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

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

We report the use of cefoperazone in 62 cases of serious infection, most of which occurred in patients with renal impairment. 43 severe or complicated urinary tract infections, 11 cases of pneumonia and 8 with other severe sepsis were treated with cefoperazone 1 to 2 g twice daily usually for 5 to 10 days. Of the patients with urinary tract infection, all who were symptomatic showed a rapid clinical response; 26 (61%) were cured including 11 of 16 with chronic renal failure; 12 relapsed and 5 were reinfected with a different pathogen. All of these patients were infected by organisms sensitive to cefoperazone by disc testing but in 5 of those who relapsed the cefoperazone MIC was in fact greater than or equal to 50 microgram/ml. Ten of 11 cases with radiologically confirmed pneumonia were cured with cefoperazone. 7 episodes of pneumonia were in patients with end-stage chronic renal failure (6 were on dialysis) and 1 was in a patient with acute renal failure. Seven of 8 cases with severe sepsis were cured with cefoperazone. 1 patient was withdrawn from the study when acute bronchospasm followed a 2 g intravenous dose. 2 of the successfully treated patients had functioning renal transplants, 2 of 3 with severe chronic renal failure were on dialysis and 1 had acute renal failure. Side effects included minor disturbances of liver function in 6 patients (11%), diarrhoea in 7 (13%) and marked alcohol intolerance in one, 4 patients with chronic renal failure developed a coagulation disorder which was corrected with vitamin K. None of the patients showed deterioration in renal function while receiving cefoperazone. Cefoperazone promises to be an effective drug for the treatment of a wide spectrum of severe infections in hospitalised patients including those with impaired renal function.
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PMID:Cefoperazone in the treatment of severe or complicated infections. 645 95

The authors report their experience of 551 arteriovenous fistulae created in 400 patients undergoing haemodialysis for chronic renal failure. The mean follow-up period was 34 months. Eighteen cases of primary thrombosis (7%) and 11 cases of secondary thrombosis (4%) were observed. There were 7 cases of local sepsis, one of these fatal, and 7 cases of systemic infection, also with one death. The authors conclude that the Cimino-Brescia fistula is superior to any other type of vascular approach in patients with chronic renal failure. They reserve vascular grafts to those cases where no other procedure is possible.
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PMID:[Arteriovenous fistulae for chronic haemodialysis. Report on 400 patients]. 711 31

The complications related to the use of subclavian catheters for hemodialysis were prospectively studied in 257 consecutive acute and chronic renal failure patients. Using 394 catheters, 3006 single needle dialyses were performed. Indications for starting catheter dialysis were mainly the absence or disappearance of an adequate vascular access. Most hazardous complications were sepsis (9), malposition (6), hemothorax (3), bleeding (2), vena cava thrombosis (2) and pneumothorax (2). A number of mechanical problems occurred, where the obstructed catheter could easily be replaced by a modified Seldinger technique. No mortal complications occurred. Patient tolerance was excellent. It is concluded that single needle subclavian hemodialysis is a valuable alternative vascular access method in acute situations. It enables the continuation of hemodialysis on an ambulatory basis.
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PMID:Complications of subclavian catheter hemodialysis: a 5 year prospective study in 257 consecutive patients. 717 35

Aeromonas hydrophila is a gram-negative bacillus which has been rarely identified as a human pathogen except in immunologically compromised hosts. We have recently treated three patients for severe A hydrophila pneumonia and sepsis. Two of these patients were healthy young men who aspirated the organism from contaminated water associated with near drowning. One patient survived severe ARDS and gram-negative sepsis. A third patient with chronic renal failure acquired A hydrophila pneumonia at home and quickly died from the infection. A hydrophila is becoming more commonly recognized as a lethal pathogen and should be sought when gram negative infection is suspected.
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PMID:Pneumonia and bacteremia due to Aeromonas hydrophila. 727 76

Vitamin B6 deficiency was evaluated in 37 patients with chronic renal failure and in 71 patients undergoing maintenance hemodialysis (HD) or intermittent peritoneal dialysis (PD). Vitamin B6 deficiency was assessed by the in vitro activity of erythrocyte glutamic pyruvic transaminase (EGPT), without (basal) and with (stimulated) the addition of pyridoxal-5-phosphate to the assay, and the EGPT index (stimulated activity ./. basal activity). Basal and stimulated EGPT activities were below normal in the HD patients, and the EGPT index was increased in each group of patients, indicating vitamin B6 deficiency. Supplemental pyridoxine hydrochloride was given to 30 HD patients who received 1.25 to 50 mg/day (37 studies), 6 PD patients who were given 1.25 or 2.5 mg/day (7 studies), and 8 nondialyzed patients with mild to severe renal failure who received 2.5 mg/ day. In all HD patients, 10 or 50 mg/day of pyridoxine hydrochloride rapidly corrected the abnormal EGPT index and maintained normal values; with supplements of 5.0 mg/day or less, the index was often abnormal, particularly in those who were septic or taking pyridoxine antagonists. In PD patients and nondialyzed patients with renal failure, 2.5 mg/day of pyridoxine hydrochloride was inadequate to correct rapidly the abnormal index in all patients. These findings suggest that HD patients should receive 10 mg/day of supplemental pyridoxine hydrochloride (8.2 mg/day pyridoxine). PD patients and patients with chronic renal failure should receive about 5.0 mg/day of supplemental pyridoxine hydrochloride (4.1 mg/day pyridoxine). When sepsis intervenes or vitamin B6 antagonists are taken, 10 mg/day of pyridoxine hydrochloride may be a safer supplement for all patients.
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PMID:Daily requirement for pyridoxine supplements in chronic renal failure. 728 98

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

Outcome of and complications associated with bilateral adrenalectomy in 8 cats with pituitary-dependent hyperadrenocorticism and bilateral adrenocortical hyperplasia and outcome of and complications associated with unilateral adrenalectomy in 2 cats with adrenocortical tumor (adrenocortical adenoma, 1 cat; adrenocortical carcinoma, 1 cat) and unilateral adrenomegaly were determined. Glucocorticoids were administered to all cats at the time of surgery, and mineralocorticoids were administered to the 8 cats that underwent bilateral adrenalectomy. A ventral midline celiotomy was performed in all cats. Intraoperative complications did not develop in any cat. Postoperative complications developed in all cats and included abnormal serum electrolyte concentrations (n = 8), skin lacerations (n = 5), pancreatitis (n = 3), hypoglycemia (n = 2), pneumonia (n = 1), and venous thrombosis (n = 1). Three cats died within 5 weeks after surgery of complications associated with sepsis (n = 2) or thromboembolism (n = 1). Clinical signs and physical abnormalities caused by hyperadrenocorticism resolved in the remaining 7 cats 2 to 4 months after adrenalectomy. Insulin treatment was discontinued in 4 of 6 cats with diabetes mellitus. Median survival time for these 7 cats was 12 months (range, 3 to > 30 months). Two cats died of acute adrenocortical insufficiency 3 and 6 months after bilateral adrenalectomy, 2 cats were euthanatized because of chronic renal failure 3 and 12 months after bilateral (n = 1) or unilateral (n = 1) adrenalectomy, and 2 cats were alive 9 and 14 months after bilateral adrenalectomy. In the remaining cat, clinical signs recurred 10 months after the cat had undergone unilateral adrenalectomy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Adrenalectomy for treatment of hyperadrenocorticism in cats: 10 cases (1988-1992). 755 48

Piperacillin (Pi) kinetics in patients with acute renal failure treated by continuous arteriovenous hemodialysis (CAVHD) are not known. Therefore, dosing regimens have been based on kinetic data derived from patients with chronic renal failure and principal pharmacokinetic considerations [Reetze-Bonorden et al. 1993]. From these estimations it has been predicted that approximately 30% of the dose of Pi is removed by CAVHD (dialysate/ultrafiltrate (D/UF) flow rate 1.5 liter/hour). To confirm this estimate single dose (4g i.v.) Pi kinetics were studied in 12 intensive care patients with anuric acute renal failure due to septicemia treated by CAVHD. Pi plasma and D/UF levels were measured by HPLC. Sieving/Saturation of Pi in the D/UF was 0.71 +/- 0.21 (+/- SD). With a mean D/UF flow rate of 20.4 +/- 1.5 ml/min, the mean extracorporal clearance (Clextra) was 12.2 +/- 1.0 ml/min and accounted for 29% (range 14-48%) of total body clearance (ClB = 47.1 +/- 22.3 ml/min). In 7 out of 12 patients the fraction of the dose eliminated by CAVHD reached a significant value above 25%. The mean volume of distribution (Vd) and elimination half life (t1/2) were 25.8 +/- 3.8 liter and 7.4 +/- 2.9 hours, respectively. In conclusion the extent of extracorporal elimination of Pi by CAVHD was well in agreement with the estimation previously published. In intensive care patients with acute renal failure on continuous hemodialysis Pi dosing should take into account the possibly significant elimination of Pi. The usual dose for anuric patients may be increased by 50% to avoid underdosing in these critically ill patients.
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PMID:Single dose kinetics of piperacillin during continuous arteriovenous hemodialysis in intensive care patients. 778 Dec

We reviewed our experience with patients suffering from civilian trauma to identify risk factors for the development of acute renal failure (ARF) and ARF outcome. Of the 437 patients consecutively admitted to a surgical intensive care unit (SICU), 206 had a SICU stay of at least 1 day and ARF developed in 30 of these patients. All ARF patients had additional organ system failure (OSF). Pre-existing chronic disease (including chronic renal failure), malnutrition, injury severity score (ISS), number of organs injured, sepsis, and all OSFs before the onset of ARF were factors predisposing to ARF. Mortality was 40%. Chronic disease, malnutrition, ISS, failure of cardiovascular, pulmonary, hepatic, and neurological systems (either before and after ARF) were significantly associated with mortality. When OSFs were considered in their temporal relationships to ARF, only cardiovascular and pulmonary failure before, and gastrointestinal failure after, the onset of ARF were related to mortality. An increasing number of OSFs increased mortality, both before and after the development of ARF. However, the number of OSFs before was significantly greater than after ARF. Sepsis was not associated with increased mortality. Thus, the outcome of ARF patients with critical trauma seems to be dependent on factors predisposing to ARF. Our results suggest that more attention must be paid to prevention of these precipitating conditions.
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PMID:Acute renal failure in patients with severe civilian trauma. 780 Feb 44


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