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Elina Varis, Ville Pettilä, Meri Poukkanen, Stephan M Jakob, Sari Karlsson, Anders Perner, Jukka Takala, Erika Wilkman
Hyperlactatemia predicts mortality in patients with sepsis and septic shock, and its normalization is a potential treatment goal. We investigated the association of blood lactate and its changes over time with 90-day mortality in septic shock. We performed a post hoc analysis of 513 septic shock patients with admission blood lactate measurements in the prospective, observational, multicenter FINNAKI study. Repetitive lactate measurements were available in 496 patients for analyses of change in lactate values during ICU stay...
October 17, 2016: Shock
Julie C Fitzgerald, Scott L Weiss, Niranjan Kissoon
OBJECTIVE: To review important articles in the field of pediatric shock and pediatric septic shock published subsequent to the Fifth Edition of the Rogers' Textbook of Pediatric Intensive Care. DATA SOURCES: The U.S. National Library of Medicine PubMed ( was searched for combination of the term "pediatric" and the following terms: "sepsis, septic shock, shock, antibiotics, extracorporeal membrane oxygenation, and steroid." The abstract lists generated by these searches were screened for potential inclusion...
September 30, 2016: Pediatric Critical Care Medicine
T Mahévas, D Gobert, M Gatfossé, A Mekinian, O Fain
INTRODUCTION: Hepatic glycogenosis is a rare syndrome, which includes poorly controlled diabetes mellitus, hepatomegaly, delayed puberty, and growth delay. Insulin edema is sometimes associated. CASE REPORT: An 18-year-old woman presented with diffuse edema, hepatomegaly, amenorrhea, uncontrolled diabetes, and elevated transaminases and cholestasis. Hepatic ultrasonography and abdominal computed tomographic scan confirmed the hepatomegaly. The liver biopsy showed a massive glycogenosis and the diagnosis of hepatic glycogenosis was confirmed...
October 13, 2016: La Revue de Médecine Interne
Rakesh Naik, Gladdy George, Sathappan Karuppiah, Madhu Andrew Philip
OBJECTIVES OF THE STUDY: To identify the factors causing high lactate levels in patients undergoing cardiac surgery under cardiopulmonary bypass (CPB) and to assess the association between high blood lactate levels and postoperative morbidity and mortality. METHODS: A retrospective observational study including 370 patients who underwent cardiac surgeries under cardiopulmonary bypass. The patients were divided into 2 groups based on serum lactate levels; those with serum lactate levels greater than or equal to 4 mmol/L considered as hyperlactatemia and those with serum lactate levels less than 4 mmol/L...
October 2016: Annals of Cardiac Anaesthesia
Kirsten S Deemer, George F Alvarez
Mauriac syndrome is a rare disorder that can present with the single feature of glycogenic hepatopathy in children and adults with poorly controlled diabetes mellitus. An often underrecognized finding of glycogenic hepatopathy is lactic acidosis and hyperlactatemia. Primary treatment of glycogenic hepatopathy is improved long-term blood glucose control. Resolution of symptoms and hepatomegaly will occur with improvement in hemoglobin A1C. We present here a case of a young adult female presenting to the intensive care unit with Mauriac syndrome...
2016: Case Reports in Critical Care
Sumeshni Birbal, Mukesh Dheda, Elizabeth Ojewole, Frasia Oosthuizen
South Africa has one of the highest prevalences of HIV and AIDS in the world. HIV/AIDS patients face countless challenges, one of which is the risk of adverse drug reactions (ADRs). This study aimed to describe the ADRs reported in South Africa with reference to the type of ADRs, antiretrovirals (ARVs) implicated, seriousness of the ADRs and patient demographics associated with specific ADRs. A retrospective quantitative study was carried out using ADR reports submitted to the National Department of Health (NDoH) from 1 January 2010 to 31 December 2014...
September 2016: African Journal of AIDS Research: AJAR
João Manoel Silva, Amanda Maria Ribas Rosa de Oliveira, Fernando Augusto Mendes Nogueira, Pedro M M Vianna, Cristina Prata Amendola, Maria José Carvalho Carmona, Luiz M Sá Malbouisson
BACKGROUND: Metabolic acidosis frequently is present in surgical patients; however, different types of metabolic acidosis (hyperlactatemia, hyperchloremia, and others) may have different relationships to perioperative outcomes. We hypothesized that in postoperative surgical patients, distinctive types of metabolic acidosis would correlate differently with the outcomes of high-risk surgeries. METHODS: A prospective, multicenter observational study was performed in 3 different tertiary care hospitals...
September 16, 2016: Anesthesia and Analgesia
Avraham Zeharia, Jonathan R Friedman, Ana Tobar, Ann Saada, Osnat Konen, Yacov Fellig, Avraham Shaag, Jodi Nunnari, Orly Elpeleg
The mitochondrial inner membrane possesses distinct subdomains including cristae, which are lamellar structures invaginated into the mitochondrial matrix and contain the respiratory complexes. Generation of inner membrane domains requires the complex interplay between the respiratory complexes, mitochondrial lipids and the recently identified mitochondrial contact site and cristae organizing system (MICOS) complex. Proper organization of the mitochondrial inner membrane has recently been shown to be important for respiratory function in yeast...
August 3, 2016: European Journal of Human Genetics: EJHG
Ville Pettilä, Tobias Merz, Erika Wilkman, Anders Perner, Sari Karlsson, Theis Lange, Johanna Hästbacka, Peter Buhl Hjortrup, Anne Kuitunen, Stephan M Jakob, Jukka Takala
BACKGROUND: Septic shock has a 90-day mortality risk of up to 50 %. The hemodynamic targets, including mean arterial pressure (MAP) are not based on robust clinical data. Both severe hypotension and high doses of vasopressors may be harmful. Hence, re-evaluation of hemodynamic targets in septic shock is relevant. METHODS/DESIGN: The targeted tissue perfusion versus macrocirculation-guided standard care in patients with septic shock (TARTARE-2S) trial is a prospective, two-parallel-group, randomized, open-label, multicenter trial with assessor-blinded outcome evaluation...
2016: Trials
Glenn Hernández, Pablo Tapia, Leyla Alegría, Dagoberto Soto, Cecilia Luengo, Jussara Gomez, Nicolas Jarufe, Pablo Achurra, Rolando Rebolledo, Alejandro Bruhn, Ricardo Castro, Eduardo Kattan, Gustavo Ospina-Tascón, Jan Bakker
BACKGROUND: Persistent hyperlactatemia during septic shock is multifactorial. Hypoperfusion-related anaerobic production and adrenergic-driven aerobic generation together with impaired lactate clearance have been implicated. An excessive adrenergic response could contribute to persistent hyperlactatemia and adrenergic modulation might be beneficial. We assessed the effects of dexmedetomidine and esmolol on hemodynamics, lactate generation, and exogenous lactate clearance during endotoxin-induced septic shock...
August 2, 2016: Critical Care: the Official Journal of the Critical Care Forum
Chandra S Pundir, Vinay Narwal, Bhawna Batra
Lactic acid (2-Hydroxypropanoic acid) is generated from pyruvic acid under anaerobic condition in skeletal muscles, brain, red blood cells, and kidney. Lactate in normal human subjects get cleared very quickly at a rate of 320mmol/L/hr, mostly by liver metabolism and re-conversion of lactate back to pyruvate. Measurement of lactate level in serum is required for the differential diagnosis and medical management of hyperlactatemia, cardiac arrest and resuscitation, sepsis, reduced renal excretion, hypoxia induced cancer, decreased extra hepatic metabolism, intestinal infarction and lactic acidosis...
December 15, 2016: Biosensors & Bioelectronics
Jess W Brallier, Pavan J Dalal, Patrick J McCormick, Hung-Mo Lin, Stacie G Deiner
BACKGROUND: Hundreds of thousands of craniotomies are performed annually in the United States. During craniotomy, elevated serum lactate is a concerning and not infrequent occurrence. Elevated intraoperative serum lactate may occur as a result of global hypoperfusion or localized intracerebral ischemia from surgical retraction or inadequate blood supply. The distinction between systemic and hypoperfusion confined to the brain is important because the treatment differs. For example, fluid resuscitation may be indicated in the former but not the latter...
July 19, 2016: Journal of Neurosurgical Anesthesiology
Stéphanie Ruiz, Fanny Vardon-Bounes, Virginie Merlet-Dupuy, Jean-Marie Conil, Marie Buléon, Olivier Fourcade, Ivan Tack, Vincent Minville
BACKGROUND: The cecal ligation and puncture (CLP) model, a gold standard in sepsis research, is associated with an important variability in mortality. While the number of punctures and needle size is well described in CLP animal studies, the length of cecal ligation is often not. The relationship between cecal ligation and survival in mice is briefly reported in the literature; therefore, we devised an investigation in mice of the consequences of three standardized cecal ligation lengths on mortality and the severity of the ensued sepsis...
December 2016: Intensive Care Medicine Experimental
Ying-Hsuan Tai, Kuang-Yi Chang, Shu-Wei Liao, Kwei-Chun Chung, Chun-Che Shih, Shung-Tai Ho, Chih-Cherng Lu, Mei-Yung Tsou
PURPOSE: The aim of the study was to evaluate the effects of high-dose nitroglycerine (NTG) on glucose metabolism, tissue oxygenation and postoperative recovery in cardiac surgical patients. METHODS: Cardiac surgical patients in the retrospective survey were classified into two groups based on the NTG regimen. NTG group had intravenous loading of NTG (infusion rate 10-20 mg/h with total dose of ≥0.5 mg/kg) starting at rewarming of cardiopulmonary bypass (CPB) (n = 101), and control group had no intravenous loading of NTG (n = 151)...
October 2016: Journal of Anesthesia
Lesleigh A Redavid, Claire R Sharp, Mark A Mitchell, Nicole F Beckel
OBJECTIVES: To document the incidence of hyperlactatemia in sick cats hospitalized for emergency care and to evaluate the prognostic utility of serial lactate measurements in cats with hyperlactatemia. DESIGN: Prospective observational study over a 10-month period (July 2010-May 2011). SETTING: Private veterinary referral center with 24-hour hospital care. ANIMALS: One hundred and twenty-three privately owned cats admitted to a private referral center...
July 2016: Journal of Veterinary Emergency and Critical Care
Kaustubh Suresh Chaudhari, Sahil Prashant Uttarwar, Nikhil Narayan Tambe, Rohan S Sharma, Anant Arunrao Takalkar
INTRODUCTION: There is no comprehensive data or studies relating to clinical presentation and prognosis of cerebral malaria (CM) in the tribal settlements of Assam. High rates of transmission and deaths from complicated malaria guided us to conduct a prospective observational cohort study to evaluate the factors associated with poor outcome and prognosis in patients of CM. MATERIALS AND METHODS: We admitted 112 patients to the Bandarpara and Damodarpur Tribal Health Centers (THCs) between 2011 and 2013 with a strict diagnosis of CM...
April 2016: Journal of Global Infectious Diseases
S Park, J Huh
No abstract text is available yet for this article.
December 2015: Intensive Care Medicine Experimental
Filippo Sanfilippo, Federica Chiarenza, Cesare Cassisi, Cristina Santonocito, Theodoros Tsoutsouras, Marialena Trivella, Stephen Gerry, Marinella Astuto, Shane George, David P Taggart
OBJECTIVE: Hyperlactatemia and base deficit (BD) are markers of adverse outcome after cardiac surgery, and their derangement can be influenced by the use of extracorporeal circulation. The authors hypothesized a better postoperative metabolic profile in off-pump coronary artery bypass grafting (OPCABG) compared with "on-pump" coronary artery bypass grafting (ONCABG). DESIGN: This was a retrospective study, with consecutive data collected for 1 year from electronic medical records...
August 2016: Journal of Cardiothoracic and Vascular Anesthesia
Savas Sipahi, Yalcin Solak, Seyyid Bilal Acikgoz, Ahmed Bilal Genc, Mehmet Yildirim, Ulku Yilmaz, Ahmet Nalbant, Ali Tamer
PURPOSE: To investigate association between renal functions, lactic acid levels and acid-base balance in type 2 diabetes patients with chronic kidney disease under metformin treatment and after metformin discontinuation in a real-life setting. METHODS: A total of 65 patients with diabetes (mean age 68.5 ± 8.9 years, 56.9 % females) in whom metformin treatment was discontinued due to reduced glomerular filtration rate (GFR) were included in this retrospective study...
August 2016: International Urology and Nephrology
Natascia Anastasio, Maja Tarailo-Graovac, Reem Al-Khalifah, Laurent Legault, Britt Drogemoller, Colin J D Ross, Wyeth W Wasserman, Clara van Karnebeek, Daniela Buhas
Hyperglycemia is a rare presenting symptom of mitochondrial disorders. We report a case of a young girl who presented shortly after birth with ketoacidosis, hyperlactatemia, hyperammonemia, and insulin-responsive hyperglycemia. Initial metabolic work-up suggested mitochondrial dysfunction. Given our patient's unusual presentation, whole-exome sequencing (WES) was performed on the parent-offspring trio. The patient was homozygous for the c.643C>T (p.Leu215Phe) variant in CYC1, a nuclear gene which encodes cytochrome c 1 , a subunit of respiratory chain complex III...
April 14, 2016: JIMD Reports
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