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management of lactic acidosis

Chih-Ning Cheng, Shu-Wen Lin, Chien-Chih Wu
Linezolid, an oxazolidinone antibiotic, does not required dose adjustment in patients with Child's class A and B liver cirrhosis. The dose adjustment data for Child's class C liver cirrhosis is inadequate. We reported a case of Child's class C liver cirrhosis, in which lactic acidosis, an adverse effect related to prolonged use, occurred only after two weeks of linezolid treatment. A 63-year old male had underlying diseases, such as end-stage renal disease (ESRD) and Child's class C liver cirrhosis, and was admitted for hepatic encephalopathy management and liver transplantation evaluation...
March 1, 2018: Journal of Infection and Chemotherapy: Official Journal of the Japan Society of Chemotherapy
Christopher Loens, Sabine Amet, Corinne Isnard-Bagnis, Gilbert Deray, Jérôme Tourret
The remarkable improvement of the outcome of HIV infection came with the price of substantial toxicity of some antiretrovirals. The first molecules used to treat HIV included an important nephrotoxicity. Zalcitabine, stavudine and didanosine can induce severe lactic acidosis. Lactate production is enhanced and the renal capacity to regulate pH is overwhelmed. However, this side effect is not due to a direct dysfunction of the kidneys. Zalcitabine was withdrawn from the market because of this risk. Indinavir, a protease inhibitor, is soluble only in very acidic solutions...
February 27, 2018: Néphrologie & Thérapeutique
Michel Tchan
The adult endocrinologist may be asked to consult on a patient for unexplained biochemical disturbances that could be caused by an underlying inborn error of metabolism. A genetic disorder is generally less likely to be the cause as these disorders are individually rare, however inborn errors of metabolism are collectively not infrequent and important to consider as they may be treatable and tragic outcomes avoided. Hyperammonemia or lactic acidosis are most often secondary markers of an acquired primary disease process, but they may be a clue to the presence of a genetic disorder...
March 1, 2018: Reviews in Endocrine & Metabolic Disorders
Charles Kodner, Laurie Anderson, Katherine Pohlgeers
Glucose management in hospitalized patients poses challenges to physicians, including identifying blood glucose targets, judicious use of oral diabetes mellitus medications, and implementing appropriate insulin regimens. Uncontrolled blood glucose levels can lead to deleterious effects on wound healing, increased risk of infection, and delays in surgical procedures or discharge from the hospital. Previously recommended strict blood glucose targets for hospitalized patients result in more cases of hypoglycemia without improvement in patient outcomes...
November 15, 2017: American Family Physician
J L Parker-Cote, J Rizer, J P Vakkalanka, S V Rege, C P Holstege
OBJECTIVE: The aim of this systematic review was to identify isolated acute cyanide poison cases and to identify reported signs, symptoms, and laboratory findings. METHODS: We searched MEDLINE, Cochrane Reviews, and Web of Science case reports and series using a number of MeSH descriptors pertaining to cyanide, toxicity, and poisonings. We excluded studies on plants, laboratory analyses, smoke inhalation poisonings, animals as well as non-English language articles and those in which data were not available...
February 8, 2018: Clinical Toxicology
Zhe Zhang, Danhua Zhao, Xiao Zhang, Hui Xiong, Xinhua Bao, Yun Yuan, Zhaoxia Wang
BACKGROUND: Mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS) is a common mitochondrial syndrome. The aim of this study was to conduct a survival analysis based on the clinical features of a Chinese MELAS patient cohort. METHODS: This is a retrospective single-center study. The MELAS patients were followed up for 1-8years (median 4years). The disease severity was evaluated by the modified Rankin Scale (mRS). The survival analysis was performed using Kaplan-Meier analysis and Cox proportional hazards model...
February 15, 2018: Journal of the Neurological Sciences
Federica N Vigotti, Germana Daidola, Antonio Marciello, Francesco Berruto, Antonietta Rizzuto, Ernesto Reina, Paolo M Perosa, Marco Saltarelli
BACKGROUND: Lactic acidosis (LA) is the most common form of metabolic acidosis, defined by lactate values greater than 5 mmol/L and pH<7.34. The pathogenesis of LA involves hypoxic causes (type A) and non-hypoxic (type B), often coexisting. Identification and removal of the trigger are mandatory in the therapeutic management of LA. The case: A 38 years-old male patient entered the Emergency Ward for dyspnea, fever, vomiting and hyporexia. An important respiratory distress with hyperventilation due to severe LA was found, together with severe hypoglicemia, without renal impairment...
February 2018: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
A Pinto, M Alfadhel, R Akroyd, Y Atik Altınok, S M Bernabei, L Bernstein, G Bruni, G Caine, E Cameron, R Carruthers, B Cochrane, A Daly, F de Boer, S Delaunay, A Dianin, M Dixon, E Drogari, S Dubois, S Evans, J Gribben, G Gugelmo, C Heidenborg, I Hunjan, I L Kok, B Kumru, A Liguori, D Mayr, E Megdad, U Meyer, R B Oliveira, A Pal, A Pozzoli, R Pretese, J C Rocha, S Rosenbaum-Fabian, J Serrano-Nieto, E Sjoqvist, C Timmer, L White, T van den Hurk, M van Rijn, H Zweers, M Ziadlou, A MacDonald
BACKGROUND: In fructose 1,6 bisphosphatase (FBPase) deficiency, management aims to prevent hypoglycaemia and lactic acidosis by avoiding prolonged fasting, particularly during febrile illness. Although the need for an emergency regimen to avoid metabolic decompensation is well established at times of illness, there is uncertainty about the need for other dietary management strategies such as sucrose or fructose restriction. We assessed international differences in the dietary management of FBPase deficiency...
January 25, 2018: Orphanet Journal of Rare Diseases
Ross Boyce, Raquel Reyes, Corinna Keeler, Michael Matte, Moses Ntaro, Edgar Mulogo, Mark J Siedner
The clinical epidemiology of severe malaria among patients presenting to peripheral health centers has not been well described. We conducted a prospective, observational cohort study to describe the epidemiology and clinical manifestations of severe malaria in a highland area of declining transmission intensity in Western Uganda. Individuals presenting with a history of fever were screened with a malaria rapid diagnostic test (RDT). We prepared blood smears and conducted clinical and laboratory testing for those with a positive RDT...
December 26, 2017: American Journal of Tropical Medicine and Hygiene
Ailsa Holbourn, Judith Hurdman
A 54-year-old asthmatic woman presented to hospital with a 10-day history of breathlessness. On examination, she was tachypnoeic with mild wheeze. She had preserved peak flows and was saturating at 100% on room air. Investigations revealed severe metabolic lactic acidosis. On further questioning, it transpired that she drank kombucha tea, which has been linked to lactic acidosis. She made a full recovery with supportive management and cessation of the tea.
December 2, 2017: BMJ Case Reports
Sherin Hassan M Mehani, Heba Ahmed A Abdeen
[Purpose] Ventilatory limitation is a common problem in patients with chronic heart failure and pulmonary hypertension. Excess ventilation may arise from augmented ventilatory drive, over activity of chemoreceptors and muscle ergoreceptors, or premature onset of lactic acidosis. Exertional dyspnea can cause limitations in the activities of daily living and as a result, reduced quality of life for these patients. The aim of the present study was to evaluate the effect of cardiopulmonary rehabilitation program on ventilatory efficiency for these patients...
October 2017: Journal of Physical Therapy Science
Maliha Naseer, Jenil Gandhi, Noor Chams, Zain Kulairi
BACKGROUND: Stercoral colitis is a rare inflammatory process involving the colonic wall secondary to fecal impaction with high morbidity and mortality; especially if complicated with ischemic colitis, stercoral ulcer formation and subsequent perforation. There are several case reports published on abdominal perforation resulting from stercoral colitis. However, stercoral colitis complicated by ischemic colitis is rare. The purpose of this case report is to describe the potential challenges in the diagnosis and management of stercoral colitis with ischemic colitis...
November 28, 2017: BMC Gastroenterology
Laura Cerland, Bruno Mégarbane, Hatem Kallel, Yanick Brouste, Hossein Mehdaoui, Dabor Resiere
Drowning represents one major cause of accidental death. Near-drowning patients are exposed to aspiration that may result in pneumonia with life-threatening consequences. We designed this descriptive study to investigate the frequency, nature, and consequences of post-drowning pneumonia. One hundred and forty-four near-drowning patients (33 children and 111 adults) admitted during four years to the University Hospital of Martinique, French Indies, were included. Patients presented pre-hospital cardiac arrest (41%) and exhibited acute respiratory failure (54%), cardiovascular failure (27%), and lactic acidosis (75%) on admission...
November 17, 2017: International Journal of Environmental Research and Public Health
Peter Blom Jensen, Sigrun Høegholm Kann, Karsten Tange Veien, Ole Kristian Møller-Helgestad, Jordi Sanchez Dahl, Charlotte Svejstrup Rud, Marianne Kjær Jensen, Lisette Okkels Jensen, Henrik Schmidt, Jacob Eifer Møller
RATIONALE: Short-term mechanical circulatory support is increasingly used in the management of cardiogenic shock, but data from controlled studies are sparse. Thus, real-life data on complication rates and predictors of adverse outcome are important. OBJECTIVE: The objective of this study was to analyse the experience with Impella devices in the management of profound cardiogenic shock. METHODS AND RESULTS: A retrospective study of 109 consecutive patients with severe shock after myocardial infarction, acute heart failure, or cardiac surgery...
November 1, 2017: European Heart Journal. Acute Cardiovascular Care
Dilip R Karnad, Mohd Basri Mat Nor, Guy A Richards, Tim Baker, Pravin Amin
Severe malaria is common in tropical countries in Africa, Asia, Oceania and South and Central America. It may also occur in travelers returning from endemic areas. Plasmodium falciparum accounts for most cases, although P vivax is increasingly found to cause severe malaria in Asia. Cerebral malaria is common in children in Africa, manifests as coma and seizures, and has a high morbidity and mortality. In other regions, adults may also develop cerebral malaria but neurological sequelae in survivors are rare...
November 8, 2017: Journal of Critical Care
Francesca Galiero, Giovanni Consani, Gianni Biancofiore, Stefano Ruschi, Francesco Forfori
Vasopressin is a potent vasopressor used for improving organ perfusion during cardiac arrest, septic and catecholamine-resistant shock; with reference to this, it is useful for the treatment of vasoplegic shock because, restoring organ perfusion pressure by contraction of vascular smooth muscle through a non-catecholamine receptor pathway, it can be employed when catecholamines are ineffective. A 49-yr-old woman was admitted to the Emergency Department after having intentionally taken 95.2g of metformin, 1...
October 28, 2017: American Journal of Emergency Medicine
Suzanne L Ishaq, Ousama AlZahal, Nicola Walker, Brian McBride
Sub-acute ruminal acidosis (SARA) is a gastrointestinal functional disorder in livestock characterized by low rumen pH, which reduces rumen function, microbial diversity, host performance, and host immune function. Dietary management is used to prevent SARA, often with yeast supplementation as a pH buffer. Almost nothing is known about the effect of SARA or yeast supplementation on ruminal protozoal and fungal diversity, despite their roles in fiber degradation. Dairy cows were switched from a high-fiber to high-grain diet abruptly to induce SARA, with and without active dry yeast (ADY, Saccharomyces cerevisiae) supplementation, and sampled from the rumen fluid, solids, and epimural fractions to determine microbial diversity using the protozoal 18S rRNA and the fungal ITS1 genes via Illumina MiSeq sequencing...
2017: Frontiers in Microbiology
Caitlin Henry, Neema Patel, William Shaffer, Lillian Murphy, Joe Park, Bradley Spieler
BACKGROUND: Mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS) syndrome is a rare inherited disorder that results in waxing and waning nervous system and muscle dysfunction. MELAS syndrome may overlap with other neurologic disorders but shows distinctive imaging features. CASE REPORT: We present the case of a 28-year-old female with atypical stroke-like symptoms, a strong family history of stroke-like symptoms, and a relapsing-remitting course for several years...
2017: Ochsner Journal
Carmelina Gurrieri, Juraj Sprung, Toby N Weingarten, Mary E Warner
BACKGROUND: Glycogen storage diseases are rare genetic disorders of glycogen synthesis, degradation, or metabolism regulation. When these patients are subjected to anesthesia, perioperative complications can develop, including hypoglycemia, rhabdomyolysis, myoglobinuria, acute renal failure, and postoperative fatigue. The objective of this study was to describe the perioperative course of a cohort of patients with glycogen storage diseases. METHODS: This is a retrospective review of patients with glycogen storage diseases undergoing anesthetic care at our institution from January 1, 1990, through June 30, 2015 to assess perioperative management and outcomes...
October 6, 2017: BMC Anesthesiology
Ha Kyung Shin, George Grahame, Shawn E McCandless, Douglas S Kerr, Jirair K Bedoyan
Pyruvate dehydrogenase complex (PDC) deficiency is a major cause of primary lactic acidemia in children. Prompt and correct diagnosis of PDC deficiency and differentiating between specific vs generalized, or secondary deficiencies has important implications for clinical management and therapeutic interventions. Both genetic and enzymatic testing approaches are being used in the diagnosis of PDC deficiency. However, the diagnostic efficacy of such testing approaches for individuals affected with PDC deficiency has not been systematically investigated in this disorder...
November 2017: Molecular Genetics and Metabolism
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