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lactic acidosis in shock

Catherine L Oberg, Robert J Hiensch, Hooman D Poor
OBJECTIVE: To report a case series of three patients with hepatitis C virus infection who all presented with severe type B lactic acidosis shortly after starting treatment with ombitasvir-paritaprevir-ritonavir-dasabuvir. DESIGN: Case series. SETTING: ICU. PATIENTS: Three patients, all who had HCV cirrhosis with mild hepatic impairment (Child-Pugh A) and had started taking ombitasvir-paritaprevir-ritonavir-dasabuvir within the preceding 2 weeks, presented with similar nonspecific symptoms of lethargy, fatigue, and nausea...
September 22, 2016: Critical Care Medicine
Michela Cottini, Marco Ranucci, Caterina Facciolo, Angela Satriano, Hassan Kandill, Fabrizio Bettini, Carlo De Vincentis, Mauro Cotza, Andrea Ballotta
No abstract text is available yet for this article.
November 1, 2016: International Journal of Cardiology
Heitor Pons Leite, Lúcio Flávio Peixoto de Lima
Despite the advances made in monitoring and treatment of sepsis and septic shock, many septic patients ultimately develop multiple organ dysfunction (MODS) and die, suggesting that other players are involved in the pathophysiology of this syndrome. Mitochondrial dysfunction occurs early in sepsis and has a central role in MODS development. MODS severity and recovery of mitochondrial function have been associated with survival. In recent clinical and experimental investigations, mitochondrion-target therapy for sepsis and septic shock has been suggested to reduce MODS severity and mortality...
July 2016: Journal of Thoracic Disease
Ellen E Connor, Nicole R Jackson, Robin R McGoey
A 51-year-old man presented to a community based emergency department with bilateral lower extremity swelling that began four days prior and that had evolved into recent blister formation on the left lower extremity. Medical history was significant only for hypertension and a recent self-described episode of "food poisoning" five days earlier characterized by diarrhea, nausea, and vomiting that quickly resolved. Physical exam revealed marked bilateral lower extremity edema and an ecchymotic rash below the knee...
May 2016: Journal of the Louisiana State Medical Society: Official Organ of the Louisiana State Medical Society
Marianne Zeller, Mathilde Labalette-Bart, Jean-Michel Juliard, Louis Potier, Laurent J Feldman, Philippe Gabriel Steg, Yves Cottin, Ronan Roussel
AIM: To analyze the association between chronic metformin treatment and the development of contrast-induced acute kidney injury (CI-AKI) after primary percutaneous coronary intervention (PCI) for ST segment elevation myocardial infarction (STEMI). METHODS: Patients with type 2 diabetes mellitus (T2DM) treated with PCI <24h in 2 coronary care units were included. Serum creatinine (Cr) was measured before and <48h after PCI. CI-AKI was defined as an increase in Cr>27μmol/l (0...
October 1, 2016: International Journal of Cardiology
Barney Thomas Jesudason Isaac, Thomas McLellan, Johnson Samuel, Bernard Yung
A 66-year-old man, an asthmatic, presented with symptoms suggestive of an acute exacerbation of asthma. His arterial blood gas revealed type 1 respiratory failure (PaO2 <8 kPa or 60 mm Hg with normal or low PaCO2) with a compensated lactic acidosis. He was treated for an asthma exacerbation and sepsis. Despite treatment, his respiratory rate remained elevated although his hypoxaemia improved. There was progressive worsening of the lactic acidosis. Treatment for sepsis was augmented. Peak flow measurements were not used to assess the severity of his exacerbation nor his response to treatment...
2016: BMJ Case Reports
Varalaxmi Bhavani Nannaka, Nihar Jani, Masooma Niazi, Dmitry Lvovsky
Near complete infiltration of the liver secondary to metastasis from the head and neck cancer is a rare occurrence. The prognosis of liver failure associated with malignant infiltration is extremely poor; the survival time of patients is extremely low. We present a case of acute warfarin toxicity as initial manifestation of metastatic liver disease. Our patient is a 64-year-old woman presenting with epigastric pain and discomfort, found to have unrecordable International Normalized Ratio. She rapidly deteriorated with acute respiratory failure requiring mechanical ventilation, profound shock requiring high dose vasopressor infusion, severe coagulopathy, worsening liver enzymes with worsening of lactic acidosis and severe metabolic abnormalities, and refractory to aggressive supportive care and died in less than 48 hours...
2016: Case Reports in Critical Care
Jiang Xiao, Shuxu Du, Yunfei Tian, Wenjing Su, Di Yang, Hongxin Zhao
The objective of this study was to elucidate the causes of death and mortality in a cohort of inpatients infected with HIV. The causes of death and mortality were evaluated by using the clinical data of 1,076 patients admitted to the Center for Infectious Diseases, Beijing Ditan Hospital, between January 1, 2009, and November 30, 2012, and who were followed for 6 months after discharge. During the 4-year study period, 216 patients had died by the 6-month follow-up (mortality rate, 20.1%). Opportunistic infections were the most common causes of death (42...
August 2016: AIDS Research and Human Retroviruses
Keren Doenyas-Barak, Ilia Beberashvili, Ronit Marcus, Shai Efrati
BACKGROUND: High serum lactate is associated with increased mortality in septic shock patients. Metformin alters lactate metabolism, and may affect its prognostic value. We compared, between metformin users and nonusers, the prognosis of extremely elevated plasma lactate levels in patients with septic shock. METHODS: The electronic medical records (EMR) of patients admitted to the emergency room between January 2011 and June 2013 were reviewed. The study cohort comprised patients with an initial diagnosis of septic shock and blood lactate higher than 10 mmol/L...
2016: Critical Care: the Official Journal of the Critical Care Forum
Alessandro Protti, Dario Ronchi, Gabriele Bassi, Francesco Fortunato, Andreina Bordoni, Tommaso Rizzuti, Roberto Fumagalli
OBJECTIVE: To better clarify the pathogenesis of linezolid-induced lactic acidosis. DESIGN: Case report. SETTING: ICU. PATIENT: A 64-year-old man who died with linezolid-induced lactic acidosis. INTERVENTIONS: Skeletal muscle was sampled at autopsy to study mitochondrial function. MEASUREMENTS AND MAIN RESULTS: Lactic acidosis developed during continuous infusion of linezolid while oxygen consumption and oxygen extraction were diminishing from 172 to 52 mL/min/m and from 0...
July 2016: Critical Care Medicine
Jennifer Dierksen, L Maximilian Buja, Lei Chen
Hematological malignancies exhibit many clinical presentations, from ambiguous systemic symptoms to rapid multi-organ failure. By identifying common clinical, laboratory, and autopsy findings in patients with a hematological malignancy, living patients may be diagnosed and treated earlier. We retrospectively reviewed our institution's 2003-2013 autopsy and respective medical records for patients with a hematological malignancy. Clinical, laboratory and autopsy findings were retrieved. 30 patients with hematological malignancy were identified, including 14 "new" cases, defined here as diagnosed either post-mortem (n=6) or within 4 weeks of death (n=8)...
2015: Annals of Clinical and Laboratory Science
Bandarn Suetrong, Keith R Walley
Increased blood lactate concentration (hyperlactatemia) and lactic acidosis (hyperlactatemia and serum pH < 7.35) are common in patients with severe sepsis or septic shock and are associated with significant morbidity and mortality. In some patients, most of the lactate that is produced in shock states is due to inadequate oxygen delivery resulting in tissue hypoxia and causing anaerobic glycolysis. However, lactate formation during sepsis is not entirely related to tissue hypoxia or reversible by increasing oxygen delivery...
January 2016: Chest
Tomohiro Suhara, Takako Hishiki, Masataka Kasahara, Noriyo Hayakawa, Tomoko Oyaizu, Tsuyoshi Nakanishi, Akiko Kubo, Hiroshi Morisaki, William G Kaelin, Makoto Suematsu, Yoji Andrew Minamishima
Loss of prolyl hydroxylase 2 (PHD2) activates the hypoxia-inducible factor-dependent hypoxic response, including anaerobic glycolysis, which causes large amounts of lactate to be released from cells into the circulation. We found that Phd2-null mouse embryonic fibroblasts (MEFs) produced more lactate than wild-type MEFs, as expected, whereas systemic inactivation of PHD2 in mice did not cause hyperlacticacidemia. This unexpected observation led us to hypothesize that the hypoxic response activated in the liver enhances the Cori cycle, a lactate-glucose carbon recycling system between muscle and liver, and thereby decreases circulating lactate...
September 15, 2015: Proceedings of the National Academy of Sciences of the United States of America
Martin Wepler, Sebastian Hafner, Angelika Scheuerle, Matthias Reize, Michael Gröger, Florian Wagner, Florian Simon, José Matallo, Frank Gottschalch, Andrea Seifritz, Bettina Stahl, Martin Matejovic, Amar Kapoor, Peter Möller, Enrico Calzia, Michael Georgieff, Ulrich Wachter, Josef A Vogt, Christoph Thiemermann, Peter Radermacher, Oscar McCook
BACKGROUND: In un-resuscitated rodent models of septic shock, the peroxisome proliferator-activated receptor-β/δ (PPAR-β/δ) agonist GW0742 improved visceral organ function. Therefore, we tested the hypothesis whether GW0742 would attenuate kidney injury during long-term, resuscitated, porcine polymicrobial septic shock. METHODS: Six, 12, and 18 h after the induction of fecal peritonitis by inoculation of autologous feces, anesthetized, mechanically ventilated, and instrumented male pigs with pre-existing atherosclerosis resulting from familial hypercholesteremia and atherogenic diet randomly received either vehicle (dimethyl sulfoxide, n = 12) or GW0742 (n = 10)...
December 2013: Intensive Care Medicine Experimental
Wisit Cheungpasitporn, Ladan Zand, John J Dillon, Qi Qian, Nelson Leung
Lactic acidosis is associated with high morbidity and mortality in hospitalized patients. Treatment of lactic acidosis is targeted on correcting the underlying causes and optimizing adequate oxygen delivery to the tissues. Even though evidence is lacking, continuous renal replacement therapy (CRRT) and dialysis have been advocated as treatments for lactic acidosis. We report a 28-year-old Caucasian male with a history of hemophagocytic lymphohistiocytosis who presented with septic shock, severe lactic acidosis and multiple organ failure...
August 2015: Clinical Kidney Journal
Shinya Unai, Daizo Tanaka, Nicholas Ruggiero, Hitoshi Hirose, Nicholas C Cavarocchi
Extracorporeal membrane oxygenation (ECMO) in our institution resulted in near total mortality prior to the establishment of an algorithm-based program in July 2010. We hypothesized that an algorithm-based ECMO program improves the outcome of patients with acute myocardial infarction complicated with cardiogenic shock. Between March 2003 and July 2013, 29 patients underwent emergent catheterization for acute myocardial infarction due to left main or proximal left anterior descending artery occlusion complicated with cardiogenic shock (defined as systolic blood pressure <90 mm Hg despite multiple inotropes, with or without intra-aortic balloon pump, lactic acidosis)...
March 2016: Artificial Organs
Qiang Li, Tao Huang, Zhen Dong
This study examined the effects of polyethylene oxide (PEO) on the survival rate, hemodynamics, blood gas indexes, lactic acid levels, microcirculation, and inflammatory cytokine levels in rats subjected to severe hemorrhagic shock. The shocked rats were resuscitated with either Ringer's lactate solution or 20 ppm of PEO in Ringer's lactate solution for 1 h. It was found that infusion of PEO effectively improved the survival, metabolic acidosis, oxygen delivery, hyperlactacidemia, tissue perfusion, and inflammatory responses of rats subjected to hemorrhagic shock...
August 2015: Canadian Journal of Physiology and Pharmacology
Jae-Hyug Woo, Yong Su Lim
CONTEXT: Flufenoxuron (Cascade™) is a new benzoylurea insecticide. We describe a case of human poisoning with previously unreported cardiac complications and review other case reports in the literature. CASE DETAILS: A 54-year-old stuporous man who had ingested a flufenoxuron-containing insecticide presented to the emergency department with severely unstable vital signs and lactic acidosis which continued to worsen over time. He was treated with gastric lavage and infusion of sodium bicarbonate, crystalloid, and dopamine...
July 2015: Clinical Toxicology
Antoine Kimmoun, Emmanuel Novy, Thomas Auchet, Nicolas Ducrocq, Bruno Levy
Lactic acidosis is a very common biological issue for shock patients. Experimental data clearly demonstrate that metabolic acidosis, including lactic acidosis, participates in the reduction of cardiac contractility and in the vascular hyporesponsiveness to vasopressors through various mechanisms. However, the contributions of each mechanism responsible for these deleterious effects have not been fully determined and their respective consequences on organ failure are still poorly defined, particularly in humans...
April 9, 2015: Critical Care: the Official Journal of the Critical Care Forum
Pankaj Saxena, James Neal, Lyle D Joyce, Kevin L Greason, Hartzell V Schaff, Pramod Guru, William Y Shi, Harold Burkhart, Zhuo Li, William C Oliver, Roxann B Pike, Dawit T Haile, Gregory J Schears
BACKGROUND: We conducted a retrospective study to assess whether providing extracorporeal membrane oxygenation (ECMO) support to elderly patients (aged 70 years or more) who failed separation from cardiopulmonary bypass after cardiac surgery was a viable option. METHODS: From 2003 to 2013, 45 patients aged 70 years or more underwent 47 runs of ECMO postoperatively. RESULTS: There were 31 men (68.9%). The mean age was 76.8 years. Five patients were in cardiogenic shock preoperatively...
June 2015: Annals of Thoracic Surgery
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