sulphate. She is
a non-smoker and occasionally drinks alcohol. DEXA scan showed
osteoporosis of the lumber spine with a T score of
−
2.7 at L1 and
osteopenia of the left hip with a T score of
−
2.4. Alendronate was
stopped and she was started on Denosumab 60mg subcutaneously
every six months. Calcium level before initiation of Denusumab was
normal. She also continued on daily calcium 1200 mg and colecalci-
ferol 800units. Three years later she attended A&E on two occasions
with hypocalcaemia related symptoms. Despite calcium and vitamin D
treatment her corrected calcium level was still low at 1.71 and
1.96 mmol/L. Phosphate and alkaline phosphatase were normal. Her
total 25-hydroxy-vitamin D level was insufficient at 29 nmol/L. Her
chronic kidney disease was stable with urea of 16.8 mmol/L and
Creatinine was 170 umol/L. Her magnesium level was normal.
Discussion:
The most common cause of hypocalcaemia is vitamin D
deficiency (1). Other causes include: malnutrition, malabsorption,
chronic kidney disease and hypoparathyroidism. Bone resorption
inhibitors such as Denosumab and bisphosphonates may induce
hypocalcaemia in patients with pre-existing vitamin D deficiency. In
patients with hypomagnesaemia, hypocalcaemia is difficult to correct
without magnesium repletion first (2) because serum magnesium is
essential for the synthesis and release of parathyroid hormone (3).
In this case, the patient had pancreatic insufficiency, biliary stricture
and short bowel syndrome due to ileojejunostomy. All can lead to
malabsorption of vitamin D, calcium and magnesium. Denosumab
therapy is likely to have exaggerated the hypocalcaemia and exposed
the vitamin D deficiency.
Conclusion:
Calcium and vitamin D should be assessed and optimized
before initiating Denosumab therapy. Monitoring of calcium and
vitamin D levels is recommended throughout treatment, especially in
patients predisposed to hypocalcaemia or vitamin D deficiency.
References
1. Holick MF. Vitamin D deficiency.
N Engl J Med
2007;357:266.
2. Cooper MS, Gittoes NJ. Diagnosis and management of hypocal-
caemia.
Brit Med J
2008;336:1298
–
302.
3. Anast CS, Winnacker JL, Forte LR, Burns TW. Impaired release of
parathyroid hormone in magnesium deficiency.
J Clin Endocrinol
Metab
1976;42:707.
P-794
Medication review starts from the front door: the success of STOPP/
START criteria in frail elderly patients in the emergency
department
L. Mieiro
1,2
, O. Kayode
2
, F. Hayat
2
, S. Mason
3
, D. Webbe
3
, S. Green
1
.
1
Department of Medicine for Elderly People, Whipps Cross University
Hospital, Barts Health NHS Trust,
2
Forest Assessment Unit, Whipps Cross
University Hospital, Barts Health NHS Trust,
3
Pharmacy Department,
Whipps Cross University Hospital, Barts Health NHS Trust, London, United
Kingdom
Background:
Polypharmacy and potentially inappropriate medication
(PIM) are common problems in frail elderly patients. STOPP/START tool
is validated for in- and outpatients. Medication review should be part
of Comprehensive Geriatric Assessment delivered in Emergency
Poster presentations / European Geriatric Medicine 7S1 (2016) S29
–
S259
S238