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

In ICU patients suffering from abdominal sepsis acute renal failure (ARF) is a common (50% incidence) and often lethal (more than 80% mortality) complication. Continuous monitoring of renal function is necessary for both adequate fluid replacement and early detection of ARF. Using a programmable handheld computer the following parameters are calculated at least daily: creatinine, osmolal and free water clearance, fractional excretion of sodium and potassium and non-saline loss. The clearance values are corrected to 1.73 m2 body surface area. Free water clearance proved to be a particularly valuable guide for fluid therapy as well as for early diagnosis of ARF. In all septic patients renal function is impaired to some degree, since despite increased cardiac output creatinine clearance is only normal or even decreased. More than 50% of our patients with abdominal sepsis develop ARF, resulting in a dramatic increase in mortality. Goal of renal monitoring in sepsis is to detect ARF as early as possible and to differentiate between extrarenal and septic origin to enable immediate surgical treatment.
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PMID:[Monitoring kidney function in abdominal infection]. 408 36

296 nonhospital abortions using an abortifacient paste method are examined in support of the outpatient abortion. Patients ranged in age from 11 to 47 years, 20% were married, and 98% were in the poverty or lower income level. The patients were seen at 2 1/2 months gestation. Under sterile conditions in a doctor's office 10-40 cc of a high viscosity paste - potassium neutral soap with KI and thymol, borne in a multitincture menstruum - was admitted by syringe into the internal os. The method paralleled the Luenbach paste method but abrasives were absent. The paste impaired circulation between zygote and chorion frondosum. On the 2nd day ergotrate was given. Flow lasted 3-7 days. There was frequent follow-up by phone. Check-up vaginals were done at 1 and 3 weeks. 78% had excellent results. 11% needed 2-3 weeks treatment with carbazochrome salicylate, vitamin K, or medrozyprogesterone acetate. 3% required dilatation and curettage. The 6% failures should be considered operator failures in misjudging length of gestation. Sepsis, serious complications, or fatality were absent with this method. Preliminary history omitted cases from this method that might preclude complications. The success with these cases indicates that the nonhospital, paste-induced abortion can be both effective and safe.
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PMID:Looking back at Luenbach: 296 non-hospital abortions. 491 44

Various metabolic, cellular, and subcellular alterations in cell function and morphology occur during shock or low-flow conditions. In attempting to find treatment programs that would be beneficial following shock, various substrates have been used. Infusion of hypertonic glucose during shock has been shown to improve survival; however, it is unlikely that the effect of glucose is by provision of energy until the circulation is restored. Infusion of glucose--insulin--potassium during shock has also been reported to be beneficial in certain clinical situations. Controversies exist concerning the efficacy of infusions of cyclic AMP, nicotinamide, and Krebs cycle intermediates during shock. Pretreatment of kidneys with inosine or raising glycogen stores of the myocardium have been shown to have protective effects of kidneys and myocardium during ischemia and these procedures may be suitable for organ preservation. Pretreatment with allopurinol has been shown to be beneficial in shock; however, it is unlikely that allopurinol by itself if given following shock would have any salutary effects. Treatment with ATP-MgCl2 has been shown to be beneficial following hemorrhagic shock, sepsis, endotoxin shock, burns, postischemic hepatic failure, and postischemic renal failure. Thus, provision of energy directly in the form of ATP during adverse circulatory conditions appears to be the most advantageous and direct method for the treatment of shock.
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PMID:The use of substrates and energy in the treatment of shock. 627 59

Amphotericin B, a systemic antifungal agent, has not been associated with clinical evidence of cardiac toxicity. We report the case of a 76-year-old patient who developed transient asystole with cardiovascular collapse on two occasions, which coincided with infusion of amphotericin B. The patient was semicomatose and had candida septicemia and renal failure. Serum potassium and digoxin levels were elevated, and serum calcium was low when these episodes occurred. Subsequent postmortem examination revealed no gross evidence of cardiac disease apart from fungal vegetations on the aortic valve. A clear causal relationship between amphotericin B and transient asystole is not demonstrated, but a temporal association, confirmed with rechallenge, is documented in this patient. No similar cases were found in a review of the literature.
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PMID:Transient asystole associated with amphotericin B infusion. 634 98

Untreated septic shock results in depletion of extracellular fluid, cellular swelling, increased intracellular sodium, and decreased intracellular potassium concentrations in primate skeletal muscle. The Langer rabbit heart interventricular septal preparation was used to determine whether similar changes occur in cardiac muscle during sepsis. Rabbit septa (n = 17) were perfused with control and septic rabbit plasma plus red blood cells. Tissue contractility (developed tension [DT] and rate of tension change [dP/dt]) was followed, plasma cations were measured (Na+, K+, Ca2+, H+), perfusion pressure (PP) was monitored, and 42K efflux was determined. The effect on 42K efflux caused by the addition of potassium chloride to control plasma was determined. During perfusion with septic plasma there was significant decline of septal function (P less than 0.001). In 12/17 experiments DT fell 77.8 +/- 21.4% and dP/dt fell 75.8 +/- 24.8% from control values (means +/- 1 SD). All septa recovered when perfusion with control plasma was resumed. If [K+] was increased in control plasma during 42K washout, the percentage increase of effluent counts per minute per minute correlated with the percentage rise of control plasma [K+] (r = 0.95, P less than 0.001). During perfusion with septic plasma there was no similar correlation (r = 0.277). 42K efflux increased during septic plasma perfusion independent of the differences between control and septic plasma [K+], demonstrating abnormal myocardial K+ efflux. An abnormal efflux of K+ is seen during septic plasma perfusion similar to that described in primate skeletal muscle. It is associated with and may be a mechanism of action for the observed fall of contractility.
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PMID:Altered potassium flux and myocardial dysfunction during sepsis. 638 64

The chemistry, microbiology, pharmacokinetics, therapeutic use, adverse effects, and dosage of amoxicillin-potassium clavulanate, a beta-lactamase-resistant antibiotic combination, are reviewed. Clavulanic acid is a "suicide" inhibitor of bacterial beta-lactamase enzymes and has been effective in preventing destruction of penicillins by these enzymes. Clavulanic acid alone has weak antibacterial activity against most organisms. After oral administration, clavulanic acid is rapidly absorbed; amoxicillin appears to increase its absorption. Absorption of amoxicillin-clavulanic acid is not affected by food. Amoxicillin-clavulanic acid is effective in treating both acute uncomplicated and complicated urinary-tract infections and exacerbations of chronic bronchitis caused by amoxicillin-resistant organisms in adults. It appears to be comparable in efficacy to cefaclor for treating uncomplicated urinary-tract infections in adults and children, acute bronchitis and bronchopneumonia, and acute sinusitis, otitis media, and skin and soft-tissue infections in children. Other infections for which the combination has been effective include cellulitis and intra-abdominal and pelvic sepsis caused by mixed aerobic/anaerobic organisms. Amoxicillin-clavulanic acid has also successfully cured urethritis in men caused by penicillinase-producing Neisseria gonorrhoeae and is superior to amoxicillin alone for beta-lactamase-positive Haemophilus ducreyi infections (chancroid). Diarrhea or loose stools is the most common side effect seen with amoxicillin-clavulanic acid; nausea, vomiting, and skin rash may also occur. Nausea, vomiting, and diarrhea may be lessened by taking the combination with food.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Amoxicillin-potassium clavulanate, a beta-lactamase-resistant antibiotic combination. 639 83

Mucormycosis in two patients with multiple-organ failure appeared as a cutaneous lesion and spread rapidly. In the first case, wet mounts and potassium hydroxide preparations were unhelpful, but a punch biopsy specimen established the diagnosis. Prompt and extensive debridement and amphotericin B administration arrested the infection. In the second case, virulent progression of the lesion occurred despite limited amputation, debridement, transfer factor, and amphotericin B, but finally responded to further amputation. Diagnosis was made by histologic examination of infected tissue. Both patients shared the following predisposing factors: sepsis, low blood flow, acidosis, multiple-organ failure, and multiple-antibiotic therapy. Although the mucormycosis was controlled, as confirmed in the first case at autopsy and in the second case by clear margins following reamputation, the outcome was fatal in both cases due to other features of multiple-organ failure.
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PMID:Mucormycosis in patients with multiple-organ failure. 647 4

The first reported case, in an adult, of cholestyramine induced hyperchloremic metabolic acidosis is a 70 year old female with a two year history of primary biliary cirrhosis confirmed by histologic and immunologic criteria. After taking cholestyramine II sachets twice daily for two months she presented with lethargy, confusion and drowsiness. Examination revealed confusion, jaundice, signs of chronic liver disease, portal hypertension and hepatic encephalopathy. Laboratory investigations confirmed a metabolic acidosis (pH 7.15) and hyperchloremia. Multiple cultures failed to reveal sepsis and a urinary pH of 4.85 together with tests of renal acidification, excluded renal tubular acidosis. She received 600 mEq of sodium bicarbonate intravenously over 36 hours by which time her mentation, electrolytes and pH were normal. It is presumed that her hyperchloremic metabolic acidosis was secondary to cholestyramine because of the similarity to pediatric reports; the rapid and lasting response to intravenous sodium bicarbonate; the absence of another etiology; normal serum potassium, chloride and bicarbonate despite continued spironolactone therapy after recovery.
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PMID:Cholestyramine induced hyperchloremic metabolic acidosis. 659 13

Measurements of total body potassium in a whole body counter revealed significant total body potassium depletion in patients suffering from high output enteric fistulas, short bowel syndrome and Crohn's disease. The clinical importance of this finding is derived from the fact that the degree of potassium depletion was found to be related to mortality, and that the introduction of an infusional regimen for preparation for surgery in Crohn's disease which effected intracellular potassium refilling resulted in a decreased surgical mortality and complication rate. In conclusion specific nutritional support as an essential measure in preparing such patients for elective surgery is particularly recommended. Significant cellular potassium depletion was also found in critically ill patients dying from sepsis. In contrast to the aforementioned diseases with malnutrition, where an increased fecal loss of potassium is the most likely cause of potassium deficiency, a different mechanism for cellular potassium loss is suggested in this condition from additional indicator dilution studies. Rather here the finding of increased distribution volumes for ions physiologically predominantly restricted to the extracellular space (82Br and 24Na) indicates a change of cell membran permeability suggestive of so called sick cell syndrome.
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PMID:[Changes in total body potassium and ion distribution compartments in general surgery and intensive care patients]. 673 38

Total exchangeable potassium (Ke) measurements were done on 13 patients who received total parenteral nutrition (TPN) at 25% dextrose and 2.5% amino acids (AA) (a hypertonic dextrose solution) by central vein, and 12 patients who received TPN as 10% dextrose, 10% fat emulsion (Intralipid), and 2.5% AA with lipid supplying about 60% of the nonprotein calories. There were 13 patients with benign diseases, three with carcinoma resected for cure, four with sepsis, three with severe burns, and two receiving chemotherapy for cancer. All but four of the septic and three of the burned patients had lost more than 10% of their normal body weight. A tracer dose of 150 to 300 microCi of K42 was injected intravenously during the first few days of the TPN therapy and a 48-hour urine collection and 24-, 36-, and 48-hour urine spot samples were obtained. Measurement of Ke was repeated after 7, 14, or 21 days of TPN therapy. Calories per kilogram per day, delta K per day, and percent delta K per day were determined for each patient and the data entered into a Textronics graphics computer for selection of curves of best fit. Similar curves of calories per kilogram per day versus delta K per day were obtained for the central and peripheral TPN groups. Intercepts where the body cell mass was maintained were at 32 calories/kg/day for the central TPN group and 34 calories/kd/day for the peripheral TPN group. Patients in both groups received a minimum of 0.6 gm protein/kg/day and the majority received from 0.8 to 1.2 gm protein/kg/day. Protein intake correlated with delta K per kilogram per day in the central but not the peripheral TPN group. We conclude that in nonseptic malnourished patients, an Intralipid calorie is as efficient as a dextrose calorie and that delta K is related to caloric rather than protein intake. None of the septic or burned patients maintained his body cell mass. However, they all received less than 30 calories/kg/day for a number of reasons.
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PMID:Total exchangeable potassium in patients receiving total parenteral nutrition. 677 83


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