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Query: UMLS:C0243026 (sepsis)
 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The effects of sepsis on intracellular Na+ activity, Na+ concentration, and H2O partition in skeletal muscle were investigated in a burn rat model. Studies were performed on either postburn day 3 or day 7 during evolving burn wound sepsis. Data are compared among 3 groups of rats: burned and infected (BI), burned not infected (B), and sham burn (C). After 3 days postburn both Na+ activity and concentration decreased in the BI group as compared with B and C groups. By postburn day 7, the BI group developed septic shock and had increased intracellular Na+ activity and concentration. The resting membrane potentials of skeletal muscle cells depolarized. The finding of an increased cell membrane relative permeability of Na+ to K+ could account for the increase in Na+ influx into cells. In addition, intracellular and total muscle H2O contents decreased and extracellular H2O increased. Hypernatremia, hyperchloremia, and hyperosmolality were also observed in the BI group. However, the fact that there was no significant difference between B and C groups indicates that the late derangements were due to septic shock rather than simple burn injury. Thus, the deleterious effects of the evolving burn wound sepsis on Na+ homeostasis might be due to the detrimental effect of increased intracellular Na+ activity on mitochondrial respiratory control with subsequent impairment of cellular functions.
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PMID:Effect of sepsis on intracellular sodium activity, sodium concentration, and water content in thermal injured rat. 139 63

Hyperosmolality complicating the management of burned patients has multiple etiologies. Sepsis, hyperglycemia, renal failure, electrolyte disturbances, shock, and substances absorbed from the burn wound may be contributing factors. Chemicals, such as propylene glycol, within bacteriostatic topicals may also lead to hyperosmolality. This report describes a patient who developed severe hyperosmolality after 5% Betadine-glycerin therapy for a 60% partial-thickness burn. Status epilepticus developed 36 hours later, and triglycerides were 9,700 mg/dl. After Betadine-glycerin was stopped the central nervous system status slowly improved but pre-seizure function was never regained.
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PMID:Hyperosmolality caused by percutaneously absorbed glycerin in a burned patient. 706 13

Small-volume resuscitation by means of bolus infusion of hypertonic saline solutions was first applied for the primary treatment of severe hemorrhagic and traumatic shock and promptly restored central hemodynamics and regional organ blood flow. Mechanisms of action are diverse--i. maintenance of high cardiac output (direct myocardial stimulation; increase in intravascular volume); ii. maintenance of peripheral arterial vasodilation (effect of hyperosmolality; plasma volume effect) and iii. reduction of tissue edema (shifting of tissue water along the osmotic gradient). These mechanisms promote the restoration of the severely impaired microcirculation frequently seen also in sepsis. Hypertonic volume therapy has been the object of several experimental studies of acute hyperdynamic endotoxemia, however, a greater number of clinical studies have to be developed for the better understanding of the positive, and perhaps hazardous, effects of small-volume resuscitation in sepsis and multiple organ failure. The aim of this paper is to review the concepts involving such solutions, and their potential use in treatment of profound hypovolemia and microcirculatory deterioration associated with sepsis and endotoxic shock.
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PMID:Hypertonic volume therapy: feasibility in the prevention and treatment of multiple organ failure and sepsis. 873 Dec 91

Diabetic ketoacidosis results from insulin deficiency and insulin resistance and is marked by hyperglycaemia, ketoacidosis, dehydration and electrolyte losses. Management includes correction of shock, dehydration, electrolyte deficits, hyperglycaemia, acidosis and sepsis (if present). Warning signs include severe dehydration, shock, pH < 7.0, hypokalaemia, hypernatraemia, hyperosmolality, hyperlipidaemia, deterioration in consciousness and diabetic ketoacidosis in very young patients. The principles of treatment include (i) admission to a unit with paediatric experience, (ii) treatment of shock, (iii) rehydration over 24-36 h, or longer if the osmolality is >360 mmoll(-1), (iv) normal saline for rehydration unless the patient is hypernatraemic, (v) avoidance of bicarbonate unless acidosis is interfering with myocardial contractility, (vi) insulin infusion to achieve a fall in blood glucose levels of 5 mmol h(-1), (vi) potassium, (vii) use of 5% glucose when the blood glucose level falls <12mmoll(-1), (ix) treatment of any complications and (x) change to subcutaneous insulin when diabetic ketoacidosis is controlled.
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PMID:Practical management of diabetic ketoacidosis in childhood and adolescence. 982 96

Many advances have improved the care of critically ill patients, but only a few have been through the use of pharmaceutical agents. Recently, the US Food and Drug Administration (FDA) approved drotrecogin alfa (activated), or recombinant human activated protein C, for the treatment of patients with a high risk of death from severe sepsis. Drotrecogin alfa (activated) has antiinflammatory, antithrombotic and fibrinolytic properties. When given as a continuous intravenous infusion, recombinant human activated protein C decreases absolute mortality of severely septic patients by 6.1%, resulting in a 19.4% relative reduction in mortality. The absolute reduction in mortality increases to 13% if the population treated is restricted to patients with an APACHE II score greater than 24, as suggested by the FDA. The most frequent and serious side effect is bleeding. Severe bleeds increased from 2% in patients given placebo to 3.5% in patients receiving drotrecogin alfa (activated). The risk of bleeding was only increased during the actual infusion time of the drug, and the bleeding risk returned to placebo levels 24 hours after the infusion was discontinued. Patients treated in the intensive care unit frequently develop anemia, usually severe enough to require at least one transfusion of red blood cells. With the recent discovery of the harmful effects of allogeneic red blood cell transfusions and the increasing shortage of available red blood cell products, emphasis has been placed on minimizing transfusions. Patients who receive exogenous recombinant human erythropoietin maintain higher hemoglobin levels, in spite of requiring fewer transfusions during their stay in the intensive care unit. Recombinant human erythropoietin appears to be effective whether it is given as 300 units/kg of body weight subcutaneously every other day or as 40,000 units subcutaneously every week. Differences in hemoglobin values were not apparent until at least one week of therapy, but they continued to diverge after that initial week. Furthermore, the incidence of adverse events was similar to that of patients receiving placebo and there was no difference in mortality, suggesting that avoidance of blood transfusions did not translate into increased survival. Thus, recombinant human erythropoietin appears to be both safe and effective in treating the anemia found in critically ill patients, but it is less clear that such treatment is cost effective, especially in the higher dose regimens. Hypotension in patients with septic shock is often difficult to correct. Despite enormous dosages of catecholamines, many of these patients continue to have inadequate blood pressures. Inadequate levels of vasopressin have been identified in patients with septic shock, as well as in other patients with hypotension secondary to refractory vasodilatation. Vasopressin is a peptide hormone secreted from the posterior pituitary in response to hyperosmolality, hypovolemia or hypotension. Levels of vasopressin initially rise in patients with septic shock, but as hypotension persists, vasopressin levels fall below normal. Administration of exogenous vasopressin in physiologic dosages significantly increases blood pressure in patients with shock associated with sepsis and other vasodilatory states. This rise in blood pressure is often significant enough that endogenous catecholamines can be decreased and frequently discontinued entirely. Early withdrawal of the vasopressin replacement infusion results in recurrent hypotension. Unfortunately, randomized, blinded, placebo-controlled trials showing improvement in long-term outcomes such as mortality and length of stay are still lacking.
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PMID:New additions to the intensive care armamentarium. 1504 37

Propylene glycol is a commonly used solvent for oral, intravenous, and topical pharmaceutical preparations. Although it is considered safe, large intravenous doses given over a short period of time can be toxic. Underlying renal insufficiency and hepatic dysfunction raise risk for toxicity. Toxic effects include hyperosmolality, increased anion gap metabolic acidosis (due to lactic acidosis), acute kidney injury, and sepsis-like syndrome. Treatment of toxicity includes hemodialysis to effectively remove propylene glycol. Prevention is best achieved by limiting the dose of propylene glycol infused.
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PMID:Recognition, treatment, and prevention of propylene glycol toxicity. 1755 87

Critical illness polyneuropathy and myopathy commonly occur in patients with multiorgan failure and sepsis. Distal muscle weakness and loss of deep tendon reflexes are usually found, with sparing of the cranial nerve musculature. Many risk factors have been identified, specifically hypoxia, hypotension, hyperpyrexia, and age. Other independent risk factors include female sex, severity of illness, duration of organ dysfunction, renal failure and renal replacement therapy, hyperosmolality, parenteral nutrition, low serum albumin level, duration of intensive care unit stay, vasopressor and catecholamine support, and central neurologic failure. Hyperglycemia also has been identified as an independent risk factor, with important potential affect in terms of prevention. Herein, we report the development of critical illness polyneuropathy and myopathy in 7 of 22 renal transplant recipients who underwent successful ventilator weaning during treatment for bronchopneumonia. This is the first report of critical illness polyneuropathy and myopathy among renal transplant recipients. Clinical suspicion and electrophysiologic studies are tools for early diagnosis. Proper management, including correction of risk factors (especially diabetes) and long-term rehabilitation measures might be beneficial.
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PMID:Successful management of critical illness polyneuropathy and myopathy in renal transplant recipients. 2230 22

Metabolic acidosis is observed in the pediatric intensive care unit (PICU) in several conditions including sepsis, intoxications, and severe catabolic states. It is occasionally seen due to acute decompensation in an inborn error of metabolism (IEM). Persistent acidosis results in a decrease in myocardial contractility, cardiac output, and catecholamine responsiveness. The mainstay of treatment of metabolic acidosis has been intravenous sodium bicarbonate infusion. However, the large amounts of sodium bicarbonate sometimes required can be hazardous resulting in hypernatremia, hypervolemia, and hyperosmolality. We report a 3-year child who presented with persistent lactic acidosis due to an IEM whom we treated with peritoneal dialysis (PD) using a bicarbonate-buffered dialysate. The child recovered uneventfully within 72 hours of dialysis. Peritoneal dialysis using a bicarbonate-buffered dialysate is a safe and simple method of treating persistent severe acidosis in the PICU. How to cite this article: Kalbhande A, Gajare U, Shanbag P. Peritoneal Dialysis Using a Bicarbonate-buffered Dialysate in a Child with an Inborn Error of Metabolism Presenting with Severe Acidosis. Indian J Crit Care Med 2020;24(3):200-202.
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PMID:Peritoneal Dialysis Using a Bicarbonate-buffered Dialysate in a Child with an Inborn Error of Metabolism Presenting with Severe Acidosis. 3243