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acidosis guidelines

P Fabbrini, K Finkel, M Gallieni, G Capasso, M Cavo, A Santoro, S Pasquali
Acute kidney injury (AKI) is a frequent complication of multiple myeloma and is associated with increased short-term mortality. Additionally, even a single episode of AKI can eventually lead to end-stage renal disease (ESRD), significantly reducing quality of life and long-term survival. In the setting of multiple myeloma, severe AKI (requiring dialysis) is typically secondary to cast nephropathy (CN). Renal injury in CN is due to intratubular obstruction from precipitation of monoclonal serum free light chains (sFLC) as well as direct tubular toxicity of sFLC via stimulation of nuclear factor (NF)κB inflammatory pathways...
October 18, 2016: Journal of Nephrology
Michael J Murray, Heidi DeBlock, Brian Erstad, Anthony Gray, Judi Jacobi, Che Jordan, William McGee, Claire McManus, Maureen Meade, Sean Nix, Andrew Patterson, M Karen Sands, Richard Pino, Ann Tescher, Richard Arbour, Bram Rochwerg, Catherine Friederich Murray, Sangeeta Mehta
OBJECTIVE: To update the 2002 version of "Clinical practice guidelines for sustained neuromuscular blockade in the adult critically ill patient." DESIGN: A Task Force comprising 17 members of the Society of Critical Medicine with particular expertise in the use of neuromuscular-blocking agents; a Grading of Recommendations Assessment, Development, and Evaluation expert; and a medical writer met via teleconference and three face-to-face meetings and communicated via e-mail to examine the evidence and develop these practice guidelines...
November 2016: Critical Care Medicine
Arun Sankaralingam, Annette Thomas, David James, Anthony S Wierzbicki
BACKGROUND: Ethylene glycol (EG) poisoning remains a rare but important presentation to acute toxicology units. Guidelines recommended that Ethylene Glycol should be available as an 'urgent' test within 4 hours but these are difficult to deliver in practice. This study assessed a semi-quantitative enzymatic spectrophotometric assay for EG compatible with automated platforms. METHODS: The EG method was assessed in 21 samples from patients with an increased anion gap and metabolic acidosis not due to EG ingestion, and 7 samples known to contain EG...
September 28, 2016: Annals of Clinical Biochemistry
Nicholas Carlson, Kristine Hommel, Jonas B Olesen, Thomas A Gerds, Anne-Merete Soja, Tina Vilsbøll, Anne-Lise Kamper, Christian Torp-Pedersen, Gunnar Gislason
Recent guidelines governing anti-diabetic medications increasingly advocate metformin as first-line therapy in all patients with type 2 diabetes. However, metformin could be associated with increased risk of acute kidney injury (AKI), acute dialysis and lactate acidosis in marginal patients. In a retrospective nationwide cohort study, a total of 168 443 drug-naïve patients with type 2 diabetes ≥50 years, initiating treatment with either metformin or sulphonyl in Denmark between 2000 and 2012 were included in this study (70...
August 18, 2016: Diabetes, Obesity & Metabolism
Varsha Thakur, Nadia Munk, Luc Mertens, Lynne E Nield
OBJECTIVE: Hypoplastic left heart syndrome is frequently diagnosed prenatally with variable benefit. We performed a systematic review to evaluate the impact of fetal diagnosis; the primary objective was to evaluate impact on mortality. METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Seven databases were searched. Meta-analysis was performed using a random effects model to evaluate the effect of fetal diagnosis on mortality...
September 2016: Prenatal Diagnosis
Concetto Sessa, Julien Blanco, Antonio Granata, Pasquale Fatuzzo, Pietro Castellino, Luca Zanoli
Metformin is the first choice among drugs used for the treatment of type II diabetes mellitus mainly because of several advantages: proven hypoglycemic effect, good safety profile, virtually no risk of hypoglycemia, body weight reduction, lipid-lowering effect, efficacy in preventing micro- and macrovascular complications as well as adverse cardiac and cerebrovascular events and reduced cost. Previous reports had shown an increased risk of lactic acidosis in patients receiving metformin. However, the current Guidelines have greatly limited this risk to certain categories of patients, such as those with severe chronic renal failure, particularly when predisposing risk factors such as administration of iodinated contrast are present...
May 2016: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
Walter Spindelboeck, Geza Gemes, Christa Strasser, Kathrin Toescher, Barbara Kores, Philipp Metnitz, Josef Haas, Gerhard Prause
PURPOSE: An arterial blood gas analysis (ABG) yields important diagnostic information in the management of cardiac arrest. This study evaluated ABG samples obtained during out-of-hospital cardiopulmonary resuscitation (OHCPR) in the setting of a prospective multicenter trial. We aimed to clarify prospectively the ABG characteristics during OHCPR, potential prognostic parameters and the ABG dynamics after return of spontaneous circulation (ROSC). METHODS: ABG samples were collected and instantly processed either under ongoing OHCPR performed according to current advanced life support guidelines or immediately after ROSC and data ware entered into a case report form along with standard CPR parameters...
September 2016: Resuscitation
Ravindra L Mehta
No abstract text is available yet for this article.
July 14, 2016: New England Journal of Medicine
Gianluca Costa, Paolo Ruscelli, Genoveffa Balducci, Francesco Buccoliero, Laura Lorenzon, Barbara Frezza, Piero Chirletti, Franco Stagnitti, Stefano Miniello, Francesco Stella
BACKGROUND: Intestinal obstructions/pseudo-obstruction of the small/large bowel are frequent conditions but their management could be challenging. Moreover, a general agreement in this field is currently lacking, thus SICUT Society designed a consensus study aimed to define their optimal workout. METHODS: The Delphi methodology was used to reach consensus among 47 Italian surgical experts in two study rounds. Consensus was defined as an agreement of 75.0% or greater...
2016: Annali Italiani di Chirurgia
Ryan Perlman, Jeannie Callum, Claude Laflamme, Homer Tien, Barto Nascimento, Andrew Beckett, Asim Alam
Hypothermia is present in up to two-thirds of patients with severe injury, although it is often disregarded during the initial resuscitation. Studies have revealed that hypothermia is associated with mortality in a large percentage of trauma cases when the patient's temperature is below 32 °C. Risk factors include the severity of injury, wet clothing, low transport unit temperature, use of anesthesia, and prolonged surgery. Fortunately, associated coagulation disorders have been shown to completely resolve with aggressive warming...
2016: Critical Care: the Official Journal of the Critical Care Forum
Tali Silberstein, Eyal Sheiner, Shimrit Yaniv Salem, Batel Hamou, Barak Aricha, Yael Baumfeld, Zehava Yohay, Debora Elharar, Inbal Idan, David Yohay
OBJECTIVE: To determine whether fetal heart rate (FHR) monitoring categories during the 1st and 2nd stage of labor can predict arterial cord pH <7.2. MATERIALS AND METHODS: A case control study was conducted including 653 consecutive term deliveries (37 weeks gestation and above) that were divided according to fetal pH ≤ 7.2 (n = 315) and fetal pH > 7.2 (n = 338). Deliveries occurred during the year 2013 in tertiary medical center, where arterial cord pH is routinely taken after birth...
June 13, 2016: Journal of Maternal-fetal & Neonatal Medicine
Dimitrios Velissaris, Vassilios Karamouzos, Charalampos Pierrakos, Ioanna Koniari, Christina Apostolopoulou, Menelaos Karanikolas
The aim of the review was to summarize the literature over the last 25 years regarding bicarbonate administration in out-of-hospital cardiac arrest. A PubMed search was conducted using the terms "bicarbonates" and "cardiac arrest", limited to human studies and reviews published in English (or at least with a meaningful abstract in English) in the last 25 years. Clinical and experimental data raised questions regarding the safety and effectiveness of sodium bicarbonate (SB) administration during cardiac arrest...
April 2016: Journal of Clinical Medicine Research
Shane A Smith, Michael H Livingston, Neil H Merritt
BACKGROUND: Severely injured pediatric trauma patients often present to hospital with early coagulopathy and metabolic acidosis. These derangements are associated with poor outcomes, but it is unclear to what degree they predict transfusion of packed red blood cells (pRBC). METHODS: We retrospectively identified pediatric trauma patients from a level 1 trauma center from 2006 to 2013. Inclusion criteria were age less than 18years, Injury Severity Score greater than 12, and pRBC transfusion within 24h of admission...
May 2016: Journal of Pediatric Surgery
François R Jornayvaz
The year 2015 was punctuated by numerous events in diabetology. First, the ADA/EASD guidelines have been updated. The pharmacological panel for type 2 diabetes treatment saw the arrival of different new molecules. Two new basal insulins were also approved. Also, cardiovascular safety trials have been published regarding recent antidiabetic drugs. A new insulin pump than can be coupled with a glucosensor was released. Finally, a new unexpected complication of SGLT2 inhibitors treatment was reported, the euglycemic keto-acidosis...
January 13, 2016: Revue Médicale Suisse
Michael Heesen, Markus Klimek
PURPOSE OF REVIEW: Nonobstetric anesthesia during pregnancy is challenging - not only for the anesthetist. Owing to the difficulties of ethical consent for randomized studies in this special patient group, the available evidence is quite low. Nevertheless, recently several guidelines for the management of pregnant patients undergoing nonobstetric anesthesia have been published. We review the current guidelines developed under the auspices of the Society of American Gastrointestinal Endoscopic Surgeons, guidelines for the management of difficult and failed tracheal intubation in obstetrics, as well as guidelines for the management of a pregnant trauma patient...
June 2016: Current Opinion in Anaesthesiology
Simon Ross Deveau
Blood loss due to trauma is a leading cause of death in young people and is the result of the 'lethal triad' of hypothermia, acidosis and coagulopathy, which collectively reduce haemostasis. Emergency department nurses can help to reverse the triad through the timely and efficient use of blood products and fluids. This article briefly examines different blood groups, describes the elements of the lethal triad, and discusses the blood products used to transfuse patients with major haemorrhage.
February 2016: Emergency Nurse: the Journal of the RCN Accident and Emergency Nursing Association
M Maegele
Trauma is a leading cause of death, with uncontrolled hemorrhage and exsanguination being the primary causes of preventable deaths during the first 24 h following trauma. Death usually occurs quickly, typically within the first 6 h after injury. One out of four patients arriving at the Emergency Department after trauma is already in hemodynamic and hemostatic depletion. This early manifestation of hemostatic depletion is referred to as the coagulopathy of trauma, which may distinguished as: (i) acute traumatic coagulopathy (ATC) and (ii) iatrogenic coagulopathy (IC)...
April 2014: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Kristofer J Spurling, Ian K Moonsie, Joseph L Perks
BACKGROUND: Patients with respiratory disease are at risk of excessive hypoxemia in the hypobaric commercial aircraft cabin environment, and the consensus is that this is easily corrected with supplementary oxygen. However, despite the risks of hypercapnia with increasing inspired oxygen in some patients being well established, this issue is not currently addressed in medical guidelines for air travel. CASE REPORT: A 76-yr-old woman with chronic type 2 respiratory failure underwent hypoxic challenge testing (HCT) to assess in-flight oxygen requirements...
February 2016: Aerospace Medicine and Human Performance
Willem Daniel Francois Venter, Lee Fairlie, Charles Feldman, Peter Cleaton-Jones, Matthew Chersich
South African doctors (n = 211) experienced in antiretroviral therapy use were asked via an online questionnaire about the WHO 2013 adult antiretroviral integrated guidelines, as well as clinical and personal issues, in three hypothetical scenarios: directing the Minister of Health, advising a family member requiring therapy amidst unstable antiretroviral supplies, and where doctors themselves were HIV-positive. Doctors (54%) favoured the 500 cells/μl WHO initiation threshold if advising the Minister; a third recommended retaining the 350 cells/μl threshold used at the time of the survey...
2016: PloS One
Min-Jeong Lee, Seirhan Kim, Inwhee Park, Heungsoo Kim, Gyu-Tae Shin
BACKGROUND: Estimated glomerular filtration rate (eGFR) is one of the most important guidelines in deciding the optimal timing of dialysis initiation. In the present study, we calculated the eGFR at the time of hemodialysis (HD) initiation using 5 commonly used equations to relate them with clinical and laboratory characteristics of the patients and to evaluate which of these equations best define the eGFR at HD initiation. METHODS: We retrospectively analyzed 409 end-stage renal disease patients who were newly started on HD treatment in our institution...
December 2015: Kidney Research and Clinical Practice
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