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Query: UMLS:C0028961 (oliguria)
 1,847 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Records of all patients with a clinical diagnosis of septic shock were reviewed retrospectively; cases occurred from August 1968-July 1971 in a general teaching hospital with 667 beds. In the 3-year period, 80 patients (38 males and 42 females) presented with 82 episodes of septic shock; this represented 14% of total hospital admissions to Intensive Care. The age range was from 15-78 years, with a mean of 52+ or -16 years. The incidence of the syndrome increased with age, reaching a maximum in the 7th decade. 66 (0f 71) of the surgical/gynecological referrals followed operative procedures, of which 1/2 were undertaken electively. By the time of referal to the Intensive Care Unit, pyrexia, hyperventilation, cyanosis, vasoconstriction, pallor, and sweating were commonly present, although 16 patients presented with warm hypotension; moderate hypotension was present in 48 patients, and severe hypotension was present in 18. Dehydration, oliguria, and azotemia were frequently present on admission. Abnormalties in serum electrolytes were common. Blood gas analysis on admission revealed that marked hypoxemia was commonly present in association with hypocapnia and metabolic acidosis. Blood cultures were performed in 62 patients and positive results were obtained in 38 on at least 1 occasion. Of a total of 47 positive blood cultures, 33 were gram-negative organisms and 5 were gram-negative anaerobic bacilli. The former were sensitive to gentamisin and the latter were resistant to both the cephalosporins and ampicillin. Gram-positive organisms were sensitive to cloxacillin and cephalosporins. Initial mortality was 64%, which increased to 70% including late deaths after return to wards. Nonsurvivors were significantly older than survivors (P .005); they were more frequently dehydrated (P .005); and they were more subject to the development of tachycardia and cardiac arrhythmias. Nonsurvivors were also considerably more hypoxemic than survivors. There was a marked difference between nonsurvivors and survivors in mode of presentation and infection source; nonsurvivors were characterized by either mediastinitis as a consequence of leakage of an esophageal anasotmosis or fecal peritonitis.
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PMID:A three year retrospective analysis of septic shock in a general hospital. 23 90

To characterize the relation between clinical and hemodynamic state in acute myocardial infarction, 200 patients with acute infarction were evaluated with clinical and hemodynamic criteria. Patients were classified clinically on the basis of peripheral hypoperfusion (hypotension, tachycardia, confusion, cyanosis, oliguria) and pulmonary congestion (rales, abnormal chest roentgenogram). Four clinical subsets were defined that correlated with cardiac index (Cl, liters/min per m2) and pulmonary capillary pressure (PCP, mm Hg): (see article). Parallel hemodynamic subsets were developed independently on the basis of depressed cardiac index (2.2 liters/min per m2 or less) and elevated pulmonary capillary pressure (greater than 18 mm Hg). The rate of accuracy of clinical examination in predicting hemodynamic abnormalities was 83 percent. Mortality rates were similar in the clinical and hemodynamic subset calssifications, averaging 2.2 percent in subset I, 10.1 percent in subset II, 22.4 percent in subset III and 55.5 percent in subset IV. Drug interventions in the course of hospitalization resulted in a 38 percent increase in depressed cardiac index and 34 percent decrease in elevated pulmonary capillary pressure. Resolution of clinical abnormalities paralleled this hemodynamic improvement in 70 percent of patients. These data suggest that clinical performance and both clinical and hemodynamic subsets are directly relevant to establishing prognosis and the selection of therapy in patients with acute myocardial infarction.
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PMID:Correlative classification of clinical and hemodynamic function after acute myocardial infarction. 83 73

In a retrospective analysis of 2110 admissions to the pediatric intensive care unit, 564 cases of septic shock were identified (26.7% of the total admissions). Septic shock was defined in patients with: (1) clinical evidence of sepsis; (2) fever (greater than 38.3 degrees C) or hypothermia (less than 35.6 degrees C); (3) tachycardia; (4) tachypnea; and (5) inadequate organ perfusion. Inadequate perfusion was defined as hypotension or evidence of peripheral hypoperfusion (poor capillary refill or cyanosis with hypoxemia, oliguria, acidosis or altered mentation). Inotropic support was required to maintain an adequate blood pressure and perfusion in 268 of 564 patients (47.5%). Septic shock with confirmed bacterial infection occurred in 143 patients (143 of 564, 25.2%); these cases were caused by Haemophilus influenzae, type b (59 of 143, 41.3%), Neisseria meningitidis (26 of 143, 18.2%) and Streptococcus pneumoniae (16 of 143, 11.2%). Eight of 564 (1.4%) cases of septic shock were not clinically apparent on initial evaluation and were diagnosed within 24 hours after admission to the hospital. We conclude that septic shock occurs more frequently in children than previously appreciated and may develop after admission to the hospital.
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PMID:Septic shock in children: bacterial etiologies and temporal relationships. 233

The maternal mortality rate associated with eclampsia ranges from 100 to 6000 per 100,000, and the perinatal mortality rate ranges from 150 to 400 per 1000. Both eclampsia and its preceding condition, pregnancy-induced hypertension, occur in varying degrees in different parts of India. The warning signs of imminent eclampsia are 1) systolic blood pressure of 160 mmHg or more on two occasions six hours apart when the patient is on bed rest; 2) proteinuria of 5 g or more in 24 hours or 3 + or more by semiquantitative assay; 3) oliguria or anuria; 4) cerebral or visual disturbances; 5) pulmonary edema or cyanosis; and 6) epigastric/right hypochondriac pain, impaired liver function, and thrombocytopenia and coagulation disorders. Eclampsia is classified as the acute fulminating type, which can occur without warning, and the insidious type. Most cases (61%) show onset of eclampsia during the prenatal period. Treatment of eclampsia involves 1) control of convulsions (through an injection of magnesium sulphate or diazepam or the intravenous administration of phenytoin); 2) correction of hypoxia and acidosis; 3) a gradual lowering of blood pressure with hydralazine hydrochloride, nifedipine, atenolol, labetalol, oxprenolol, or metoprolol); and 4) steps to effect delivery. Diagnosis of HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) requires a complete blood count, blood film for platelet count and red blood cell fragmentation, and a coagulation screen for diagnosis of disseminated intravascular coagulation. Efforts to induce delivery in cases of prenatal eclampsia can take place 12-24 hours after convulsions have stopped. There is no reason to prolong pregnancy in the interests of the fetus, and in some cases Cesarean section may be required. Adequate prenatal care should allow the identification of almost every potential case of eclampsia and allow the prompt treatment of pre-eclampsia or termination of pregnancy when necessary. Medical staff must receive proper training to diagnose pre-eclampsia and treat the condition.
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PMID:Eclampsia. 765 39

A six-month old male infant with severe atopic dermatitis was admitted with hypoalbuminemia, oliguria and cyanosis of the extremities. There was marked edema and generalized eczema with foul, yellowish exudates. The patient's major clinical manifestations were attributed to the loss of albumin through the skin. Although atopic dermatitis is a common disease in children, here we want to show that systemic disturbances may arise from such condition, describe the total care given the patient, and emphasize the wholistic approach in managing cases of severe atopic dermatitis. Intensive treatment was instituted and the patient was discharged after three weeks and remained in a stable condition.
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PMID:Hypoalbuminemia, oliguria and peripheral cyanosis in an infant with severe atopic dermatitis. 890 61

Necrotizing cellulitis and fasciitis may be difficult to recognize. When skin necrosis is not obvious, the diagnosis must be suspected if there are signs of severe sepsis (accelerated heart or respiratory rates, oliguria, mental confusion.) and/or some of the following local symptoms or signs: severe spontaneous pain, indurated edema, bullae, cyanosis, skin pallor, absence of lymphangitis, skin hypoesthesia, crepitation, muscle weakness, foul smell of exudates. Many risk factors are suspected. A recent case-control study demonstrated that using ibuprofen increased the risk of cellulitis complicating chickenpox in children. Evidence is lower for other risk factors that are present with a high prevalence in most series: local lesion of skin or mucous membranes (acute or chronic disease, traumatism, surgery.), diabetes, arteriopathy, alcoholism, obesity, immunosuppression, NSAIDs. The risk of streptococcal necrotizing fasciitis is increased when in contact with patients infected by the same streptococcus.
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PMID:[Necrotizing fasciitis. Clinical criteria and risk factors]. 1131 68

The Abdominal Compartment Syndrome (ACS) is a clinical entity, which can be defined as the adverse physiologic consequences that occur as a result of a severe increase in intra-abdominal pressure (IAP), and is characterized by cardiovascular, pulmonary, renal, splanchnic, and intra-cranial disturbances regardless of the cause. The level of IAP at which ACS occurs is not known in children, therefore we suggest that the clinical signs of tensely distended abdomen, inability to palpate the femoral pulses, cyanosis of the lower extremities, progressive oliguria and hypoxia due to increasing airway pressures are sufficient to justify abdominal decompression. We report three cases of ACS and review the management of this condition.
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PMID:Abdominal compartment syndrome in children: the dilemma of treatment. 1461 25

Ergot toxicity in the newborn usually manifests itself as respiratory depression, cyanosis, oliguria, and seizures. Death is usually caused by respiratory failure. A limited number of neonatal cases have been reported worldwide, and almost all cases involved confusion of maternal methylergonovine with neonatal vitamin K. Previous case reports provided little information regarding the effectiveness and dosing of antidotal therapy, especially sodium nitroprusside. A full-term male infant was inadvertently given methylergonovine instead of naloxone at birth. Several hours later, he required intubation for respiratory failure. Peripheral perfusion, ventilation, and renal function improved rapidly with nitroprusside infusion, and he was extubated on the third hospital day. Even asymptomatic newborns should be transferred to a neonatal intensive care unit for close observation after methylergonovine administration because toxicity can be life threatening. Rapid recognition of the therapeutic error, ventilatory support, and prompt administration of sodium nitroprusside should lead to a good outcome.
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PMID:Neonatal ergot poisoning: a persistent iatrogenic illness. 1604 32

Rhabdomyolysis is associated with infectious diseases in approximately 5% of cases and acute kidney injury occurs in 33-50% of cases. Gangrenous myositis is a deep seated infection of the subcutaneous and muscular tissues. We report the case of an 18 year-old man who was admitted to the emergency room with leg pain, fever, nausea, vomiting and oliguria. Physical examination showed moderate dehydration, peripheral cyanosis and skin necrosis with severe myalgia and no subcutaneous gas. Laboratory findings at admission were: serum urea 111 mg/dL, creatinine 1.3 mg/dL, potassium 6.3 mEq/L, creatine kinase (CK) 112,452 IU/L, aspartate amino transaminase (AST) 1116 IU/L, alanine amino transaminase (ALT) 1841 IU/L, pH 7.31, bicarbonate (HCO3) 11 mEq/L and lactate 4.3 mmol/L. Emergency hemodyalisis was started, and antibiotics were given due to high suspicion for bacterial infection. The patient developed respiratory insufficiency and septic shock needing mechanical ventilation and vasoactive drugs. He presented spontaneous gangrenous myositis in both legs and in his left arm. After 26 sessions of hemodialysis, partial recovery of renal function was observed. He was discharged from the ICU after 38 days, still with leg pain. Acute kidney injury due to rhabdomyolysis should be considered as a possible complication of gangrenous myositis.
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PMID:Acute kidney injury due to rhabdomyolysis-associated gangrenous myositis. 1926 Mar 87

Prader-Willi syndrome is an uncommon multisystem genetic disorder caused by defects of chromosome 15 (15qll-ql3), often due to deletions or uniparental disomy The syndrome is characterized by neonatal hypotonia, dysmorphic facial features, short stature, motor and mental disabilities, behavioral changes, hyperphagia, precocious obesity and hypogonadotropic hypogonadism. We present a 17 year-old woman, with a previous genetic diagnosis of Prader-Willi syndrome and BMI of 74 Kg/m(2), that was admitted in anasarca, with marked cyanosis, dyspnea and oliguria. She presented high levels of blood urea, creatinine and aminotransferases, in addition to hyperkalemia and hyperuricemia. She had been in regular use of fluoxetine during the last six months, and evolved with severe high blood pressure and respiratory failure, which needed intensive care support. Moreover, sequels and clear signs of recent self-injuries were observed in her trunk, forearms and hands. The findings of morbid obesity, anasarca, self-injury, hyperuricemia and hypoxemia in Prader-Willi syndrome are emphasized.
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PMID:Morbid obesity in an adolescent with Prader-Willi syndrome. 1954 50


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