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Relentless Shock

Charles H. Pitegoff, M.D.
JAMA. 1961;175(11):1020. doi:10.1001/jama.1961.03040110084025.
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To the Editor:—  I read with interest the report in The Journal of Nov. 5, 1960, on Relentless Shock by Backer and associates. The description of muscular twitching and tremors in both patients, with marked disorientation in one of the patients, suggests strongly the possibility that a condition of magnesium deficency may have existed. I have just seen a similar patient with shock, paroxysmal fibrillation, and marked disorientation, 3 days after a subtotal gastrectomy. Pressor agents were required continuously to maintain the blood pressure. Magnesium therapy was instituted, and within 16 hours the patient could sustain his blood pressure without the need of vasopressor substances.I realize that the situation of the patient I treated was of much shorter duration, and therapy was empirical because magnesium levels were unobtainable. I do think that any occurrence of prolonged shock, twitching, and acute disorientation which cannot be explained by the usual


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