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

This review evaluates the various causes and management of acute renal failure (ARF) in children. ARF is defined as an abrupt decline in the renal regulation of water, electrolytes and acid-base balance, and continues to be an important factor contributing to the morbidity and mortality of critically ill infants and children. The common causes of ARF in children include acute tubular necrosis secondary to various causes (including congestive heart failure and sepsis), haemolytic uremic syndrome, and glomerulonephritis and urinary tract obstruction. Ischaemia, toxins (including drugs) as well as primary parenchymal disease, have to be considered and ARF can also be a complication of systemic disease. The basic principles of management are avoidance of life-threatening complications, maintenance of fluid and electrolyte balance, and nutritional support. Only a few patients require specific management of the underlying disorder, although it is important to diagnose these conditions. Knowledge about the use of drugs for the prevention of ARF is scarce. Mannitol, low-dose dopamine, calcium channel antagonists, atrial natriuretic peptide and albumin have been evaluated and, where possible, meta-analyses are cited. Mannitol treatment appears to be warranted prophylactically after paediatric renal transplantation. Albumin infusion can reverse prerenal ARF in children with nephritic syndrome. For treatment of the complications of hyperkalaemia and volume overload, salbutamol, insulin and glucose infusion and diuretics such as furosemide and sodium bicarbonate, are discussed. All of the major dialysis modalities (peritoneal dialysis, haemodialysis and continuous haemofiltration) can be used to provide equivalent solute clearance and ultrafiltration. The indication for, and the choice of the modality depend on the patient requirements and on local resources, and should involve the care of a paediatric nephrologist. Peritoneal dialysis requires minimal equipment and infrastructure, is easy to perform and remains the favoured modality of renal replacement therapy in children. However, continuous haemofiltration is an excellent alternative to peritoneal dialysis in patients with ARF and severe fluid overload. Dialysis remains the most important tool to bridge the time needed for recovery of renal function. There is increasing evidence that more intense use of dialysis may improve the overall prognosis.
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PMID:Acute renal failure in children: aetiology and management. 1173 64

Albumin has a stabilizing effect on endothelium and helps maintain capillary permeability to macromolecules. Critically ill patients with sepsis may have profound hypoalbuminemia, but the effect of this hypoalbuminemia on microvascular permeability is unknown. To determine the degree and potential importance of this effect, we measured the transcapillary escape rate (TER) of (125)I-labeled albumin in 12 adult patients fulfilling American College of Chest Physicians/Society of Critical Care Medicine criteria for septic shock. We measured TER over a 90-min baseline period and then repeated these measurements immediately after the rapid infusion of 200 ml of 20% albumin. At baseline, patients had a mean serum albumin concentration of 10.3 +/- 3.8 g/l, which, at 30 min after the albumin infusion, was 18.5 +/- 3.7 g/l. The baseline TER was 6.7 +/- 1.5%/h, with a postinfusion TER of 6.4 +/- 2.1%/h (P = 0.550). Albumin supplementation sufficient to nearly double serum concentrations in profoundly hypoalbuminemic septic patients had no clinically significant effect in reducing microvascular permeability.
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PMID:Effects of albumin supplementation on microvascular permeability in septic patients. 1196 Sep 67

The ability of increased endogenous adenosine to mitigate microvascular derangements in sepsis was studied. Pentostatin (2'-deoxycoformycin), an inhibitor of adenosine deaminase, was administered to mice immediately after induction of sepsis by cecal ligation and puncture. Intravital video microscopy of cremasteric postcapillary venules was performed. Leukocyte rolling and adhesion were significantly increased in septic mice compared with control mice. Treatment of septic mice with pentostatin significantly decreased leukocyte rolling and adhesion (6.02 +/- 0.09 versus 1.72 +/- 0.12 rolling cells/min, 2.07 +/- 0.04 versus 0.62 +/- 0.05 adherent cells/100 microm per minute; p < 0.001). Albumin leakage (ratio) was significantly attenuated in septic animals treated with pentostatin (0.42 +/- 0.05 versus 0.21 +/- 0.04; p < 0.01). Circulating levels of interleukin-6, tumor necrosis factor-alpha, and soluble tumor necrosis factor type II receptor were decreased in septic mice treated with pentostatin. Survival was significantly improved at 48 hours in mice treated with pentostatin. These results suggest an important role for adenosine in modulating both leukocyte-dependent and -independent mechanisms of endothelial injury in sepsis. Exploiting the advantageous action of endogenous adenosine represents a potentially useful and novel therapeutic approach for the treatment of sepsis.
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PMID:Adenosine deaminase inhibition attenuates microvascular dysfunction and improves survival in sepsis. 1209 Nov 65

The diet of industrialised countries is usually rich in amino acids, which are in part used as a source of calories. However, metabolic alterations are observed in diseased patients and a preferential retention of Sulphurated Amino Acids (SAA) occurs during the inflammatory response. Moreover, it has been demonstrated in a model of an acute sepsis phase of rats that the metabolism of Cysteine is modified. The liver converts Cysteine at a different ratio of Sulphate to Taurine (Tau) i.e. the sulphate production decreases while the Tau conversion increases. The Glutathione (GSH) concentration is greater in the liver, kidneys and other organs and the Cysteine incorporation into proteins is higher in the spleen, lungs and plasma (Acute Phase Proteins) while the Albumin level decreases. The pro-inflammatory cytokines such as Interleukin-1, Interleukin-6 and TNF- alpha are the main initiators that alter protein and amino acid metabolism. Another important phenomenon is the impairment of Methionine conversion to Cysteine during stress. For example, premature infants or AIDS patients are capable of synthesizing Cysteine from Methionine at a much lower rate. Thus, the metabolic flow through the trans-sulphuration path may be inadequate to meet the Cysteine demand under critical conditions. In this complex picture, an SAA supply may contribute to an immune system regulation.
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PMID:The regulation of sulphurated amino acid junctions: fact or fiction in the field of inflammation? 1243 3

The mechanisms leading to hypoalbuminemia in sepsis were explored by measuring plasma volume, albumin distribution, plasma albumin transcapillary escape rate (TER), and efflux (TER x albumin intravascular pool). These parameters were quantified in infected rats, injected intravenously with live Escherichia coli, and pair-fed and well-fed rats using an injection of (35)S-albumin and measuring plasma and whole body albumin concentrations. Animals were studied on days 1, 6, and 10 after infection. In pair-fed rats, neither albumin distribution nor exchange rate between the intra- and extravascular compartments was modified. The increase of plasma volume after infection partly explained hypoalbuminemia. Infection resulted in a reduction of the total albumin pool of the body all along the experimental period, indicating a net loss of the protein. Albumin TER (%/day) was significantly increased 1 and 6 days after infection, but the absolute efflux was increased only on day 1. Normal values were observed on day 10. Therefore, an accelerated plasma efflux contributes to hypoalbuminemia only during the early period of sepsis. During this phase, the protein was retained in the extravascular space where it was probably catabolized. Later on, other factors are probably involved.
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PMID:Increased albumin plasma efflux contributes to hypoalbuminemia only during early phase of sepsis in rats. 1257 Oct 74

There is evidence suggesting that early fluid resuscitation is beneficial in the treatment of septic shock. The question as to which solution should be used remains controversial. Using a porcine septic shock model, we tested the effects of a new synthetic colloid hydroxyethyl starch (HES 130 kD) and a crystalloid regimen with Ringer's solution (RS) on plasma volume (PV) maintenance as well as on systemic and regional hemodynamics. Fourteen anaesthetized mechanically ventilated pigs received 0.75 g kg body weight of feces into the abdominal cavity to induce sepsis. They were randomly allocated to receive 6% HES 130 kD (n = 5) or RS (n = 5) and were compared with nonseptic controls receiving 6% HES 130 kD (n = 4). The infusion rate was titrated to maintain a central venous pressure of 12 mmHg. PV was determined by chromium-51-tagged erythrocytes and hematocrit. Albumin escape rate (AER) was calculated using iodine-125-labeled albumin. Arterio-intramucosal pCO2 gap, systemic hemodynamics, and oxygenation were obtained before and 6 h after induction of sepsis. AER increased in the HES (+38%) and RS groups (+38%) compared with control. PV was reduced in the RS group (-39%), but was maintained in the HES group (-1%). After 6 h of sepsis, HES 130 kD-treated animals had a significantly higher cardiac output (166 +/- 28 mL min kg vs. 90 +/- 18 mL min kg, P < 0.05), and a significantly higher mixed-venous oxygen saturation (65% +/- 8% vs. 40% +/- 14%, P < 0.05) than RS animals. In this porcine septic shock model with concomitant capillary leakage syndrome, resuscitation with HES 130 kD but not RS could maintain PV and preserve systemic hemodynamics and oxygenation.
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PMID:Resuscitation from septic shock with capillary leakage: hydroxyethyl starch (130 kd), but not Ringer's solution maintains plasma volume and systemic oxygenation. 1517 34

In the present study, we evaluated the clinical course and outcome of chronic peritoneal dialysis (PD) in a group of elderly patients. We enrolled 60 elderly patients (37 men, 23 women) starting PD over a 4-year study period and assessed outcomes. The mean age of our patients was 61 +/- 7 years; mean PD duration was 16 months (range: 3 - 40 months). Primary diseases were mainly diabetic nephropathy (54%) and glomerulonephritis (20%). In most patients, the PD modality was chosen because of cardiac instability. Complications during PD included peritonitis (1 episode per 9 patient-months) and exit-site infection (1 episode per 26 patient-months). Technique survival was 89% at 1 year. Patient survival was 83% and 32% at 1 and 4 years respectively. The most frequent causes of death were cerebrovascular accident, cardiac complications, and sepsis. We also compared predialysis parameters to final parameters for 20 deceased patients. Mean age in this group was 62 +/- 8 years, and mean PD duration was 13 +/- 8 months. Body mass index (BMI) was 23 +/- 3 kg/m2 predialysis versus 22 +/- 3 kg/m2 at the end of dialysis (p < 0.01); residual renal creatinine clearance was 4.4 +/- 2 mL/min versus 2.3 +/- 2 mL/min (p < 0.003), and weekly total Kt/V was 2.1 +/- 0.3 versus 1.8 +/- 0.3 (p < 0.002). Albumin showed positive correlations with BMI (r = 0.40, p < 0.02) and with creatinine (r = 0.40, p < 0.01). We conclude that survival of elderly patients on continuous ambulatory peritoneal dialysis is reasonable in the first year, and that further improvement may be achieved by initiating dialysis early, by increasing the dialysis dose, and by improving the patients' nutrition status.
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PMID:Outcome of continuous ambulatory peritoneal dialysis in a group of elderly patients from Bangladesh. 1538 6

Free radicals have been implicated in the pathogenesis of neonatal septicemia. The present study was planned to estimate the lipid peroxidation and antioxidant status in neonatal septicemia. The study was done to evaluate the lipid peroxidation and antioxidant status, both enzymatic and non-enzymatic in neonates with septicemia. This prospective study included 44 septicemic babies as cases and a group of 84 matched healthy babies formed the control. Malondialdehyde (MDA), Superoxide dismutase (SOD), Glutathione peroxidase (GTPx), Catalase, Uric acid (UA) and Albumin (Alb) were estimated in the serum and compared between the groups. The statistical analysis was done by using SPSS-10 software. Neonates with septicemia had significantly higher levels of MDA, SOD, GTPx, and Catalase, while the levels of UA and Alb were significantly lower as compared to controls (p<0.001). Significantly elevated levels of MDA (p<0.05) and depressed levels of UA (p<0.001) were found in babies with late onset sepsis. Neonates who ultimately succumbed had significantly elevated levels of MDA, SOD, GTPx and Catalase, whereas levels of UA and Alb were significantly depressed (p<0.001). Neonates with sepsis are handicapped in terms of their defense mechanism against free radicals. The utility of supplementation of antioxidant enzymes in neonates with septicemia needs further evaluation.
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PMID:Lipid peroxidation and antioxidants in neonatal septicemia. 1655 40

Diagnostic medicine has seen significant changes during the past decade. The emergence of proteomics and genomics has significantly increased our understanding of disease. These fields have also revealed the vast array of proteins that are expressed in various disease processes, such as cancer. Measurement of these unique proteins expressed in certain diseases may offer diagnostic clues or allow patient prognosis to be assessed. Another approach is to measure the effects that these ligands have on the structure and function of albumin. Albumin is known to play an important role in modulating the serum concentrations of various proteins produced by tumor cells. In this review, we introduce the reader to the technique of spin labeling followed by electron paramagnetic resonance spectroscopy. This method is a powerful tool for evaluating the structural and functional changes that can occur to albumin following the binding of various ligands. We describe the utility of this technique for the diagnosis of cancer and sepsis, as well as some other novel potential applications.
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PMID:Application of spin label electron paramagnetic resonance in the diagnosis and prognosis of cancer and sepsis. 1878 41

Albumin has been used for volume resuscitation and supplementation in critically ill patients for over 50 years. While regarded as a "gold standard" colloid solution, albumin is associated with substantial cost, and questions have been raised about its safety and efficacy. A large-scale randomised controlled trial (the Saline vs. Albumin Fluid Evaluation [SAFE] study) demonstrated that albumin and saline were clinically equivalent treatments for intravascular volume resuscitation in a heterogenous population of critically ill patients. However, in patients with traumatic brain injury, albumin was associated with a significantly higher mortality and cannot be recommended for acute resuscitation of such patients. A potential beneficial role of albumin in patients with severe sepsis, particularly malaria, requires further study. Extrapolation of the results of the SAFE study to other, synthetic, colloid solutions requires caution, and a randomised controlled trial comparing albumin, starch and crystalloids in patients with severe sepsis is warranted. The safety of synthetic colloids in patients with traumatic brain injury should not be assumed. Although hypoalbuminaemia is associated with increased mortality, use of albumin for volume resuscitation of critically ill patients with a serum albumin concentration < or =25 g/L is not associated with reductions in mortality, duration of ICU stay or mechanical ventilation, or in use of renal replacement therapy. Similarly, there is no substantive evidence to justify the use of hyperoncotic albumin solutions for resuscitation or supplementation in critically ill patients. Albumin is a safe and effective resuscitation solution in critically ill patients without traumatic brain injury. However, the acquisition costs of albumin and synthetic colloids are more than those of crystalloids, and, as yet, colloids have not been proven to confer substantive benefits over crystalloids such as saline.
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PMID:Albumin is a blood product too - is it safe for all patients? 1928 47


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