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management of hypocalcemia in icu

Goran Cuturilo, Danijela Drakulic, Ida Jovanovic, Slobodan Ilic, Jasna Kalanj, Irena Vulicevic, Misela Raus, Dejan Skoric, Marija Mijovic, Biljana Medjo, Snezana Rsovac, Milena Stevanovic
22q11.2 microdeletion is the most common microdeletion in humans. The purpose of this study was to evaluate postoperative outcome in children with 22q11.2 microdeletion who had undergone complete surgical correction of a congenital heart defect. The study included 34 patients who underwent complete correction of conotruncal heart defects. Of these, 17 patients diagnosed with 22q11.2 microdeletion represent the investigated group. Another 17 patients without 22q11.2 microdeletion represent the control group...
December 2017: Pediatric Cardiology
Emily J MacKay, Michael D Stubna, Daniel N Holena, Patrick M Reilly, Mark J Seamon, Brian P Smith, Lewis J Kaplan, Jeremy W Cannon
BACKGROUND: Admission hypocalcemia predicts both massive transfusion and mortality in severely injured patients. However, the effect of calcium derangements during resuscitation remains unexplored. We hypothesize that any hypocalcemia or hypercalcemia (either primary or from overcorrection) in the first 24 hours after severe injury is associated with increased mortality. METHODS: All patients at our institution with massive transfusion protocol activation from January 2013 through December 2014 were identified...
September 2017: Anesthesia and Analgesia
Maryam I Khan, R Phillip Dellinger, Steven G Waguespack
Electrolyte disturbances are frequently encountered in critically ill oncology patients. Hyponatremia and hypernatremia as well as hypocalcemia and hypercalcemia are among the most commonly encountered electrolyte abnormalities. In the intensive care unit, management of critical electrolyte disturbances is focused on initial evaluation and immediate treatment plan to prevent severe complications. A PubMed search was performed to identify best available evidence for evaluation and management of dysnatremias, hypocalcemia, and hypercalcemia...
March 2018: Journal of Intensive Care Medicine
Sibel Ocak Serin, Gulsah Karaoren, Yildiz Okuturlar, Ethem Unal, Seda Ahci, Eda Karakoc, Sema Ucak Basat
INTRODUCTION: Re-feeding Syndrome (RS) is a deadly complication, which can be encountered during "refeeding" of malnourished patients. In these patients, thiamin deficiency may develop and "risk awareness" is the most significant factor in the management of these patients. In this case report, the treatment is presented of an elderly patient who was diagnosed with RS and followed-up in the intensive care unit (ICU) due to resistant fluidelectrolyte imbalance. CASE: An 87-year-old elderly woman was admitted to the hospital due to aspiration pneumonia...
March 2017: Asia Pacific Journal of Clinical Nutrition
Emine Polat, Nilden Tuygun, Halise Akca, Can Demir Karacan
BACKGROUND: Colchicine poisoning is an uncommon but serious form of drug intoxication. It may produce life-threatening systemic effects. In toxic doses it produces nausea and vomiting and bone marrow suppression, often leading to sepsis, hypocalcemia, adult respiratory distress syndrome, and direct cardiotoxic effects. OBJECTIVE: The aim of this study was to describe demographic features and the outcome of patients poisoned with colchicine. METHODS: A retrospective study of the pediatric intensive care unit database was performed for patients ≤18 years of age who had colchicine poisoning between July 2008 and July 2013...
April 2017: Journal of Emergency Medicine
Chandra Kant Pandey, Anshuman Singh, Kamal Kajal, Mandeep Dhankhar, Manish Tandon, Vijay Kant Pandey, Sunaina Tejpal Karna
Liver transplantation has been associated with massive blood loss and considerable transfusion requirements. Bleeding in orthotopic liver transplantation is multifactorial. Technical difficulties inherent to this complex surgical procedure and pre operative derangements of the primary and secondary coagulation system are thought to be the principal causes of perioperative hemorrhage. Intraoperative practices such as massive fluid resuscitation and resulting hypothermia and hypocalcemia secondary to citrate toxicity further aggravate the preexisting coagulopathy and worsen the perioperative bleeding...
June 27, 2015: World Journal of Gastrointestinal Surgery
Daniela von Ah Lopes, Marcelo Araújo do Valle, Jéfferson Taguti, Regina Celli Thomé Castro Taguti, Gustavo Navarro Betônico, Fabiana Clemente Medeiros
Acute intermittent porphyria is an unusual pathology with potentially severe consequences when not early detected. Among the possible causes of porphyric crises decrease of caloric intake has been described. A case of acute intermittent porphyria in the late postoperative period of a bariatric surgery performed for treatment of obesity is reported. A review of the diagnostic aspects and management of this pathology in the intensive care unit follows. A 31 year old woman was admitted in the intensive care unit three weeks after a bariatric surgery, with decreased level of consciousness and respiratory distress...
December 2008: Revista Brasileira de Terapia Intensiva
Mohammod J Chisti, Mohammed A Salam, Hasan Ashraf, A S G Faruque, Pradip K Bardhan, Abu S M S B Shahid, K M Shahunja, Sumon K Das, Tahmeed Ahmed
Hypocalcaemia is common in severely-malnourished children and is often associated with fatal outcome. There is very limited information on the clinical predicting factors of hypocalcaemia in hospitalized severely-malnourished under-five children. Our objective was to evaluate the prevalence, clinical predicting factors, and outcome of hypocalcaemia in such children. In this case-control study, all severely-malnourished under-five children (n=333) admitted to the Longer Stay Ward (LSW), High Dependency Unit (HDU), and Intensive Care Unit (ICU) of the Dhaka Hospital of icddr,b between April 2011 and April 2012, who also had their total serum calcium estimated, were enrolled...
June 2014: Journal of Health, Population, and Nutrition
Ya-chang Zeng, Mu-jun Li, Yue Chen, Li Jiang, Su-mei Wang, Xiao-liang Mo, Bin-Yi Li
PURPOSE: Glyburide has been used for managing gestational diabetes mellitus (GDM) in a number of countries. It is rather inexpensive. However, its efficacy and safety remain controversial. With this meta-analysis, we evaluated glyburide in comparison with insulin. MATERIAL/METHODS: With a systematic literature search strategy, a total of 93 randomized controlled trials (RCTs) with insulin and glyburide comparison were identified. Based on the revised Consolidated Standards of Reporting Trials (CONSORT) checklist, five of them met the inclusion criteria and were included in this meta-analysis...
March 2014: Advances in Medical Sciences
Mary Abraham, Jennifer Mitchell, Debra Simsovits, James Gasperino
Norethindrone acetate/ethinyl estradiol (Estrostep; Warner Chilcott, Rockaway, New Jersey) is an "estrophasic" type of oral contraceptive, which combines a continuous low progestin dose with a gradually increasing estrogen dose. In clinical trials, this medication failed to produce clinically significant changes in serum lipid levels. We report a case of severe hypertriglyceridemia-induced acute pancreatitis in a 24-year-old woman caused by Estrostep, occurring nearly 10 years after she began using the drug...
July 2015: Journal of Intensive Care Medicine
Richard D Collage, Gina M Howell, Xianghong Zhang, Jennifer L Stripay, Janet S Lee, Derek C Angus, Matthew R Rosengart
BACKGROUND: Calcium plays an essential role in nearly all cellular processes. As such, cellular and systemic calcium concentrations are tightly regulated. During sepsis, derangements in such tight regulation frequently occur, and treating hypocalcemia with parenteral calcium administration remains the current practice guideline. OBJECTIVE: We investigated whether calcium administration worsens mortality and organ dysfunction using an experimental murine model of sepsis and explored the mechanistic role of the family of calcium/calmodulin-dependent protein kinases in mediating these physiological effects...
November 2013: Critical Care Medicine
Zhongheng Zhang, Ni Hongying
PURPOSE: Regional citrate anticoagulation (RCA) is an attractive anticoagulation mode in continuous renal replacement therapy (CRRT) because it restricts the anticoagulatory effect to the extracorporeal circuit. In recent years, several randomized controlled trials have been conducted to investigate its superiority over other anticoagulation modes. Thus, we performed a systematic review of available evidence on the efficacy and safety of RCA. METHODS: A systematic review of randomized controlled trials investigating the efficacy and safety of RCA was performed...
January 2012: Intensive Care Medicine
Michael Gruber, Carsten Nehring, Marcus Creutzenberg, Bernhard Graf, Susanne Hopf
BACKGROUND: Discrepancies in ionised calcium concentrations between results from several point-of-care devices derived from intensive care unit (ICU) patients were postulated to be caused by perchlorate, a thyroid blocking agent. The deviations were serious concerning the diagnosis of hyper- or hypocalcaemia and administration of calcium infusions. METHODS: The problem was studied from three perspectives. First: quantification of ionised calcium in heparinised blood samples spiked with sodium perchlorate from healthy volunteers measured using five blood gas analysers (BGAs from IL, Radiometer, Roche and Siemens)...
June 2011: Clinical Chemistry and Laboratory Medicine: CCLM
G Burghi, D Berrutti, W Manzanares
The tumor lysis syndrome (TLS) is a life-threatening complication caused by the massive release of nucleic acids, potassium and phosphate into the blood. This complication is the result of tumor cell lysis, which may occur due to treatment of drug sensitive and is characterized by rapid capacity of proliferation, that is often hematological origin. Moreover, the TLS can be observed before starting the treatment due to spontaneous tumor cell death, and frequently worsens when chemotherapy is initiated. TLS has high mortality, so that its prevention continues to be the most important therapeutic measure...
April 2011: Medicina Intensiva
Mitchell S Buckley, Jaclyn M Leblanc, Michael J Cawley
Electrolyte imbalances are common in critically ill patients. Although multiple disease states typically encountered in the intensive care unit may be responsible for the development of electrolyte disorders, medications may contribute to these disturbances as well. Medications can interfere with the absorption of electrolytes, alter hormonal responses affecting homeostasis, as well as directly impact organ function responsible for maintaining electrolyte balance. The focus on this review is to identify commonly prescribed medications in the intensive care unit and potential electrolyte disturbances that may occur as a result of their use...
June 2010: Critical Care Medicine
Florian Eyer, Thomas Zilker
Caustic injuries of the eye usually occur accidentally and can result in minor eye irritations to total loss of vision. All chemical exposures to the eye require immediate decontamination by copious irrigation with an aqueous solution for at least 15-30 minutes up to two hours in single cases of massive exposure. Tap water is readily available, safe, and effective and, thus, the preferred irrigation fluid. Warmed lactated Ringer's solution is theoretically preferable to normal saline as an ocular irrigant because it has a more physiologic pH and osmolarity...
May 2009: Therapeutische Umschau. Revue Thérapeutique
K-W Cheng, C-L Chen, C-S Wang, C-J Huang, K-H Chen, C-C Wang, A M Concejero, Y-F Cheng, T-L Huang, K-W Chiu, S-H Wang, C-C Lin, Y-W Liu, B Jawan
We describe the anesthetic management in a 56-year old man with hepatocellular carcinoma and cirrhosis who underwent liver transplantation (LT). Pretransplantation workup showed a 3-cm wide by 10-cm long infrarenal abdominal aortic aneurysm (AAA) with chronic dissection. He subsequently underwent living donor LT. The total operative time was 12 hours. The systolic blood pressure was maintained at normal levels. Severe hypertension was not noted. Hypotension noted during the anhepatic phase was managed with increased volume infusion and small doses (0...
October 2008: Transplantation Proceedings
Sreeram Subramanian, Ramesh Agarwal, Ashok K Deorari, Vinod K Paul, Arvind Bagga
Acute renal failure (ARF) is a common condition seen in neonatal intensive care units. It is broadly classified into prerenal, intrinsic renal and post renal failure. There is no consensus on the definition of neonatal ARF. Of utmost importance is to differentiate prerenal from intrinsic renal failure. The most common causes of neonatal ARF are hypovolemia, hypotension and, hypoxia. Among several indices that are available for differentiating prerenal failure from intrinsic renal failure, fractional excretion of sodium is the preferred index...
April 2008: Indian Journal of Pediatrics
Vishal Jatana, Jonathan Gillis, Boyd H Webster, Lesley C Adès
OBJECTIVE: To report on the experience of a pediatric intensive care unit (PICU) with patients with deletion 22q11.2 syndrome: 1) to delineate the clinical characteristics and management of these patients; 2) to assess whether these patients were managed appropriately, especially in terms of blood transfusion; and 3) to make recommendations for PICU management. DESIGN: Retrospective assessment of medical records of patients with fluorescent in situ hybridization-proven 22q11 deletion admitted to the PICU at the Children's Hospital at Westmead, Sydney...
September 2007: Pediatric Critical Care Medicine
Jennifer E Bevacqua
Diabetic ketoacidosis (DKA), a pathophysiologic, life-threatening process that results from uncontrolled diabetes mellitus-induced hyperglycemia, is seen frequently in the pediatric ICU. This article reviews the pathophysiology, management, goals of treatment, and nursing implications of the child who is diagnosed with DKA. Facets particular to the pediatric population are reviewed.
December 2005: Critical Care Nursing Clinics of North America
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