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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Seventy-seven very low birthweight (VLBW) infants (mean birthweight 891 +/- 209 g) with a diagnosis of bronchopulmonary dysplasia (BPD) were treated with a steroid (dexamethasone) in an attempt to wean them from mechanical ventilation. Seventeen of 77 (22%) treated infants died. Death from respiratory failure occurred in 13 infants; sepsis occurred in six infants (7.8%) and contributed to death in one. During steroid therapy systemic hypertension occurred in 18 surviving infants (30%), glucose intolerance occurred in 29 infants (38%), and marked irritability occurred in three infants (3.8%). Elevated blood pressure returned to normal and glucose intolerance resolved in all infants following discontinuation of therapy. Fifty infants were available for follow-up at a mean corrected age of 14.9 +/- 9.8 months. Twenty-two percent required rehospitalization in the first year of life for respiratory illnesses. Results of testing by Bayley Scales of Infant Development were normal in 60% of infants. Fifty percent were considered normal based on both developmental testing and physical examination. Twenty-eight percent had mild to moderate abnormalities, and 22% were severely handicapped. These follow-up results are statistically similar to those recorded in LBW infants with BPD not treated with steroids who were hospitalized during the same period. We conclude that the side effects of steroid therapy for BPD consist primarily of blood pressure elevation, glucose intolerance, and irritability. Causes of death are unchanged by steroids. The incidence of severe infection and the long-term neurologic outcome of high-risk infants with BPD are not appreciably compromised by this therapy. These data suggest that concern for steroid side effects should not prevent additional prospective investigation to determine the role of steroid therapy in the overall management of BPD.
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PMID:Side effects and long-term follow-up of corticosteroid therapy in very low birthweight infants with bronchopulmonary dysplasia. 235 96

Although nutritional support is vital to treatment of severe sepsis, the septic patient does not respond normally to glucose infusion. We have used the hyperglycemic glucose clamp technique to investigate the initial hormonal and metabolic responses of the septic patient to glucose under controlled conditions. The plasma glucose concentration was raised to and maintained at 12 mmol/liter for 2 hr in 12 septic patients and 11 normal controls. Glucose utilization, assessed from the amount infused, was significantly depressed in the patients, despite similar plasma insulin concentrations in the two groups. Forearm glucose uptake was similarly impaired. Despite very similar plasma free fatty acid concentrations in the two groups, which were suppressed equally by the glucose infusion, whole-body fat oxidation was elevated in the patients compared with the controls, and suppressed to a lesser extent in response to glucose. Glycerol and ketone body concentrations were elevated in the patients in keeping with a picture of accelerated release, clearance, and oxidation of fatty acids. Plasma cortisol, epinephrine, and norepinephrine concentrations were elevated in the septic patients in a severity-related manner, but not to high levels compared with experimental work. Norepinephrine showed no response to the glucose infusion in either group. Plasma glucagon concentrations were not significantly elevated in the septic patients. We conclude that the hyperglycemic glucose clamp provides a useful model for studying glucose intolerance in sepsis. Impaired glucose utilization in septic patients is associated with increased fat oxidation, although the hormonal basis for these changes is still unclear.
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PMID:Hormonal and metabolic responses to glucose infusion in sepsis studied by the hyperglycemic glucose clamp technique. 311 25

Current concepts in the nutritional support of patients with renal disease are reviewed. In chronic renal failure, alterations in fat, carbohydrate, and glycogen metabolism usually occur and may be worsened by acute illness. Total parenteral nutrient (TPN) therapy is rarely required unless complications occur. In contrast, acute renal failure is generally associated with hypovolemia, sepsis, soft tissue injury, and coagulation defects, all of which influence metabolism and extracellular fluid volume; the gluconeogenesis that often occurs in these patients masks the metabolic effects of uremia. Nutritional support of patients with renal disease aims at providing adequate nutrients while limiting accumulation of nitrogenous waste. Current concepts concerning essential amino acids (EAAs), nonessential amino acids (NEAAs), and urea recycling are reviewed. The caloric needs of patients with renal failure are assumed to be similar to those of other hospitalized patients. There is no clinically important advantage of using an EAA formulation rather than mixed (EAA and NEAA) amino acids. Since fluid restriction is recommended and protein use is improved with diets with a high calorie-to-nitrogen ratio, the use of TPN solutions with dextrose 350 g is recommended. If glucose intolerance is severe, fat should be considered as a calorie source. Recommendations for monitoring the metabolic status of patients with renal failure receiving nutritional support are reviewed. Monitoring the metabolic status of patients with renal disease is crucial to providing safe and effective nutritional therapy. There appears to be no clinically important advantage to amino acid products specially formulated for use in renal disease.
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PMID:Nutritional support of patients with renal disease. 642 98

This is a brief review of the observed hormonal alterations following trauma and sepsis. The major changes noted in the metabolic status of the stressed patient have been characterized by deranged carbohydrate metabolism, altered metabolic rate as measured by oxygen consumption and increased ureagenesis. Each of these phenomena are regulated to a large extent by the specific hormonal profile of the patient. Failure of insulin and growth hormone production have been associated with glucose intolerance, excessive urinary nitrogen loss and a fatal outcome. Glucagon, cortisol and catecholamines exhibit sustained elevation and have been associated with increased metabolic rate and excessive ureagenesis. These changes are usually self limited following trauma but will persist if the patient enters a septic phase. The use of specific nutritional support, namely hypertonic glucose versus a balanced fat emulsion system in the face of sepsis is considered.
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PMID:Hormonal changes and their influence on metabolism and nutrition in the critically ill. 675 38

Glucose intolerance and its hormonal influence was examined in patients with sepsis. Eighteen patients were included in the protocol, which studied the response to a standard intravenous glucose tolerance test (GTT) in the postoperative stressed, septic, and septic protein malnourished (depressed albumin level) states. Four groups could be defined: stress (1), sepsis with depressed albumin level and normal glucose tolerance (2), sepsis with mild glucose intolerance and normal albumin levels (3), and sepsis with severe glucose intolerance and depressed albumin (4). Serial hormone levels were measured during the GTT, including insulin, glucagon, epinephrine, and human growth hormone values. Each group demonstrated a characteristic hormone profile. In a comparison with controls, group 2 was associated with mild suppression of insulin; group 3 exhibited mild glucose intolerance, hyperglucagonemia, and increased insulin; and group 4 demonstrated severe glucose intolerance, hyperglucagonemia, and marked suppression of growth hormone production.
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PMID:Sepsis, glucose intolerance, and protein malnutrition: a metabolic paradox. 677 57

Major alterations in the glucose-mediated regulation of growth hormone are associated with sepsis; however, these alterations are not related to the rate of change in plasma glucose or changes in glucagon, epinephrine levels, or circulating levels of arginine. Alterations in the growth hormone regulatory mechanism occurred among septic patients who manifested severe glucose intolerance which was associated with suppression of insulin production. Inhibition of growth hormone release in these patients may have an adverse effect on amino acid movement, which lends further support to the concept that sustained hyperglycemia in the septic patient is undesirable.
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PMID:Glucose-dependent changes in growth hormone regulation associated with sepsis. 702 2

Patients with sepsis, burn, or trauma commonly enter a hypermetabolic stress state that is associated with a number of alterations in carbohydrate metabolism. These alterations include enhanced peripheral glucose uptake and utilization, hyperlactatemia, increased glucose production, depressed glycogenesis, glucose intolerance, and insulin resistance. The hypermetabolic state is induced by the area of infection or injury as well as by organs involved in the immunologic response to stress; it generates a glycemic milieu that is directed toward satisfying an obligatory requirement for glucose as an energy substrate. This article reviews experimental and clinical data that indicate potential mechanisms for these alterations and emphasizes aspects that have relevance for the clinician.
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PMID:Alterations in carbohydrate metabolism during stress: a review of the literature. 782 23

Four hundred and eighty-two patients with spontaneous skin and superficial sepsis and 291 controls of similar age and sex underwent random capillary blood glucose measurements in order to assess whether screening for diabetes in patients presenting with skin sepsis to an Accident & Emergency Department detects a greater number of cases than that present in the background population. All subjects with a concentration > 7.8 mmol/l were subsequently followed up with a 75 g oral glucose tolerance test. Forty-two (8.7%) of the 482 skin sepsis patients had a capillary blood glucose > 7.8 mmol/l compared to eight (2.7%) of the 291 without sepsis (chi 2 = 9.71, P < 0.002). Of these, 26 of the skin sepsis group and 7 of the control group attended for follow up. Of those who attended, 13 of the skin sepsis group had an abnormal glucose tolerance test (seven diabetes, six impaired glucose tolerance-IGT) compared to two (one diabetes, one IGT) of the control group (chi 2 = 2.87, P < 0.1). The difference in cases of frank diabetes between the two groups was not statistically significant. Of the total eight diabetic cases identified, five (on direct questioning) had symptoms of hyperglycaemia (thirst, polyuria and/or weight loss) and two of the others were obese, one of whom had documented ischaemic heart disease. Thus, while most cases of diabetes in patients with skin sepsis could be detected by specifically asking about hyperglycaemic symptoms and performing a blood glucose estimation when these are present, we suggest that the screening of patients with skin sepsis over 40 years of age provides an opportunistic method of screening. This strategy should yield clinically significant numbers of abnormal cases.
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PMID:The value of screening for diabetes in patients with skin sepsis. 845 78

An analysis of beta thalassemia major patients seen at Hospital Juan P. Garrahan was carried out in order to determine the characteristics and outcome of the population. From August 1987 to July 2000, 45 patients were admitted (27 males-18 females). The most common beta globin gene defects were C-39 (30.7%); IVS-I nt 110 (20%); IVS-I nt 6 (13.3%); IVS-I nt 1(4%). alpha globin genes were normal in 42 patients, 1 patient had triplicate and cuadriplicate alpha globin genes and 2 patients were not analyzed. Six patients of 5 families were heterozygous for -158G gamma mutation. Allogeneic stem cell transplantation was performed in 7 patients, with an identical sibling. Transfusion-related infections and alloantibodies were detected in 6.7% patients. Growth assessment showed no significant difference in the stature of girls compared to the reference population, but 5 boys had short stature. There is a tendency to short trunk. Growth velocity was normal at prepubertal age. No X-ray lesions related to desferrioxamine were observed. Delayed puberty and hypogonadotropic hypogonadism were found in 35.7% and abnormalities in GH/IGF-I axis in 12.5% of the patients. Impaired glucose tolerance was found in 2 patients. No patient developed diabetes mellitus, thyroid or adrenal insufficiency. One patient had cardiac complications. Forty-two patients are alive and 3 died (cardiac failure 1, central nervous system bleeding 1, sepsis 1). We conclude that beta thalassemia major, originated mainly from Italian immigrants, has a cumbersome treatment and is severely hindered by the lack of adequate economic resources in our patients.
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PMID:[Beta thalassemia major in Argentina]. 1203 33

Increased cardiovascular risk in diabetes mellitus has been well-documented. In contrast, it is not widely known, that the relation between degree of hyperglycemia and mortality of diabetics or nondiabetics with acute coronary syndromes (ACS) shows a positive correlation. Insulin treatment significantly improves survival of patients with both ACS and septicemia. New onset diabetes or impaired glucose tolerance can be detected in significant proportion of patients with AMI or coronary artery disease. New onset disturbance of carbohydrate metabolism has a powerful negative influence on clinical prognosis, therefore it's early diagnosis is considered an important new challenge for clinicians. The authors discuss prognostic significance of hyperglycemia-induced macroangiopathy, postprandial blood glucose, and concomitant metabolic state, respectively, furthermore potential therapeutic role of insulin in treatment of ischemic, reperfusional, and toxic metabolic disturbances.
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PMID:[Role of blood glucose in prediction of cardiovascular risk]. 1651 30


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