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

Over a period of 2 years, 82 patients out of 2,390 (3.43%) admitted to an intensive care unit developed acute renal failure (ARF). The diagnosis of ARF was based on the usual criteria of oliguria, a rising blood urea nitrogen and creatinine, urine sodium concentration greater than 20 mmol/l and a U/P osmolality ratio less than 1.1. In 9.2% of patients the latter two criteria were misleading. Sepsis was the commonest cause of vasomotor nephropathy but in 20.7% potentially nephrotoxic agents had been administered before development of ARF. Overall mortality was 73.2%, with patients older than 50 years of age having the highest mortality. ARF is associated with prolonged bed occupancy--an average of 59.8 days for the dialysed patients with ARF versus an average length of stay of 8.4 days for the hospital overall.
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PMID:Aetiology, diagnosis, treatment and prognosis of acute renal failure in an intensive care unit. 54 32

Hormonal and substrate profiles and urinary nitrogen and urea excretion were measured in 78 underweight patients admitted for surgical investigation, who were placed into either a normo- or a hyperketonemic group, depending upon their levels of acetoacetate and beta-hydroxybutyrate. The two groups were otherwise similar in terms of weight loss, arm muscle circumference, triceps skinfold thickness, and serum protein levels. Before surgery only one-quarter of them were hyperketonemic displaying mean glucose, insulin, and glucagon levels characteristic of starvation-adaption, and excreted significantly less urinary nitrogen than in normoketonemic group. Those patients who underwent surgery tended to retain their presurgery hormonal and substrate profile. The normoketonemic group excreted significantly greater amounts of urinary nitrogen, depleted body protein to a greater extent as evidenced by larger changes in arm muscle circumference and serum protein levels, and mortality was greater. Interference with insulin-glucagon balance by sepsis and disease is suggested as a possible explanation for the failure of three-quarters of the patients to become starvation-adapted. The implications of this finding on the parenteral feeding of undernourished patients are discussed.
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PMID:Ketosis and nitrogen excretion in undernourished surgical patients. 57 67

The metabolic response to injury and illness as manifested by increases in energy expenditure and nitrogen losses makes it difficult for the clinician to evaluate calorie and protein needs. A method for determining daily calorie needs in hospitalized patients is presented. Average increases in resting metabolic expenditure for a group of patients following elective operation, skeletal trauma, skeletal trauma with head injury, blunt trauma, sepsis and burns were determined by indirect calorimetry and protein need by urinary nitrogen losses over extended time periods. Total daily calorie needs were then calculated, using the Harris-Benedict equation and adjusting this value upward using a previously measured activity and injury factor to arrive at the daily needs. Protein requirements may be determined on periodic 24 hour urine samples analyzed for the urinary urea nitrogen and adjusting this to a total nitrogen or protein equivalent. This approach to estimating the calorie nitrogen needs of the hospitalized patient under various degrees of stress more closely approximates the patient's variable needs at the height of the catabolic response and during convalescence.
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PMID:Metabolic response to injury and illness: estimation of energy and protein needs from indirect calorimetry and nitrogen balance. 57 68

Six boys, 2 weeks to 5 years old, underwent cutaneous ureterostomy for massively dilated upper urinary tracts secondary to obstruction by posterior urethral valves. Cutaneous ureterostomies had been performed elsewhere in 2 patients. Two patients underwent transurethral fulguration of the valves initially with no improvement. Blood urea nitrogen, creatinine and serum electrolyte values continued to increase and, therefore, cutaneous ureterostomies were performed with dramatic improvement. Two patients presented with sepsis, one of whom had a positive blood culture. Both children had severe pyonephrosis and after the conditions improved with medical treatment cutaneous ureterostomies were done. The total number of surgical procedures required for all patients was 59, including renal biopsies, nephrostomies and cystoscopies. No kidneys, except for the severely dysplastic ones, were lost and all patients resumed normal growth rates and have had no urinary tract infections. All laboratory values are within normal limits.
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PMID:Posterior urethral valves managed by cutaneous ureterostomy with subsequent ureteral reconstruction. 66 Jul 48

Long-term parenteral feeding in childhood must be adapted to the requirements of the young organism. The caloric requirements are mainly provided by glucose and fat emulsions; additional calories can be supplied by xylite and, with some reservations, by fructose. For neonates and young infants the combination and quantity of amino-acids is of particular importance: histidine, arginine, proline and tyrosine are essential amino-acids; glycine, glutamic acid, aspartic acid and cystine should form part of the unspecific sources of nitrogen. Addition of trace elements and vitamins is obligatory in long-term parenteral feeding. Complications may arise at the site of the catheter (sepsis, clotting). Late damage due to intravenous feeding is known to occurs; but a more detailed knowledge needs long-term investigations.
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PMID:[Problems of long-term parenteral feeding in childhood (author's transl)]. 82 14

Renal failure developed in 20 patients following blunt civilian trauma. Ten recovered normal renal function; 8 currently survive. Survivors and nonsurvivors did not differ in age, time from trauma to anuria, mean blood urea nitrogen or creatinine level prior to the first or to subsequent dialyses. However, there was an increased incidence of sepsis and liver failure in those who died. When outcome was related to site of injury, patients with closed head injury and/or intra-abdominal injury had a worse prognosis than those with thoracic or extremity injury only. Only 2 patients with perforated bowel survived; both had peritoneal dialysis combined with peritoneal lavage with antibiotic solutions. Mortality in patients with posttraumatic renal failure remains high; however, death is usually a result of associated complications rather than a result of the renal failure. Aggressive management of other complications of the trauma, especially sepsis or potential sepsis, is necessary. We recommend peritoneal dialysis combined with peritoneal antibiotic lavage where there is a potential for posttraumatic intra-abdominal sepsis associated with renal failure.
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PMID:Acute renal failure following blunt civilian trauma. 84 28

Indirect calorimetry and nitrogen measurements suggest that uncomplicated abdominal surgery produces no significnat change in resting metabolic expenditure and only a slight loss of urinary nitrogen. More severe injury and infections produce larger increases in resting metabolic expenditure and nitrogen loss. Severe injuries can result in a 15 to 30% loss of body weight, but the protein contribution to caloric expenditure does not exceed 20% and is less than expected. The provision of calories and nitrogen can change the course of the septic patient. A continual conversion of alanine carbon to glucose occurs in septic patients, including those who are receiving exogenous glucose at the normal hepatic production rate. In sepsis, the release of glucogenic substrates from peripheral tissues may determine the rate of hepatic gluconeogenesis.
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PMID:Energy balance and carbohydrate metabolism in infection and sepsis. 88 81

The protein catabolic response to sepsis has been measured in three patients and in two normal subjects using a pulse injections of L-[15N]alanine. In addition, the urea kinetics were measured using a pulse administration of [15N]urea. Several nitrogen models which simulated the metabolic pathways of nitrogen-labeled compounds were tried. Best curve fits and acceptable confidence limits were obtained with a four-pool model containing two metabolic pools and two urea pools. Using this model, synthesis and catabolism rates were calculated for a fast and slow protein turnover pool. The mean daily total protein synthesis rate in the normal was 3.695 g/kg compared to 4.479 g/kg in sepsis. Because all subjects were in negative nitrogen balance, the mean total protein catabolic rate in the normal was 4.379 g/kg, compared to 5.298 g/kg in sepsis. These data suggest an increase in both protein synthesis and catabolism during sepsis.
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PMID:Whole body protein synthesis and catabolism in septic man. 88 84

Major thermal injury is associated with extreme hypermetabolism and catabolism as the principal metabolic manifestations encountered following successful resuscitation from the shock phase of the burn injury. Substrate and hormonal measurements, indirect calorimetry, and nitrogen balance are biochemical metabolic parameters which are useful and more readily available biochemical parameters worthy of serial assessment for the metabolic management of burn patients. However, the application of stable isotopes with gas chromatography/mass spectroscopy and more recently, new immunoassays for growth factors and cytokines has increased our understanding of the metabolic manifestations of severe trauma. The metabolic response to injury in burn patients is biphasic wherein the initial ebb phase is followed by a hypermetabolic and catabolic flow phase of injury. The increased oxygen consumption/metabolic rate is in part fuelled by evaporative heat loss from wounds of trauma victims, but likely also by a direct central effect of inflammation upon the hypothalamus. Although carbohydrates in the form of glucose appear to be an important fuel source following injury, a maximum of 5-6 mg/kg/min only is beneficial. Burn patients have accelerated gluconeogenesis, glucose oxidation, and plasma clearance of glucose. Additionally, considerable futile cycling of carbohydrate intermediates occurs which includes anaerobic lactate metabolism and Cori cycle activity arising from wound metabolism of glucose and other substrates. Similarly, accelerated lipolysis and futile fatty acid cycling occurs following burn injury. However, recent evidence suggests that lipids in the diet of burned and other injured patients serve not only as an energy source, but also as an important immunomodulator of prostaglandin metabolism and other immune responses. Amino acid metabolism in burn patients is characterized by increased oxidation, urea synthesis, and protein breakdown which is prolonged and difficult to reduce with current nutritional therapy. However, the current goal of nutritional support is to optimize protein synthesis. Specific unique requirements may exist for supplemental glutamine and arginine following burn injury but further research is needed before enhanced branched chain amino acids supplements can be recommended for burn patients. Recent research investigations have revealed the importance of enteral feeding to enhance mucosal defense against gut bacteria and endotoxin. Similarly, research has demonstrated that many of the metabolic perturbations of burns and sepsis may be due, at least in part, to inflammatory cytokines. Investigation of their pathogenesis and mechanism of action both at a tissue and a cellular level offer important prospects for improved understanding and therapeutic control of the metabolic disorders of burn patients.
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PMID:The metabolic effects of thermal injury. 129 Feb 69

We retrospectively evaluated the clinical outcome of 45 female and 11 male patients with biopsy-proven lupus nephritis, followed at our hospital between February 1974 and February 1990. In the majority signs of nephritis were present at the time systemic lupus erythematosus was diagnosed (range: -42-156 months) and the median time from onset of nephritis to biopsy was 2 months. The median follow-up from the time of the biopsy was 53.5 months (range: 2-192), the median age at biopsy 25 years and the median serum creatinine level 1.2 mg/dl. Initial renal biopsies had the following histopathological classes according to the World Health Organization criteria (n): I (2); II (10); III (10); IV (28); V (5); VI (1). Over the study period active episodes were treated with high-dose oral prednisone alone or combined with intravenous nitrogen mustard and oral chlorambucil (1974-75), azathioprine (1978-86), cyclophosphamide (1986-90) and/or plasma-exchange (1976-84). These strategies were based on literature data or multicenter studies in which we participated. Eight patients developed end-stage renal disease (ESRD) (median: 47 months post-biopsy; range: 20-120). In these, initial biopsies showed class IV in seven, and class V in one. Confounded risk factors for ESRD were class IV biopsy, male gender and serum creatinine level above 1.4 mg/dl. The calculated proportion without ESRD 5 years post-biopsy was 87% (95% confidence limits: 98-76%), and at 10 years 70% (95% confidence limits: 90-49%). Five patients (11.2%) died; causes of death were cerebrovascular accident (n = 2), cerebral lupus (n = 2) and S. aureus sepsis (n = 1).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The long-term clinical outcome of 56 patients with biopsy-proven lupus nephritis followed at a single center. 130 70


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