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

The incidence and the clinical implications of hypocalcemia were evaluated in acutely ill patients admitted to the Medical Intensive Care Unit of the Detroit Receiving Hospital. Total and ionized calcium levels were prospectively evaluated upon admission for all patients over a three-month interval. A high proportion of patients (62 of 88, 70 percent) were found to have decreased levels of both total and ionized calcium. Known causes of hypocalcemia could be identified in only 28 patients (45 percent). These included hypomagnesemia (17, 28 percent), renal insufficiency (five, 8 percent), alkalosis (four, 6 percent), and acute pancreatitis (two, 3 percent). In the remaining 34 patients (55 percent), no readily identifiable cause could be found. These 34 patients had a lower mean albumin level than did the 23 normocalcemic patients (p less than 0.01), but there were no differences in age, pH, serum creatinine, magnesium, or phosphate between the two groups. Serum albumin correlated directly with ionized calcium levels (n = 82, r = 0.33, p less than 0.01), as well as with total calcium levels (n = 76, r = 0.70, p less than 0.01). There was a strong association between sepsis and hypocalcemia. Patients who survived the hospitalization had higher mean ionized calcium, total calcium, and albumin values than did nonsurvivors, but there were no differences in age, serum creatinine, magnesium, and phosphate between the two groups. The mortality of the hypocalcemic patients (44 percent) was significantly greater (p less than 0.05) than the mortality of the normocalcemic patients (17 percent). These findings suggest that hypocalcemia is a very common abnormality in acutely ill patients and is associated with a poor prognosis.
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PMID:Prevalence and clinical implications of hypocalcemia in acutely ill patients in a medical intensive care setting. 340 50

1. Intramuscular concentrations of adenosine 5'-triphosphate (ATP) and creatine phosphate were measured in the vastus lateralis muscle of 28 non-septic malnourished patients and 31 septic malnourished patients. Similar measurements were made on the rectus abdominis muscle of about one-third of these patients. All results were compared with those obtained from 15 normally nourished non-septic control subjects. 2. Objective measurements of nutritional status (both anthropometric and biochemical) and sepsis were recorded in all subjects. 3. The vastus lateralis muscle of the non-septic and septic malnourished patients had intramuscular concentrations of ATP and total adenine nucleotides (TAN) that were up to 30% lower than control values, depending on the reference base used. 4. In the rectus abdominis muscle, ATP and TAN concentrations were up to 60% lower than control values, and creatine phosphate up to 47% lower, again depending on the reference base used. 5. In both muscles, the changes were more marked in those patients who were septic as well as malnourished.
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PMID:Muscle adenosine 5'-triphosphate and creatine phosphate concentrations in relation to nutritional status and sepsis in man. 341 59

The possibility that group B streptococci (GBS) may induce neonatal neutropenia by promoting neutrophil aggregation and the entrapment of aggregates in the lung was studied in vivo and in vitro utilizing a cell free GBS extract [(GBS)-trichloroacetic acid (TCA)]. The intravenous infusion of the extract into neonatal lambs induced reductions of circulating white blood cells (0 time, 3.1 X 10(3)/mm3 +/- 0.5 versus 2.2 X 10(3)/mm3 +/- 0.7) 5 min after infusion (p less than 0.01). At necropsy these lambs had prominent accumulation of polymorphonuclear leukocytes in their pulmonary interstitium. Subsequently, neutrophil aggregation was studied by incubating GBS-TCA in human serum or phosphate-buffered saline with subsequent addition to human polymorphonuclear leukocytes in an aggregometer. GBS-TCA incubated in human serum induced prompt polymorphonuclear leukocyte aggregation (mean delta T 12.3% +/- 2.8 in human serum versus delta T 2.5% +/- 2.1 in phosphate-buffered saline, p less than 0.001). Preincubation of GBS-TCA followed by incubation in human serum with human GBS hyperimmune IgG significantly reduced aggregation (GBS-TCA in serum mean delta T 14.9 +/- 2.44 versus 5.42 +/- 1.80, p = 0.002). Cell-free GBS products may induce polymorphonuclear leukocyte aggregation in the presence of whole serum. This phenomenon might contribute to the pulmonary injury experienced by infants with GBS pneumonia and sepsis.
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PMID:A group B streptococcal extract reduces neutrophil counts and induces neutrophil aggregation. 355 23

A synthesis of the postulated sequence of events for development of the inappropriate response of the myocardium to a demand for increased cardiac index is schematically represented in Fig. 10. In sepsis, bacteremia and/or the release of endotoxin activate the macrophages which release a spectrum of mediators. Some of these mediators (and possibly also endotoxin itself) have a negative influence on myocardial contractile function either directly and/or through altering cellular calcium flux. This results in impaired myocardial function manifested initially by decreased stroke volume. Subsequently, stroke volume will be either partially or completely restored to normal through the action of circulating catecholamines, the concentration of which is markedly elevated due to the presence of endotoxin and/or macrophage-produced mediators. Endotoxin and/or these mediators also act on the SA node increasing its sensitivity to beta-adrenergic stimulation. This will result in elevated heart rates. The latter, combined with the restored stroke volume, will yield an increased cardiac index which is the hallmark of the hyperdynamic phase of sepsis. In the cecal ligation and puncture model of sepsis, where cardiac index is maintained at the original level, the partially restored stroke volume and the elevated heart rate will combine to maintain cardiac index. Although this mechanism of increasing cardiac index through tachycardia is not energy efficient, the myocardium is able to cope with these changes and also to maintain its high energy phosphate concentrations, since the utilization of the three major myocardial substrates (fatty acids, lactate and glucose) is not affected by sepsis. Although this putative sequence of events is consistent with the observed experimental findings, further work is needed to substantiate its applicability to the etiology of myocardial dysfunction in man during sepsis.
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PMID:Myocardial dysfunction in sepsis. 361 52

Clindamycin pharmacokinetics was compared in critically ill patients with sepsis and healthy volunteers, and the relationship between pharmacokinetic values and physiological measurements obtained from the critically ill patients was characterized. Pharmacokinetic evaluations were performed on 10 patients with sepsis who were receiving clindamycin phosphate 900 mg i.v. every eight hours and on 6 previously studied healthy men receiving the same dosage regimen. Physiological variables measured included age, weight, cardiac index, systemic vascular resistance, central venous pressure, liver-function tests, alpha 1-acid glycoprotein concentration, and APACHE II score. Clindamycin was administered to the critically ill patients via a central venous catheter over 30 minutes; the healthy volunteers received their infusions via a peripheral venous catheter over 30 minutes. Blood samples were obtained at five minutes before and at various intervals after drug administration. Serum clindamycin concentrations were determined by a gas-liquid chromatographic method. Serum concentration data were analyzed using noncompartmental methods based on statistical moment theory, and the a priori level of significance was 0.05. The critically ill patients had significantly increased values for area under the curve (AUC), area under the moment curve (AUMC), mean residence time (MRT), and average concentration at steady state (Css), while total body clearance (TBC) was less than half that in the healthy volunteers. TBC in three of the critically ill patients was not different from that in the healthy volunteers. The apparent volume of distribution at steady state (Vss) was not significantly different between the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Decreased hepatic clearance of clindamycin in critically ill patients with sepsis. 366 68

Experiments were conducted to test the hypothesis that the previously demonstrated depression in ventricular function of rats with hyperdynamic sepsis was a result of depressed high energy phosphate levels or altered myocardial substrate utilization. Rats were inoculated with a pooled fecal homogenate, and 48 hr later their hearts were removed and studied using the Langendorff preparation. The coronaries were perfused with a hydrostatic pressure of 90 mmHg, and hearts were paced at 310-320 beats/min. Substrate oxidation was determined by supplying 14C-labeled glucose, lactate, or palmitate in physiologic concentrations, ie, 5.5, 1, and 0.6 mM, respectively. Hearts were frozen either in situ or after 40-50 min of perfusion for the determination of tissue metabolite levels. Myocardial content of high energy phosphates, total adenine nucleotides, and creatine were similar in septic animals and time-matched controls both in situ and after perfusion. Oxidation of exogenous substrates accounted for the total myocardial O2 consumption in both groups of perfused hearts. Palmitate oxidation was responsible for approximately 50% of the total O2 consumption of the heart, with glucose accounting for approximately 20% and lactate for the remainder. The percentage contribution of the three substrates to oxidative metabolism was similar in hearts from septic and time-matched controls; therefore, myocardial substrate preference was not altered by sustained sepsis. These studies also indicate that ischemia and the concomitant fall in high energy phosphates do not contribute to the myocardial dysfunction of hyperdynamic sepsis.
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PMID:Substrate utilization and high energy phosphate levels of hearts from hyperdynamic septic rats. 369 11

Malassezia furfur, a recently described agent of catheter-associated sepsis, requires long-chained fatty acids for in vitro growth. To determine optimum conditions for recovery of the organism from blood culture, we compared a radiometric (BACTEC) with a lysis centrifugation-direct agar plating (Isolator) blood culture method. When blood culture isolates of M. furfur were suspended in phosphate-buffered saline and used as inocula, the BACTEC system detected the organisms radiometrically only when bottles were supplemented with lipid compounds; detection was often delayed (greater than or equal to 72 h) when small inoculum sizes were tested. The Isolator pediatric tube system detected growth of M. furfur within 48 h of plating onto a lipid-supplemented agar medium. Simulated blood culture experiments showed that the addition of whole human blood and Intralipid to the BACTEC 6B bottle was associated with rapid lysis of erythrocytes, accumulation of a chocolate brown sediment in the bottles, and fungicidal activity to the M. furfur isolates. In contrast, suspensions of M. furfur in whole human blood were stable for at least 8 h in Isolator tubes and quantitatively recoverable after plating onto agar. Of the two systems studied, the Isolator tube system provided a more suitable procedure for isolation of M. furfur from blood culture.
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PMID:Methods for optimal recovery of Malassezia furfur from blood culture. 377 59

Energy-consuming, ATP-dependent step of transmembrane transmission of the signal for chemotaxis was studied at the pathway between receptors of formylpeptide and membrane kinase of polymorphonuclears leukocytes. Some peptides, particularly formylmethionyl leucylphenylalanine (FMLP), were demonstrated to have a property of chemostimulation, i.e. they had an ability to stimulate phagocytosis in human and animal neutrophils due to presence of specific receptors on the cell surface. Isolation, identification and use of the membrane ATP, synthesized in presence of the chemotactic peptide FMLP, is described. The ATP was produced within 1 min on the surface of polymorphonuclear leukocytes during aerobic phosphorylation from ADP and inorganic phosphate, coupled with transmission of electrons and protons. The ATP-producing activity of polymorphonuclear leukocytes, stimulated by the formylpeptide, was distinctly decreased in the patients with various forms of purulent surgical infections--sepsis, pyo-resorptive fever. The ATP, synthesized in plasmatic membranes of polymorphonuclear leukocytes, appears to serve as a translator of the chemotactic, energy-consuming signal.
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PMID:[Formation of signal ATP in plasma membranes of polymorphonuclear leukocytes activated by formyl-methionyl-leucyl-phenylalanine]. 377 22

The effect of dexamethasone sodium phosphate on visceral organ glucose metabolism was studied in order to gain further understanding of the altered glucose dynamics that occur following catabolic states. Glucose, glutamine, and alanine exchange across the gastrointestinal (GI) tract, liver, and kidneys was determined in 25 awake dogs that were catheterized on a long-term basis during a control period and after dexamethasone sodium phosphate treatment (0.44 mg/kg/day) for two (dexamethasone 2) and nine (dexamethasone 9) days. The GI tract consumed glucose in control dogs but switched to an organ of balance or slight release with dexamethasone. Simultaneously, gut glutamine consumption increased markedly, as did intestinal alanine release. Hepatic glucose production more than doubled with dexamethasone at a time when hepatic alanine uptake was greatly increased. The kidneys demonstrated glucose balance in control animals, but released glucose with dexamethasone 9. The gut and kidneys may play an important role in the altered glucose dynamics seen in patients with sepsis and other catabolic diseases.
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PMID:Gut-liver interaction during accelerated gluconeogenesis. 383 33

Nine patients with severe sepsis were studied to determine causes for any alterations in oxygen dissociation. Seven of the patients had oxyhemoglobin curves shifted to the left of expected and diminished DPG levels. These deficiences were not corrected in one case. The other eight patients survived or expired with normal to elevated P(50T) and DPG levels. In this study, three factors occurring either individually, in concordance, or in sequence were present when P(50T) was decreased. Correction of these deficiencies lead to normalization and, in one case, exceedingly high P(50T) and DPG levels. Where hypophosphatemia, acidosis, and transfusion of DPG deficient blood were avoided, no such change occurred. Hypophosphatemia is a common occurrence in the seriously ill patient whether or not hyperalimentation is used and may occur in spite of phosphate supplementation. Blood transfusions with CPD as the preservative are effective in reducing the severity of this disorder by the addition of an inorganic phosphate load. Septic shock itself had no untoward effect on oxygen dissociation. This held true even in the terminal stages of the disease process.
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PMID:The left shifted oxyhemoglobin curve in sepsis: a preventable defect. 484 83


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