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

Ileostomy function was studied in 12 patients with an established ileostomy following proctocolectomy, in 6 of whom minimal amounts (less than 9 cm) and in 6 significant amounts (30-120 cm, mean 60 cm) of terminal ileum had been removed. Patients who had undergone significant ileal resection had daily faecal volumes considerably greater than those with minimal ileal resection (1202 +/- 284 ml versus 401 +/- 92 ml, P less than 0.001), and also greater daily outputs of sodium (146 +/- 53 mEq versus 43 +/- 12 mEq) and potassium (12.7 +/- 9.0 mEq versus 4.0 +/- 0.99 mEq). The percentage water content of the ileostomy fluid was greater in patients who had had the ileum resected (93.1 +/- 1.8% versus 89.8 +/- 2.5%). In addition, the sodium/potassium ratio in the urine in patients with a properly acting ileostomy after ileal resection was low. It is concluded that when recurrent inflammatory bowel disease, partial small bowel obstruction and intraperitoneal sepsis have been excluded there remains a number of patients whose high ileostomy output is due entirely to the amount of ileum resected. The management of patients with a high output ileostomy with codeine phosphate, Lomotil and oral administration of sodium chloride tablets is discussed.
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PMID:Cause and management of high volume output salt-depleting ileostomy. 117 16

Septic shock in young children is often characterized by clinical findings consistent with a reduction in cardiac index (CI) and elevation of systemic vascular resistance index (SVRI). In this context, infusion of inotropic agents, alone or in combination with vasodilators, has been recommended. We have utilized group B streptococcal (GBS) infusion in piglets to develop a model of low-CI/high-SVRI septic shock, and report here the effects of the combination of epinephrine (EPI) plus either nitroglycerin (NG) or nitroprusside (NP) in this model of infant sepsis. Piglets were anesthetized, intubated, and ventilated. All piglets received GBS continuously for 90 minutes and were further divided into three experimental groups. Group 1 received NG 16 micrograms/kg.min plus EPI 2 micrograms/kg.min; group 2 received NP 10 micrograms/kg.min plus EPI 2 micrograms/kg.min, and group 3 received 0.9% sodium chloride (saline) only. CI, which fell for all three groups at the onset of GBS infusion, rose significantly in group 2 animals (but not in groups 1 and 3). This effect was mediated entirely by an increase in myocardial stroke volume. Aortic blood pressure, initially unaffected by GBS infusion, rose significantly in both group 1 and 2 compared with group 3. SVRI, which rose for all three groups at the onset of GBS infusion, was further markedly elevated in group 1 (but not in groups 2 and 3). Pulmonary artery pressure and pulmonary vascular resistance index, both significantly increased after GBS infusion, were reduced in group 2 but not groups 1 and 3. These observations illustrate the potential for unexpected, and possibly detrimental, hemodynamic consequences when vasoactive agents are combined in young septic animals.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Hemodynamic effects of combining epinephrine with nitroglycerin or nitroprusside during group B streptococcal sepsis in piglets. 141 51

The toxic components of supernatants from Pseudomonas aeruginosa cultures directed against HeLa cells and Staphylococcus aureus were evaluated with the aim of discovering interactions. Supernatants of eight different strains of P. aeruginosa were assayed for cytotoxic activity. All were active against HeLa cells; seven were toxic for S. aureus. On repeated suspension of P. aeruginosa in 0.9% sodium chloride solution, a shift from HeLa cell toxicity to staphylococcal lytic activity occurred along with a change of toxic activity from a high (50,000 +/- 5,000) to a low (8,000 +/- 400) molecular weight (MW) range on gel filtration. Addition of protein to the minimal medium of cultures producing material toxic only for S. aureus reactivated the generation of HeLa cell-toxic material. Cultivation of P. aeruginosa in the presence of HeLa cells and a chloramphenicol supplement produced suppression of the generation of material toxic for S. aureus but facilitated that of HeLa-toxic material of high MW. Adaptation of toxicity against fibroblasts developed only on cocultivation of P. aeruginosa together with S. aureus and in the presence of fibroblasts. Under these conditions a strong lytic activity for S. aureus appeared, even in the presence of chloramphenicol. Chloramphenicol caused the material toxic for fibroblasts to elute at a low MW well separated from that toxic for HeLa cells. In contrast to the high-MW toxic substances, the low-MW material did not induce antibodies after injection into rabbits. This may explain failures of vaccination against P. aeruginosa infection and of serum therapy of homologous sepsis in humans.
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PMID:Variation and adaptation of Pseudomonas aeruginosa toxicity to HeLa cells and fibroblasts. 309 24

V vulnificus is a halophilic or salt-requiring vibrio that has been isolated repeatedly from seawater and shellfish in coastal waters. This vibrio, first described by Hollis et al in 1976, can be differentiated from other similar vibrios by its ability to ferment lactose and by its lower tolerance for sodium chloride. V vulnificus, unlike most other vibrios, has seldom been incriminated as a cause of gastroenteritis but is a particularly virulent organism that causes severe wound infections in mostly healthy persons, or causes primary septicemia in persons with an underlying chronic disease, particularly chronic liver disease. Wound infections may range from relatively mild to severe and rapidly progressive cellulitis and myositis. Approximately 50% of patients with wound infections have some type of chronic underlying disease and the mortality rate is in the range of 15%. Wound infections are almost always associated with contact with seawater or the handling or cleaning of shellfish. Patients with primary septicemia have fever, chills, and prostration, and rapidly become hypotensive. Over 70% have distinctive bullous skin lesions that can strongly suggest the diagnosis in a patient with the appropriate history. The mortality rate is over 50%. There is a striking association between eating raw oysters and primary septicemia, with patients usually reporting having eaten raw oysters (or other shellfish) 24 to 48 hours before onset of symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Vibrio vulnificus. 366 22

Steroids and cyclooxygenase inhibitors have been advocated as adjunctive treatment for sepsis. We studied the influences of these treatments on the survival of 98 male Sprague-Dawley rats in which sepsis was induced by cecal ligation and puncture. Rats received one of four treatments: sodium chloride (NaCl); methylprednisolone, 30 mg/kg (MP); ibuprofen, 12.5 mg/kg (I); methylprednisolone, 30 mg/kg, plus ibuprofen, 12.5 mg/kg (MP + I). Cumulative survival statistics were determined daily for 14 days thereafter. Survival was not altered by either MP or I when compared to animals receiving NaCl only. However, the combination of MP + I increased mortality from day 2 through day 14. The authors conclude that (1) MP administration alone does not increase mortality in septic rats; therefore, the results do not support the contention that steroid treatment in the absence of antibiotic therapy may be detrimental; (2) the cyclooxygenase inhibitor I does not improve survival in septic rats; and (3) the combined administration of MP and I increases mortality in septic rats and the possibility that this combination might be harmful in septic patients should be considered also.
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PMID:Methylprednisolone plus ibuprofen increases mortality in septic rats. 650 29

A 68-year-old female on two-year chronic hemodialysis for chronic renal failure due to chronic pyelonephritis, was admitted to hospital for weakness, dulled sensorium and dizziness. On examination the patient was in a state of circulatory collapse, the electrocardiogram showed an accelerated idioventricular rhythm and laboratory analysis revealed extreme hyperkalemia (K+ 10.1 mmol/l). There were no common causes of shock, such as hypovolemia, sepsis, heart failure and presence of vasodilator drugs. The patient was treated with calcium gluconate, sodium bicarbonate and sodium chloride (to oppose the effects of hyperkalemia on the cell membrane to minimize cardiac and neuromuscular toxicity), insulin and dextrose (to increase the transport of K+ from the extracellular to the intracellular compartment), and hemodialysis (to remove K+ from the body). At the end of the hemodialysis session, the patient was in a clinically good condition, blood pressure was 160/90 mm Hg and the serum K+ concentration was normal. The case appeared to suggest that extreme hyperkalemia may have direct effects on vascular resistance, causing hypotension and shock.
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PMID:A life-threatening complication of extreme hyperkalemia in a patient on maintenance hemodialysis. 748 41

Recently, sepsis has been shown to impair intestinal amino acid absorption in addition to gut metabolic and barrier functions. We investigated intestinal proline absorption in a rabbit model of sepsis. Twelve hours after intraperitoneal injection of lipopolysaccharide, proline uptake by everted jejunal sacs prepared from septic animals (480.4 +/- 67.4 nmol per sac per hour) was significantly reduced compared with controls (846.8 +/- 73.5 nmol per sac per hour) (p < .001 by t test). We next investigated whether reduced expression of transporter proteins contributed to the impaired intestinal proline uptake during sepsis. The proline (imino) carrier of rabbit jejunum is covalently bound by fluorescein isothiocyanate (FITC) and/or phenylisothiocyanate with irreversible inhibition of proline uptake. This binding and inhibition is prevented by sodium chloride and L-proline. Single-cell suspensions of rabbit enterocytes were prepared 12 hours after intraperitoneal injection of lipopolysaccharide/saline or saline alone. Enterocytes were incubated for 30 minutes in tris(hydroxymethyl)aminomethane/ethylenediaminetetraacetate (Tris/EDTA) buffer; buffer with 1 mM phenylisothiocyanate; or buffer with 10 mM proline, 100 mM sodium chloride, and 1 mM phenylisothiocyanate. After incubation with 10 microM FITC in Tris/EDTA buffer for 15 minutes, the percent positivity and fluorescent intensity of FITC binding to enterocytes were determined by using flow cytometry. Sepsis significantly reduced the percentage of enterocytes binding FITC and the fluorescent intensity of FITC binding of proline/sodium chloride-pretreated or untreated cells. This suggests that sepsis depresses the expression of imino transporters by rabbit enterocytes, which may explain the reduced intestinal proline absorption.
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PMID:The role of the imino transporter protein in sepsis-impaired intestinal proline absorption. 830 2

A case of hyponatremia and then hypernatremia in a hospitalized patient receiving total parenteral nutrition (TPN) is described, and the etiologies, diagnoses, and treatments of hyponatremia and hypernatremia are reviewed. A 23-year-old man whose left leg had been amputated after a motorcycle accident required parenteral nutrition because of an ileus. After developing sepsis, he was given antimicrobials administered in standard dilutions of 5% dextrose injection, contributing 3 L of free water a day to his fluid intake. The patient subsequently became hyponatremic, and the sodium content of the TPN solution was increased to 140 meq/L. Multiple doses of furosemide and albumin were administered because of weight gain and edema of the lower extremity. After 14 days, all antimicrobial therapy was discontinued, and 2 days later the patient became hypernatremic. The sodium content of the TPN solution was decreased and then eliminated. Because of a 16-kg weight loss, diuretic therapy was stopped. This patient's hyponatremia was caused by administration of large amounts of sodium-free fluids (i.e., antimicrobials in 5% dextrose injection). The most appropriate management would have been to change the fluids in which the antimicrobials were diluted, with no change in the sodium content of the TPN solution. The patient's subsequent hypernatremia is best explained by a loss of free water. To manage this condition, it would have been appropriate to administer 5% dextrose injection to replace the free-water loss. Once the patient had reached baseline weight and therapy with the diuretic had been discontinued, maintenance therapy with 0.45% sodium chloride injection would have been beneficial. No change in the TPN sodium content should have been required. It is important to recognize all factors that predispose patients receiving TPN to hyponatremia and hypernatremia. Although the focus is often on the sodium content of the TPN solution, sodium and fluid can be administered by other means, including medication admixtures and maintenance intravenous fluids.
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PMID:Sodium imbalance in a patient receiving total parenteral nutrition. 845 63

Blood cultures were performed on 141 newborn infants who had clinical features or laboratory data indicative of sepsis between January 1993 and April 1995. Clinical features included respiratory deterioration, poor activity, abdominal distension and apnea. Abnormal laboratory data included leukocytosis, leukopenia, elevated C-reactive protein values or increased immature neutrophil counts. The 141 neonates with suspected bacterial infections received antibiotic therapy and were randomly divided into two groups. One group received a single dose of 500 mg/kg of intravenous immunoglobulin (IVIG), while the other group received placebo (0.9% sodium chloride). Patients with negative blood cultures were excluded from this study. A total of 56 neonates with positive blood cultures were enrolled in this study. The IVIG-treated group and placebo-treated group consisted of 10 premature and 18 term neonates, respectively. Another 10 healthy premature and healthy 18 term neonates were selected as the control group. Serum IgG values increased significantly 1 and 2 weeks after administration of IVIG in the IVIG-treated group. However, there was no significant difference in the duration of treatment and mortality between the IVIG-treated and placebo-treated groups. Our preliminary observations suggest that administration of 500 mg/kg IVIG to neonates with sepsis had no effect on reducing mortality. In addition, it shortened neither the duration of antibiotic therapy nor hospitalization. No adverse reactions to the IVIG infusions were noted during the study.
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PMID:Intravenous immunoglobulin in the treatment of full-term and premature newborns with sepsis. 899 Jul 71

This study was carried out to compare the efficacy of a cereal based ORS (prepared with 50 G of sagodana (cereal), 3.5 G/L sodium chloride, 1.5 G/L potassium chloride, 2.9 G/L trisodium citrate) with rice based oral rehydration solution (using same amounts of rice and electrolytes) for treatment of diarrhoea. One hundred and twelve children aged 3 months to 2 years with watery diarrhoea of less than 5 days duration with mild to moderate dehydration and no sepsis, were included in the study. The amount of ORS intake, stool volume and frequency were similar in both groups. Clinical success was seen in 79% of rice ORS group and 81% in sagodana group. Both can be used as a cereal based ORS in the management of acute diarrhoea in communities where it is culturally accepted and used as a weaning diet.
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PMID:Sagodana based verses rice based oral rehydration solution in the management of acute diarrhoea in Pakistani children. 905 31


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