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ICU management of lactic acidosis

Rienzi Díaz, Jorge Vega, Helmuth Goecke
We report a 74-year-old man with diabetes mellitus type 2 and hypertension, who recently underwent coronary bypass surgery due to severe triple vessel disease receiving cardiological and combined antidiabetic therapy, including metformin 4 g/day. He was admitted with abdominal pain, nausea, vomiting, diarrhea and loss of consciousness. At admission, he was disoriented and agitated with signs of poor perfusion. His blood pressure was 80/70 mmHg, pulse rate 40 beats/min, respiratory rate 20-breaths/min, and axillary temperature 35 °C...
March 2015: Revista Médica de Chile
Sami Alsolamy, Majid Al Salamah, Majed Al Thagafi, Hasan M Al-Dorzi, Abdellatif M Marini, Nawfal Aljerian, Farhan Al-Enezi, Fatimah Al-Hunaidi, Ahmed M Mahmoud, Ahmed Alamry, Yaseen M Arabi
BACKGROUND: Early recognition of severe sepsis and septic shock is challenging. The aim of this study was to determine the diagnostic accuracy of an electronic alert system in detecting severe sepsis or septic shock among emergency department (ED) patients. METHODS: An electronic sepsis alert system was developed as a part of a quality-improvement project for severe sepsis and septic shock. The system screened all adult ED patients for a combination of systemic inflammatory response syndrome and organ dysfunction criteria (hypotension, hypoxemia or lactic acidosis)...
December 5, 2014: BMC Medical Informatics and Decision Making
Darrell H S Tan, Sharon L Walmsley
Rates of admission to the intensive care unit (ICU) for persons infected with human immunodeficiency virus (HIV) remain relatively unchanged in the modern era despite advances in antiretroviral therapy (ART) and improvements in ICU survival. Critical care may be required for patients with HIV because of severe opportunistic infections or malignancy, antiretroviral drug toxicity, or critical illness seemingly unrelated to HIV, and each of these scenarios may present different management challenges. In this article, the epidemiology of HIV-related ICU admission is reviewed and key management issues are discussed...
July 2013: Critical Care Clinics
Mojtaba Mojtahedzadeh, Arash Jafarieh, Atabak Najafi, Mohammad Reza Khajavi, Neda Khalili
INTRODUCTION: It is accepted that preventing hyperglycaemia during critical illness while assuring adequate caloric intake can reduce mortality and morbidity. The aim of this study was to compare the metabolic effects of metformin and insulin on hyperglycaemia in ICU patients. METHODS: This double-blind randomised clinical trial was performed on 24 patients who were admitted to the intensive care unit (ICU) from 20 March to 20 September 2007. All patients with serious injuries or with major non-abdominal surgeries were included if they met the inclusion criteria, and were assigned randomly to one of the study groups...
2012: Endokrynologia Polska
R T Grundmann, M Petersen, H Lippert, F Meyer
AIM: This review comments on epidemiology, diagnosis and general principles of surgical management in patients with acute abdomen. DEFINITION AND EPIDEMIOLOGY: The most common cause of acute abdominal pain is non-specific abdominal pain (24 - 44.3 % of the study populations), followed by acute appendicitis (15.9 - 28.1 %), acute biliary disease (2.9 - 9.7 %) and bowel obstruction or diverticulitits in elderly patients. Acute appendicitis represents the cause of surgical intervention in two-thirds of the children with acute abdomen...
June 2010: Zeitschrift Für Gastroenterologie
Luuk C Otterspoor, Cornelis J Kalkman, Olaf L Cremer
PURPOSE OF REVIEW: The propofol infusion syndrome is a rare condition characterized by the occurrence of lactic acidosis, rhabdomyolysis and cardiovascular collapse following high-dose propofol infusion over prolonged periods of time. Patients with traumatic brain injury are particularly at risk of developing this complication because large doses of propofol are commonly used to control intracranial pressure, whereas vasopressors are administered to augment cerebral perfusion pressure...
October 2008: Current Opinion in Anaesthesiology
J A Kellum
OBJECTIVE: To review the mechanisms of metabolic acidosis in sepsis. DATA SOURCES: Articles and published reviews on metabolic acidosis in sepsis. SUMMARY OF REVIEW: Sepsis affects millions of patients each year and efforts to limit mortality have been limited. It is associated with many features one of which is acidosis which may be a result of the underlying pathophysiology (e.g. respiratory failure, shock, renal failure) or may also result from the way in which we manage critically ill patients...
September 2004: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
Nicholas D Mansfield, Lui G Forni
Sepsis and septic shock continue to contribute to our workload and stimulate our research activities although many fundamental questions remain. Studies reported on here focus on inotrope use and a novel way of predicting inotrope response. Continuing this theme more fundamental work is reported examining the mitochondrial respiratory chain and the effects of sepsis coupled with interesting work on lactic acidosis. Troponin raises its head again and we are still left quizzing over its value in the ICU. Finally we discuss a paper on the outcome of the obese patient on a general ICU...
2005: Critical Care: the Official Journal of the Critical Care Forum
Germano De Cosmo, Elisabetta Congedo, Antonio Clemente, Paola Aceto
In critically ill patients, adequate sedation increases comfort, minimizes stress response and facilitates diagnostic and therapeutic procedures. Propofol (2-, 6-diisopropylphenol) is an intravenous sedative-hypnotic agent popular for sedation in the Intensive Care Unit. The favorable propofol pharmacokinetic, characterized by a three compartment linear model, allows rapid onset and short duration of action. The emergence time from sedation with propofol varies with the depth and the duration of sedation and the patient's bodyweight...
November 2005: Current Drug Targets
R Blaine Easley, Tiffanie R Johnson, Joseph D Tobias
The authors present a 25-year-old woman who was admitted to the ICU for treatment of shock, respiratory failure, and acidosis related to congenital lactic acidosis from pyruvate dehydrogenase deficiency. To aid in ongoing management of the metabolic acidosis, the Paratrend blood gas monitoring sensor was inserted through a peripheral venous site to provide a continuous measurement of pH and partial pressure of carbon dioxide (Pco2). With the venous insertion of the Paratrend, a clinically useful correlation with arterial blood gas values was noted...
June 2002: Clinical Pediatrics
James C Jeng, Kathleen Jablonski, Amy Bridgeman, Marion H Jordan
BACKGROUND: Clinical studies document correlation of serum lactate and base deficit with mortality in trauma and sepsis. No study of the prognostic value of these two serum markers has been reported in burn injury. METHODS: Resuscitation data from 49 patients admitted to the adult Burn ICU were analyzed. Lactate and base deficit were analyzed upon admission and every 2h during the initial 48 h after admission. Resuscitation was managed per standard routine, blinded to these data, guided by the Parkland formula...
March 2002: Burns: Journal of the International Society for Burn Injuries
L Oud, M T Haupt
STUDY OBJECTIVES: (1) To determine the effects of resuscitation of patients with severe sepsis to conventional hemodynamic end points and normal blood lactate levels on postresuscitation sequential assessments of gastric intramucosal pH (pHi). (2) To determine whether trends in pHi are reflected in trends in systemic hemodynamic, oxygen utilization, and acid-base assessments. DESIGN: Prospective cohort study. SETTING: Medical ICU in an inner-city, university-based medical center...
May 1999: Chest
S H Cray, B H Robinson, P N Cox
OBJECTIVES: To describe a severe adverse reaction in a child who received an infusion of propofol for sedation in the intensive care unit (ICU). To describe the management and further investigation of this patient and review similar published reports. DESIGN: Case report and literature review. SETTING: Community hospital ICU and tertiary pediatric ICU. PATIENT: Infant with upper respiratory obstruction secondary to an esophageal foreign body who required tracheal intubation and mechanical ventilation...
December 1998: Critical Care Medicine
F G Alvarez, K K Guntupalli
OBJECTIVES: To review the pathophysiology, presentation and treatment of isoniazid (INH) intoxication. DATA SOURCES: Human, animal and modeling studies published since 1940 identified through MEDLINE and a review of the bibliographies of relevant articles. STUDY SELECTION AND DATA EXTRACTION: The studies identified were reviewed with emphasis on the most recent. Earlier studies were selected for their historical value and relevance to the clinical setting...
August 1995: Intensive Care Medicine
R S Howard, S Russell, N Losseff, A E Harding, J M Hughes, C M Wiles, D H Miller, N P Hirsch
Patients with mitochondrial disease may present to the Intensive Care Unit (ICU) with a variety of neurological and general medical disorders. Eleven patients were admitted to a neurological ICU between 1970 and 1992 because of respiratory insufficiency, status epilepticus and/or metabolic encephalopathy associated with mitochondrial disease. Respiratory impairment occurred in eight patients and was associated with nocturnal hypoventilation due to respiratory muscle weakness, aspiration due to bulbar weakness and abnormalities of central control leading to a reduced CO2 drive, irregular respiratory patterns and sleep apnoea...
March 1995: QJM: Monthly Journal of the Association of Physicians
B Kirschbaum, M Galishoff, H D Reines
OBJECTIVE: To evaluate the effectiveness of continuous arteriovenous hemodiafiltration (CAVHD) using citrate as the anticoagulant for the treatment of lactic acidosis in patients with renal failure. DESIGN: Case series with careful monitoring of the clinical course of patients being treated in a medical or surgical ICU. SETTING: University hospital ICU. PATIENTS: Two patients with lactic acidosis are described, along with our experience using CAVHD and citrate in other clinical settings...
March 1992: Critical Care Medicine
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