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Query: UMLS:C0020672 (hypothermia)
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Previous studies showed significant differences in postmortem urea nitrogen (UN), creatinine (Cr) and uric acid (UA) levels in heart blood depending on the causes of death, including acute death. In addition, the levels in pericardial fluid approximated the clinical serum reference ranges, and their elevations may be assessed based on clinical criteria. The present study investigated difference between blood and pericardial levels of these markers. Medicolegal autopsy cases (n=556, within 48h postmortem) of the following causes of death were examined: injury (n=136), asphyxiation (n=50), drowning (n=39), fire fatalities (n=99), hyperthermia (n=11), hypothermia (n=8), poisoning (n=26), delayed traumatic death (n=44) and natural diseases (n=143). When serum UN, Cr and UA levels were compared with the pericardial levels, there was an equivalency for delayed traumatic death and chronic renal failure, although each level was markedly elevated. Parallel increases in serum and pericardial UA and/or Cr levels were also observed for hypothermia and gastrointestinal bleeding. However, in drowning cases, the left cardiac and pericardial UN levels were lower than the right cardiac and peripheral levels, suggesting the influence of water aspiration. Significant elevations in serum and pericardial Cr and UA levels with a higher serum/pericardial UA ratio for fatal methamphetamine intoxication suggest progressive skeletal muscle damage due to advanced hypoxia/acidosis. Similar findings were often observed for other acute and subacute deaths. These findings suggest that a comparison between blood and pericardial nitrogenous compounds would be useful for investigating the cause and process of death.
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PMID:Differences in postmortem urea nitrogen, creatinine and uric acid levels between blood and pericardial fluid in acute death. 1719 25

Acute kidney injury (AKI) is encountered in a variety of settings (e.g., hospitalized and outpatient, non-intensive and intensive care unit patients, pediatric, adult, and elderly), with varied clinical manifestations ranging from a minimal elevation of serum creatinine (SCr) to anuric renal failure and/or multi organ failure (MOF), and a wide variation in causes, risk factors and comorbiditis. There is no hard and fast rule as to when renal replacement therapy (RRT) should be initiated, but is clearly not sensible to wait until an obvious uremic complication arises. Modern practice is to initiate RRT sooner rather than later, for example, when the SCr concentration reaches 500-700 micromol/L, perhaps even earlier, unless there is clear evidence that renal function is about to recover. The choice of the treatment will depend on the clinical practice, technical resources, and well-trained nurses of a given department, than on precise clinical indication. The ideal RRT should mimic the functions and physiological mechanisms of the native organ, ensuring qualitative and quantitative blood purification, be free of complications, have good clinical tolerance and restore and maintain homeostasis, thus favouring organ recovery. Now available RRT options /peritoneal dialysis (PD), 2. intermittent hemodialysis (IHD), 3. continuous therapies (CRRT), and 4. hybrid therapies/, differ in the method of delivery, efficiency, and their clinical tolerability. AKI without MOF is less complex, can be managed outside intensive care unit and the same RRT techniques used for the treatment of chronic renal failure may be applied. AKI associated with MOF is a more complex condition and requires more flexible RRT. Acute PD remains a viable option for the treatment of selected patients with AKI, particularly pediatric population, and those who are hemodynamically compromised, have severe coagulation abnormalities, difficulty in obtaining blood access, removal of high molecular weight toxins (> 10 kD), and clinically significant hypothermia and hyperthermia. Patients that are hemodynamically stable can be managed with IHD techniques. Maintaining hemodynamic stability is probably one of the most important aspects of dialysis technique as well as one of the most difficult challenges. With CRRT, the continuous regulation of volume homeostasis could lessen the hourly rate of required UF, thereby improving hemodynamic stability compared with IHD. Clinical data suggest that CRRT should be strongly considered for patients with severe hyperphosphatemia, elevated intracranial pressure, cerebral edema complicating acute liver failure, sepsis or septic shock, might be a useful component of therapy for lithium intoxication, and because of continuous nature of process prevents the post-dialytic "rebound" elevation of plasma concentration of uremic toxins typically seen with IHD. Hybrid therapies using a variety of machines are safe and convenient, providing excellent control of electrolytes and fluid balance, and offers several advantages over CRRT, including less cumbersome technique, patient mobility, and decreased requirements for anticoagulation, while providing similar hemodynamic stability and volume control. Currently, it has been found no difference in mortality or renal recovery between hybrid RRT, CRRT or IHD for critically ill patients with AKI. However, future investigations should collect detailed information on long-term costs and the relative likelihood of renal recovery associated with dialysis modality.
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PMID:New experiences with the therapy of acute kidney injury. 1925 43

The present study analyzed serum levels of urea nitrogen (UN), creatinine (Cr), and C-reactive protein (CRP), which are very stable during the early postmortem period, for investigation of the cause of death with special regard to hyperthermia (heat stroke) in serial medico-legal autopsy cases (n = 429), excluding fatal injury, intoxication, and fire fatality. In this series, mechanical asphyxiation, drowning, and sudden cardiac death cases (n = 56, n = 43, and n = 212, respectively) usually showed low levels within postmortem reference ranges for these serum markers, although UN and CRP levels were mildly elevated in cases of sudden cardiac death and cerebrovascular stroke. There were concomitant significant elevations in serum levels of UN (>50 mg/dL), Cr (>2 mg/dL), and CRP (>2 mg/dL) for chronic renal failure, gastrointestinal bleeding, pneumonia, and hypothermia (cold exposure). UN and CRP were especially high for chronic renal failure and pneumonia, respectively. However, hyperthermia cases showed an isolated elevation in the serum Cr level, suggesting an influence of systemic skeletal muscle damage. These serum markers may be practically useful for postmortem investigation of death due to hyperthermia (heat stroke), for which specific pathological and toxicological evidence may not be available.
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PMID:Postmortem serum nitrogen compounds and C-reactive protein levels with special regard to investigation of fatal hyperthermia. 1929 58


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