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potassium disturbance in critical ill patients

Goran Mitrić, Andrew Udy, Hiran Bandeshe, Pierre Clement, Rob Boots
BACKGROUND: Atrial fibrillation is a common rhythm disturbance in the general medical-surgical intensive care unit. Amiodarone is a popular drug in this setting but evidence to inform clinical practice remains scarce. We aimed to identify whether variation in the clinical use of amiodarone was associated with recurrent atrial fibrillation. METHODS: This was a retrospective audit of 177 critically ill patients who developed new-onset atrial fibrillation after admission to a tertiary level medical-surgical trauma intensive care unit...
April 2, 2016: Critical Care: the Official Journal of the Critical Care Forum
Hoi-Ping Shum, Harriet Hoi-Yan Kong, King-Chung Chan, Wing-Wa Yan, Tak Mao Chan
Purpose The objective of this study is to examine the incidence, clinical characteristics, and outcome (90-day mortality) of critically ill Chinese patients with septic AKI. Methods Patients admitted to the ICU of a regional hospital from 1 January 2011 to 31 December 2013 were included, excluding those on chronic renal replacement therapy. AKI was defined using KDIGO criteria. Patients were followed till 90 days from ICU admission or death, whichever occurred earlier. Demographics, diagnosis, clinical characteristics, and outcome were analyzed...
June 2016: Renal Failure
John R Klinck, Lisa McNeill, David K Menon
Marked dysnatremia is associated with increased mortality in patients admitted to intensive care. However, new evidence suggests that even mild deviations from normal and simple variability of sodium values may also be significant. Should these findings prompt clinicians to re-evaluate the approach to fluid management in this setting? Sodium disorders, on one hand, are known to result from overzealous administration or restriction of free water or sodium ions. However, they are also associated with a range of co-morbidities and drug treatments that alter water loss and sodium handling in the nephron independently of prescribed fluid regimens...
April 2, 2013: Critical Care: the Official Journal of the Critical Care Forum
Shailja Gupta, Sakshi Sodhi, Jaskiran Kaur, Jaskiran Yamini
Hypomagnesaemia is common finding in current medical practice mainly in critically ill, post-operative patients and patients admitted to ICU in tertiary cancer cases. Magnesium has been directly implicated in hypokalemia, hypocalcaemia and dysrrthymias. We report a case of 60 year old patient, suffering from rectal carcinoma for a period of one year with confirmed hypokalemia, hypocalcaemia and hyponatremia. Magnesium supplementation corrected the underlying multiple electrolyte disturbances in the patient thus, establishing a positive correlation of magnesium with sodium, potassium and calcium...
April 2009: Indian Journal of Clinical Biochemistry: IJCB
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
Henry Thomas Stelfox, Sofia B Ahmed, David Zygun, Farah Khandwala, Kevin Laupland
PURPOSE: Although intensive care unit (ICU) acquired sodium disturbances are common in critically ill patients, few studies have examined sodium disturbances in patients following cardiac surgery. The objective of this study was to describe the epidemiology of ICU-acquired hyponatremia and hypernatremia in patients following cardiac surgery. METHODS: We identified 6,727 adults (> or =18 yr) who were admitted consecutively to a regional cardiovascular intensive care unit (CVICU) from January 1, 2000 to December 31, 2006 and were documented as having normal serum sodium levels (133 to 145 mmol...
July 2010: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
M S Biagioni Santos, A C Seguro, L Andrade
The objective of the present study was to determine the prevalence of electrolyte disturbances in AIDS patients developing acute kidney injury in the hospital setting, as well as to determine whether such disturbances constitute a risk factor for nephrotoxic and ischemic injury. A prospective, observational cohort study was carried out. Hospitalized AIDS patients were evaluated for age; gender; coinfection with hepatitis; diabetes mellitus; hypertension; time since HIV seroconversion; CD4 count; HIV viral load; proteinuria; serum levels of creatinine, urea, sodium, potassium and magnesium; antiretroviral use; nephrotoxic drug use; sepsis; intensive care unit (ICU) admission, and the need for dialysis...
March 2010: Brazilian Journal of Medical and Biological Research, Revista Brasileira de Pesquisas Médicas e Biológicas
Joanne Man-Wai Ho, David Nelson Juurlink, Rodrigo Brandao Cavalcanti
BACKGROUND: Polyethylene glycol-based bowel preparations (PEGBPs) are widely perceived as safe and effective alternatives to oral sodium phosphate for bowel cleansing prior to colonoscopy. Most studies supporting this belief involve young patients with few comorbidities. OBJECTIVE: To characterize the incidence of electrolyte disturbances following PEGBPs administered prior to colonoscopy among elderly inpatients and hypothesize that PEGBP would be associated with hypokalemia in this setting...
March 2010: Annals of Pharmacotherapy
Fernando Luiz Zanoni, Simon Benabou, Karin Vicente Greco, Ana Carolina Ramos Moreno, José Walber Miranda Costa Cruz, Fernando Paranaiba Filgueira, Marina Baquerizo Martinez, Luiz Francisco Poli de Figueiredo, Maurício Rocha e Silva, Paulina Sannomiya
PURPOSE: Bacterial translocation has been shown to occur in critically ill patients after extensive trauma, shock, sepsis, or thermal injury. The present study investigates mesenteric microcirculatory dysfunctions, the bacterial translocation phenomenon, and hemodynamic/metabolic disturbances in a rat model of intestinal obstruction and ischemia. METHODS: Anesthetized (pentobarbital 50 mg/kg, i.p.) male Wistar rats (250-350 g) were submitted to intestinal obstruction or laparotomy without intestinal obstruction (Sham) and were evaluated 24 hours later...
2009: Clinics
Gregor Lindner, Nikolaus Kneidinger, Ulrike Holzinger, Wilfred Druml, Christoph Schwarz
BACKGROUND: Hypernatremia is a serious electrolyte disturbance and an independent risk factor for mortality in critically ill patients. In many cases, hypernatremia is an iatrogenic problem that develops in the intensive care unit (ICU). STUDY DESIGN: Case series. SETTING & PARTICIPANTS: 45 patients were studied in a medical ICU. For inclusion in the study, patients needed to show an increase in serum sodium concentration to greater than 149 mEq/L from an initial concentration of less than 146 mEq/L...
October 2009: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Henry Thomas Stelfox, Sofia B Ahmed, Farah Khandwala, David Zygun, Reza Shahpori, Kevin Laupland
INTRODUCTION: Although sodium disturbances are common in hospitalised patients, few studies have specifically investigated the epidemiology of sodium disturbances in the intensive care unit (ICU). The objectives of this study were to describe the incidence of ICU-acquired hyponatraemia and hypernatraemia and assess their effects on outcome in the ICU. METHODS: We identified 8142 consecutive adults (18 years of age or older) admitted to three medical-surgical ICUs between 1 January 2000 and 31 December 2006 who were documented to have normal serum sodium levels (133 to 145 mmol/L) during the first day of ICU admission...
2008: Critical Care: the Official Journal of the Critical Care Forum
B Antonini, S Piva, M Paltenghi, A Candiani, N Latronico
BACKGROUND AND OBJECTIVE: Stewart's and Fencl's methods have recently been proposed to interpret acid-base disorders where traditional theory has proven inadequate. Our objectives were to evaluate: (1) the occurrence of acid-base disturbances in critically ill patients and their trend over the first 3 intensive care unit days, (2) whether Stewart's theory offers advantages over the traditional theory in the diagnosis of acid-base metabolic disturbances and (3) whether variables derived from Stewart's and Fencl's methods offer advantages over the traditional method to predict patient mortality...
July 2008: European Journal of Anaesthesiology
T Matthäus, R Schnitzler, P Weithofer, M Weber, F Merkel
Management of critically ill patients regularly involves the treatment of water and electrolyte disturbances. Moreover, critical care itself may contribute to volume overload and electrolyte abnormalities. Initial therapy should be followed by consequent diagnostic evaluation. The shift of volume and potassium in severe pancreatitis, for example, may lead to a life-threatening situation. In brain-dead patients, successful organ donation is facilitated by careful maintenance of water and electrolyte homeostasis...
November 2006: Der Internist
Mohammed Hijazi, Mariam Al-Ansari
BACKGROUND: The intensive care unit is a dynamic environment, where high numbers of patients cared for by health care workers of different experiences and backgrounds might result in great variability in patient care. Protocol-driven interventions may facilitate timely and uniform care of common problems, like electrolyte disturbances. We prospectively compared protocol-driven (PRD) vs. physician-driven (PHD) electrolyte replacement in adult critically ill patients. PATIENTS AND METHODS: In the first month of the two-month study, potassium, magnesium, and phosphate levels were checked by a physician before ordering replacement (PHD replacement period)...
March 2005: Annals of Saudi Medicine
Mervyn Singer, Flaminia Coluzzi, Alastair O'Brien, Lucie H Clapp
We describe three critically ill patients who received drugs with K(ATP) channel-opening properties and subsequently developed severe life-threatening complications, including hyperkalaemia and cardiovascular disturbances. Administration of the sulfonylurea-receptor inhibitor glibenclamide promptly reversed these abnormalities. Over the past 3 years, we have seen this syndrome and response in five patients taking nicorandil, ciclosporin, or isoflurane, which suggests that this disorder arises more frequently than is currently realised...
May 28, 2005: Lancet
Pavlos M Myrianthefs, Arturo Briva, Emilia Lecuona, Vidas Dumasius, David H Rutschman, Karen M Ridge, George J Baltopoulos, Jacob Iasha Sznajder
Acid-base disturbances, such as metabolic or respiratory alkalosis, are relatively common in critically ill patients. We examined the effects of alkalosis (hypocapnic or metabolic alkalosis) on alveolar fluid reabsorption in the isolated and continuously perfused rat lung model. We found that alveolar fluid reabsorption after 1 hour was impaired by low levels of CO2 partial pressure (PCO2; 10 and 20 mm Hg) independent of pH levels (7.7 or 7.4). In addition, PCO2 higher than 30 mm Hg or metabolic alkalosis did not have an effect on this process...
June 1, 2005: American Journal of Respiratory and Critical Care Medicine
D Deheinzelin, E M Negri, M R Tucci, M Z Salem, V M da Cruz, R M Oliveira, I N Nishimoto, C Hoelz
Hypomagnesemia is the most common electrolyte disturbance seen upon admission to the intensive care unit (ICU). Reliable predictors of its occurrence are not described. The objective of this prospective study was to determine factors predictive of hypomagnesemia upon admission to the ICU. In a single tertiary cancer center, 226 patients with different diagnoses upon entering were studied. Hypomagnesemia was defined by serum levels <1.5 mg/dl. Demographic data, type of cancer, cause of admission, previous history of arrhythmia, cardiovascular disease, renal failure, drug administration (particularly diuretics, antiarrhythmics, chemotherapy and platinum compounds), previous nutrition intake and presence of hypovolemia were recorded for each patient...
December 2000: Brazilian Journal of Medical and Biological Research, Revista Brasileira de Pesquisas Médicas e Biológicas
K R Lawrence, S A Nasraway
Droperidol and haloperidol have demonstrated efficacy and safety in the treatment of acute delirium in critically ill patients. We conducted MEDLINE and manual searches of literature published from 1966-1996 to identify articles describing conduction disturbances associated with the drugs. The objectives were to describe the proposed mechanisms of acquired long QTc interval syndrome and torsades de pointes, and to recommend how critically ill patients receiving these agents should be monitored. We found 11 published reports of conduction disturbances associated with intravenous administration of droperidol or haloperidol...
May 1997: Pharmacotherapy
A Jabor, A Kazda
A quantitative evaluation of metabolic acid-base component is described. The model is based on Stewart's analysis of acid-base chemistry. The metabolic component of acid-base disturbances is divided into four partial metabolic disorders; they can result from abnormal concentrations of chloride, albumin and phosphate disturbances, or from appearance of abnormal unidentified strong anions. The efficiency of the model is sufficient, quantitative partial results are given in the same units as base excess. In complex acid-base disturbances, such as are seen in critically ill patients, a detailed analysis of the specific components of the metabolic acid-base status allows one to plan specific therapeutic interventions...
1995: Acta Anaesthesiologica Scandinavica. Supplementum
B M Wolfe, P G Moore
Improved methods for monitoring and treating critically ill patients have increased the number of surgical candidates with multiorgan system impairment. Whereas such patients may have been considered "too sick to undergo surgery" in the past, many such patients linger in the intensive care unit unless definitive therapy is accomplished. Specific attention to review of the patient's preoperative preparation for surgery on a system-by-system basis may improve outcome substantially. The need for possible mechanical ventilation prior to transport to the operating room must receive particular attention...
March 1993: World Journal of Surgery
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