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Maroua Eid, Olivier Fouquet, Cédric Darreau, Marc Pierrot, Achille Kouatchet, Alain Mercat, Christophe Baufreton
INTRODUCTION: Necrotizing fasciitis represents a life-threatening infectious condition that causes spreading necrotisis of superficial fascia and subcutaneous cellular tissues. We describe the case of a patient diagnosed with septic and toxic shocks leading to multiple organ failure successfully treated with a combination of extracorporeal life support, continuous renal replacement therapy, and a hemoadsorption device. METHODS: A 41-year-old patient presented with necrotizing fasciitis and multi-organ failure...
March 2018: International Journal of Artificial Organs
Cathy Liu, Jade Lodge, Christopher Flatley, Alexander Gooi, Cameron Ward, Karen Eagleson, Sailesh Kumar
OBJECTIVE: To determine obstetric, intrapartum and perinatal outcomes for pregnancies with isolated fetal congenital heart defects (CHD). METHODS: This was a retrospective cohort study of women that delivered an infant with an isolated major CHD between January 2010 and April 2017 at a major Australian perinatal centre. The study cohort was compared with a cohort of women with infants without CHD. Cardiac abnormalities were broadly subdivided into the following five categories using the International Classification of Diseases Tenth Revision (ICD-10) as a guide - transposition of the great arteries (TGA), septal defects, right heart lesions (RHL), left heart lesions (LHL) and "other"...
March 16, 2018: Journal of Maternal-fetal & Neonatal Medicine
Christina Schumann, Michael Faust
BACKGROUND:  Diabetic ketoacidosis and the hyperosmolar hyperglycemic state are the most serious diabetic emergencies. Before the discovery of insulin in 1921 by Banting and Best the diagnosis of type 1 diabetes was fatal ending in diabetic ketoacidosis equivalent to a torturous death. Today, mortality from diabetic ketoacidosis is low at approximately 2 %. But each death from these two acute metabolic complications of diabetes is potentially avoidable by improved patient and healthcare professional education...
March 2018: Deutsche Medizinische Wochenschrift
Frédéric J Baud, Mohamad K Haidar, Romain Jouffroy, Jean-Herlé Raphalen, Lionel Lamhaut, Pierre Carli
OBJECTIVES: To investigate the magnitude of lactic acidosis in response to cyanide poisoning compared with the secondary response caused by cardiovascular shock. DESIGN: Retrospective case-control observational study. SETTING: University Hospital of Assistance Publique - Hôpitaux de Paris. SUBJECTS: Patients admitted for suspicion of cyanide poisoning or drug overdose. Medical charts provided by Assistance Publique - Hôpitaux de Paris of patients between January 1988 and December 2015...
March 14, 2018: Critical Care Medicine
Matthew C Hernandez, Brandon R Bruns, Nadeem Haddad, Margaret Lauerman, David S Morris, Kristen Arnold, Herb A Phelan, David Turay, Jason Murry, John S Oh, Toby Enniss, Matthew M Carrick, Thomas M Scalea, Martin Zielinski
INTRODUCTION: Threatened, perforated, and infarcted bowel is managed with conventional resection and anastomosis (hand sewn (HS) or stapled (ST)). The SHAPES analysis demonstrated equivalence between HS and ST techniques, yet surgeons appeared to prefer (HS) for the critically ill. We hypothesized that HS is more frequent in patients with higher disease severity as measured by the AAST EGS grading system. METHODS: We performed a post hoc analysis of the SHAPES database...
March 12, 2018: Journal of Trauma and Acute Care Surgery
Jeremy Brice Bitton, Josh Jiaxing Wang, Winnie Teng, Eric Villeneuve, Sophie Gosselin
No abstract text is available yet for this article.
March 14, 2018: Clinical Toxicology
David H Jang, Utsha G Khatri, Anita Mudan, Jennifer S Love, Shawn Owiredu, David M Eckmann
It is conservatively estimated that 5,000 deaths per year and 20,000 injuries in the USA are due to poisonings caused by chemical exposures (e.g., carbon monoxide, cyanide, hydrogen sulfide, phosphides) that are cellular inhibitors. These chemical agents result in mitochondrial inhibition resulting in cardiac arrest and/or shock. These cellular inhibitors have multi-organ effects, but cardiovascular collapse is the primary cause of death marked by hypotension, lactic acidosis, and cardiac arrest. The mitochondria play a central role in cellular metabolism where oxygen consumption through the electron transport system is tightly coupled to ATP production and regulated by metabolic demands...
March 13, 2018: Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology
Helen M Golder, Jennifer M Thomson, Stuart E Denman, Chris S McSweeney, Ian J Lean
Dairy heifers were subjected to a non-life-threatening challenge designed to induce ruminal acidosis by feeding grain and sugar. Large among animal variation in clinical signs of acidosis, rumen metabolite concentrations, and the rumen microbiome occurred. This exploratory study investigates sources of the variation by examining associations between the genome, metabolome, and microbiome, albeit with a limited population. The broader objective is to provide a rationale for a larger field study to identify markers for susceptibility to ruminal acidosis...
2018: Frontiers in Genetics
Angela L Chiew, Daniel F B Wright, Nicola M Dobos, Kylie McArdle, Ahmed A Mostafa, Annemarie Newth, Michael S Roberts, Geoffrey K Isbister
Massive metformin overdose can cause metabolic acidosis with hyperlactatemia. A 55-year-old female presented 5h post multi-drug overdose, including 132 g extended-release metformin. Continuous venovenous haemodiafiltration (CVVHDF) and noradrenaline were commenced due to metabolic acidosis (pH 7.0, lactate 17 mmol/L) and shock. Despite 3 hours of CVVHDF, her acidosis worsened (pH 6.83, lactate 24 mmol/L). Intermittent haemodialysis(IHD) improved acidosis (pH 7.13, lactate 26 mmol/l), but again worsened (pH 6...
March 13, 2018: British Journal of Clinical Pharmacology
Paul Mel van Dam, Mark Wl van Geffen, Thomas Ra Havenith, Dirk Posthouwer
Triumeq is a single-tablet regimen for patients with HIV infection comprising dolutegravir, abacavir and lamivudine. Overdoses with Triumeq have not been reported previously. We present a case of a 26-year-old man who presented to our hospital after intentionally ingesting 30 tablets of Triumeq. An intoxication with Triumeq can lead to several side effects. An overdose of abacavir and lamivudine can cause mitochondrial toxicity and lactic acidosis. An intoxication with dolutegravir appears to be relatively harmless...
March 13, 2018: Antiviral Therapy
Patricia G Rosenstein, Brett S Tennent-Brown, Dez Hughes
OBJECTIVE: To review the current literature with respect to the physiology, pathophysiology, and measurement of lactate. DATA SOURCES: Data were sourced from veterinary and human clinical trials, retrospective studies, experimental studies, and review articles. Articles were retrieved without date restrictions and were sourced primarily via PubMed, Scopus, and CAB Abstracts as well as by manual selection. HUMAN AND VETERINARY DATA SYNTHESIS: Lactate is an important energy storage molecule, the production of which preserves cellular energy production and mitigates the acidosis from ATP hydrolysis...
March 2018: Journal of Veterinary Emergency and Critical Care
Michael J Brazeau, Caroline A Bolduc, Brian L Delmonaco, Azfar S Syed
We present the case of a patient with new-onset diabetes, severe acidosis, hypothermia, and shock who presented to a Role 1 Battalion Aid Station (BAS) in Afghanistan. The case is unique because the patient made a rapid and full recovery without needing hemodialysis. We review the literature to explain how such a rapid recovery is possible and propose that hypothermia in the setting of his severe acidosis was protective.
2018: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
S Höstman, R Kawati, G Perchiazzi, A Larsson
BACKGROUND: In a previous study, we found a rebound of arterial carbon dioxide tension (PaCO2 ) after stopping THAM buffer administration. We hypothesized that this was due to reduced pulmonary CO2 elimination during THAM administration. The aim of this study was to investigate this hypothesis in an experimental porcine hypercapnic model. METHODS: In seven, initially normoventilated, anesthetized pigs (22-27 kg) minute ventilation was reduced by 66% for 7 h. Two hours after commencing hypoventilation, THAM was infused IV for 3 h in a dose targeting a pH of 7...
March 12, 2018: Acta Anaesthesiologica Scandinavica
Zahra Laleh Eslamian, Elahe Zarean, Maryam Moshfeghi, Zahra Heidari
Background: Early prediction of adverse neonatal outcome would be possible by Doppler impedance indices of middle cerebral artery (MCA), umbilical artery (UmA), and descending aortal artery (AO) that result in decrease neonatal morbidity and mortality rate. The aim of the present study was a determination of optimal value for the ratio of MCA to descending aorta blood flow (MCA/AO) impedance indices and its comparison with the ratio of MCA to UmA (MCA/UmA) impedance indices and their relationship with neonatal outcome...
2018: Journal of Research in Medical Sciences: the Official Journal of Isfahan University of Medical Sciences
Shalendra Singh, Ankur Khandelwal, Rashmi Datta, Ashutosh Kaushal, Gyaninder Pal Singh
High-dose continuous midazolam therapy has been used successfully for control of refractory status epilepticus. However, normal anion gap (AG) metabolic acidosis, a deleterious complication of this therapy is underrecognized. Even though previously reported in an isolated case report in a pediatric patient, we observed similar complication in an adult patient. Stereotyped normal AG metabolic acidosis along with hypotension developed on two occasions during high-dose continuous midazolam hydrochloride infusion that reverted rapidly following cessation of the infusion...
February 2018: Indian Journal of Critical Care Medicine
Md Fazlur Rahman, Radhika Raj, Rajgopal Govindarajan
Combination antiretroviral drug treatments depend on 3'-deoxy-nucleoside analogs such as AZT (3'-azido-3'-deoxythymidine) and DDI (2'3'-dideoxyinosine). Despite being effective in inhibiting HIV viral replication, these drugs produce a range of toxicities, including myopathy, pancreatitis, neuropathy and lactic acidosis, that are generally considered as sequelae to mitochondrial damage. While the cell surface localized nucleoside transporters (e.g., human equilibrative nucleoside transporter 2 (hENT2), human concentrative nucleoside transporter 1 (hCNT1)) are known to increase the carrier mediated uptake of 3'-deoxy-nucleoside analogs into cells, another ubiquitously expressed intracellular nucleoside transporter, namely, hENT3, has been implicated in the mitochondrial transport of 3'-deoxy-nucleoside analogs...
March 12, 2018: Drug Metabolism and Disposition: the Biological Fate of Chemicals
Anıl Er, Aykut Çağlar, Fatma Akgül, Emel Ulusoy, Hale Çitlenbik, Durgül Yılmaz, Murat Duman
AIM: High-flow nasal cannula (HFNC) is a new treatment option for pediatric respiratory distress and we aimed to assess early predictive factors of unresponsiveness to HFNC therapy in a pediatric emergency department (ED). METHOD: Patients who presented with respiratory distress and were treated by HFNC, were included. The age, gender, weight, medical history, diagnosis, vital signs, oxygen saturation/fraction of inspired oxygen (SpO2 /FiO2 ) ratio, modified Respiratory Distress Assessment Instrument (mRDAI) scores, medical interventions, duration of HFNC therapy, time to escalation, adverse effects, and laboratory test results were obtained from medical and nursing records...
March 12, 2018: Pediatric Pulmonology
Paola Algeri, Clelia Callegari, Davide Paolo Bernasconi, Maddalena Incerti, Sabrina Cozzolino, Giuseppe Paterlini, Salvatore Andrea Mastrolia, Francesca Pellizzoni, Patrizia Vergani
OBJECTIVE: Optimal management of twin deliveries is controversial. We aimed to assess potential risk factors correlated to the development of hypoxia in the second twin after vaginal delivery of the first twin. STUDY DESIGN: This is a retrospective observational study including diamniotic twin pregnancies delivering at our Institution at 35 weeks of gestational age or more, weighing ≥ 1800 g. Hypoxia was defined as at least one of the following: Apgar score < 5 at 10', neonatal resuscitation for > 10 minutes, neonatal acidosis (pH ≤ 7 and/or BE ≥ 12 mmol/L)...
March 11, 2018: Journal of Maternal-fetal & Neonatal Medicine
Gianluca Vergine, Elena Fabbri, Annalisa Pedini, Silvana Tedeschi, Niccolò Borsa
Bartter syndrome (BS) type 1 (OMIM #601678) is a hereditary salt-losing renal tubular disorder characterized by hypokalemic metabolic alkalosis, hypercalciuria, nephrocalcinosis, polyuria, recurrent vomiting, and growth retardation. It is caused by loss-of-function mutations of the SLC12A1 gene, encoding the furosemide-sensitive Na-K-Cl cotransporter. Recently, a phenotypic variability has been observed in patients with genetically determined BS, including absence of nephrocalcinosis, hypokalemia, and/or metabolic alkalosis in the first year of life as well as persistent metabolic acidosis mimicking distal renal tubular acidosis...
2018: Case Reports in Pediatrics
A S Sagar, Carlos A Jimenez, Brandy J Mckelvy
Ethylene glycol toxicity is a known cause of anion gap metabolic acidosis, with the presence of an osmolar gap and the right clinical context suggesting to the diagnosis. Rapid recognition and early treatment is crucial. Unfortunately, ethylene glycol levels are not readily available and must be performed at a reference laboratory. We present a case where recognising the significance of the 'lactate gap' assisted in identifying ethylene glycol poisoning.
March 9, 2018: BMJ Case Reports
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