A woman with complex psychiatric illness and substance use disorder presented with nausea, vomiting, and episodes of oculogyric crisis. A medication review suggested drug-induced acute dystonia, likely triggered by metoc...A woman with complex psychiatric illness and substance use disorder presented with nausea, vomiting, and episodes of oculogyric crisis. A medication review suggested drug-induced acute dystonia, likely triggered by metoclopramide. Other symptoms were possibly related to cumulative anticholinergic effects. Fluoxetine, a potent CYP2D6 inhibitor, may have increased exposure to metoclopramide and promethazine. This case report demonstrates that pharmacological insight and deprescribing can improve symptoms and support rational pharmacotherapy in vulnerable psychiatric patients.
Polypharmacy is common among the elderly. This case report details the experience of an 85-year-old man whose notable polypharmacy and additional over-the-counter medicines led to anemia and acute kidney injury. These is...Polypharmacy is common among the elderly. This case report details the experience of an 85-year-old man whose notable polypharmacy and additional over-the-counter medicines led to anemia and acute kidney injury. These issues were traced to an unintended »triple-whammy« effect due to the interaction of diuretics, ACE inhibitors, and NSAIDs, and concurrent treatment with an anticoagulant. Highlighting the role of systematic medication reviews, this case illustrates how targeted interventions can prevent severe health outcomes and underscores the importance of medication monitoring in elderly patients.
In this case report, a 60-year-old patient was referred to a multidisciplinary pain clinic to discontinue methadone. Before referral, a self-managed dose reduction from 40 to 15 mg had led to loss of function due to with...In this case report, a 60-year-old patient was referred to a multidisciplinary pain clinic to discontinue methadone. Before referral, a self-managed dose reduction from 40 to 15 mg had led to loss of function due to withdrawal symptoms. After referral, methadone was successfully deprescribed over three months. Withdrawal symptoms were managed through an individually tailored plan, supportive consultations with a nurse, and the use of clonidine. The patient regained function after deprescribing methadone. Deprescribing opioids can be managed through a patient-centered approach and close monitoring.
Polypharmacy with anticholinergic and sedative effects is a major contributor to cognitive decline in older adults. This case study of an 80yearold man with mild cognitive impairment illustrates how systematic deprescrib...Polypharmacy with anticholinergic and sedative effects is a major contributor to cognitive decline in older adults. This case study of an 80yearold man with mild cognitive impairment illustrates how systematic deprescribing resulted in improved cognition, mood, and functional capacity. The intervention emphasises the value of regular medication review to uncover reversible contributors to decline and promote quality of life even amid neurodegenerative progression.
This case report describes a 69-year-old woman on long-term pantoprazole therapy, initially prescribed for nonspecific upper gastrointestinal symptoms. Despite resistance to discontinuation due to rebound symptoms, a gra...This case report describes a 69-year-old woman on long-term pantoprazole therapy, initially prescribed for nonspecific upper gastrointestinal symptoms. Despite resistance to discontinuation due to rebound symptoms, a gradual dose reduction combined with patient education and use of antacids led to successful cessation. The case highlights the importance of regular medication review, patient involvement, and awareness of rebound acid hypersecretion in facilitating rational PPI use and deprescribing efforts.
Deprescribing is often challenged by differing attitudes of patients, relatives, and healthcare professionals. Such attitudes are summarised in this review. Patients may hold conflicting views, relatives influence decisi...Deprescribing is often challenged by differing attitudes of patients, relatives, and healthcare professionals. Such attitudes are summarised in this review. Patients may hold conflicting views, relatives influence decisions, and healthcare professionals face barriers such as a lack of guidance, uncertainty about benefits and harm, and resource constraints. Increasing awareness of these perspectives and integrating structured tools, clear guidance, and patient involvement in the deprescribing process can support shared decision-making and improve clinical practice and patient outcomes.
Iodine-based contrast agents are routinely used for contrast-enhanced CT. However, CT contrast has been associated with acute kidney injury (CA-AKI) and thus international guidelines recommend prior screening of kidney f...Iodine-based contrast agents are routinely used for contrast-enhanced CT. However, CT contrast has been associated with acute kidney injury (CA-AKI) and thus international guidelines recommend prior screening of kidney function using eGFR. However, eGFR screening is resource-consuming, and current evidence suggests that the risk of CA-AKI is very low. This review examines the evidence, recommendations, and current practices of eGFR screening in Danish radiology departments. Following a Choosing Wisely-strategy, we recommend minimising eGFR screening before contrast-enhanced CT scans.
Celiac disease (CeD) is caused by an autoimmune reaction triggered by dietary intake of gluten. CeD affects approximately 1% of the population, although many cases remain undiagnosed. CeD is diagnosed by testing for CeD...Celiac disease (CeD) is caused by an autoimmune reaction triggered by dietary intake of gluten. CeD affects approximately 1% of the population, although many cases remain undiagnosed. CeD is diagnosed by testing for CeD antibodies, and if positive, referral to a gastroenterologist or pediatrician is indicated. Treatment of CeD is a lifelong gluten-free diet. Guidance from a dietitian is needed. Symptoms of CeD vary and are often non-specific, which can cause diagnostic challenges and often a significant diagnostic delay. Therefore, increased awareness of CeD symptoms and knowledge of diagnostic procedures is important, as argued in this review.
Hypersensitivity reactions during hemodialysis remain a clinical concern despite advances in materials and techniques. A reaction should prompt swift interruption of treatment, identification of possible triggers, and th...Hypersensitivity reactions during hemodialysis remain a clinical concern despite advances in materials and techniques. A reaction should prompt swift interruption of treatment, identification of possible triggers, and thorough documentation. Filter change is recommended before the next treatment. Current handling varies across centers, underlining the need for national guidelines to standardize treatment and improve patient safety, as argued in this review.
Phenibut (β-phenyl-γ-aminobutyric acid) is a GABA-B agonist associated with sedation, dependency, and withdrawal. In this case report, a young man was admitted unconscious with partial brainstem areflexia. Based on clini...Phenibut (β-phenyl-γ-aminobutyric acid) is a GABA-B agonist associated with sedation, dependency, and withdrawal. In this case report, a young man was admitted unconscious with partial brainstem areflexia. Based on clinical findings, a container of phenibut found on him, and his later statement of ingestion, phenibut intoxication was suspected, and he was admitted to the ICU. He later developed withdrawal symptoms, treated effectively with baclofen. This highlights phenibut as a potential cause of coma and the role of baclofen in withdrawal treatment.
Chemsex refers to the use of psychoactive substances, such as GHB, methamphetamine, and poppers, to enhance sexual experiences, predominantly among men who have sex with men and transgender individuals in LGBT+ communiti...Chemsex refers to the use of psychoactive substances, such as GHB, methamphetamine, and poppers, to enhance sexual experiences, predominantly among men who have sex with men and transgender individuals in LGBT+ communities. The practice is associated with increased risks, including sexually transmitted infections, substance dependence, overdose, and cardiac arrest. We present a fatal case of cardiac arrest following chemsex, where high levels of GHB and methamphetamine were detected. This highlights the severe health consequences and the need for targeted support and harm reduction strategies.
The literature review indicates how drug holidays are relevant for patients who experience weight loss and a decline in BMI, as well as in adolescents who need insight into their need for treatment and sense of responsib...The literature review indicates how drug holidays are relevant for patients who experience weight loss and a decline in BMI, as well as in adolescents who need insight into their need for treatment and sense of responsibility. Drug holidays will also be relevant to patients with insomnia or acquired tolerance. Further research on the topic is needed, and the development of specific guidelines for both healthcare professionals, parents and patients is important for the application of drug holidays, as argued in this review.
Pregnancy and lactation-associated osteoporosis is a rare but potentially debilitating condition characterised by vertebral and, less frequently, hip fractures during late pregnancy or the postpartum period. Due to sympt...Pregnancy and lactation-associated osteoporosis is a rare but potentially debilitating condition characterised by vertebral and, less frequently, hip fractures during late pregnancy or the postpartum period. Due to symptom overlap with common pregnancy-related discomforts, diagnosis is often delayed. This paper synthesises current evidence regarding the pathophysiology, risk factors, diagnostics, and management strategies. Given the vulnerability of affected women, early diagnosis and individualised, multidisciplinary care are critical, although evidence-based treatment guidelines remain scarce, as argued in this review.
Introduced in 2019, "puff bars" quickly gained popularity among youth globally, with Denmark as no exception. This rapid surge of "puff bars" happened despite a prohibition on sale and purchase, due to their attractive f...Introduced in 2019, "puff bars" quickly gained popularity among youth globally, with Denmark as no exception. This rapid surge of "puff bars" happened despite a prohibition on sale and purchase, due to their attractive flavours, design and successful promotion on social media platforms. Recently, various mental health issues such as insomnia, anxiety, and even psychotic experiences have been reported, rising concern about "puff bars". This review aims to shed light on the status of "puff bar" use in Denmark and explore their possible mechanisms of the development of psychotic symptoms.
A 49-year-old woman developed new-onset type 1 diabetes after initiating Wegovy (semaglutide) via an online clinic, without prior screening. She experienced rapid weight loss and hyperglycemia symptoms. Blood tests indic...A 49-year-old woman developed new-onset type 1 diabetes after initiating Wegovy (semaglutide) via an online clinic, without prior screening. She experienced rapid weight loss and hyperglycemia symptoms. Blood tests indicated high GAD65 and low C-peptide. The case underscores the need for biochemical screening and follow-up in digital obesity care.
Respiratory syncytial virus (RSV) is the leading cause of infant hospitalisations in Denmark, with about 1,300 admissions annually. Until now, prevention relied on palivizumab for high-risk infants, limited by high costs...Respiratory syncytial virus (RSV) is the leading cause of infant hospitalisations in Denmark, with about 1,300 admissions annually. Until now, prevention relied on palivizumab for high-risk infants, limited by high costs and monthly injections. This review describes new preventive options including maternal vaccination (Abrysvo) and monoclonal antibodies (nirsevimab, clesrovimab). From October 2025, Denmark introduced a seasonal maternal vaccination, expected to substantially reduce RSV-related hospitalisations. Additionally, monoclonal antibodies are recommended for premature and high-risk infants.