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

In 14 premature infants suffering from bacterial sepsis during the first week of life the daily renal sodium and potassium losses as well as the concentrations in serum of both electrolytes were measured before and during the period of infection. 24 hours before appearance of first clinical symptoms of sepsis the sodium concentration in urine increases and the balance becomes negative. Hyponatraemia occurs later and is in correlation with the clinical course of the disease. Thus, the hyponatraemia is caused more by shifting of sodium from the extracellular space than by renal sodium excretion. To prevent this hyponatraemia the sodium intake has to be increased to 6 mmol/kg X 24 h as a minimum and the fluid intake has to be decreased to 80 ml/kg X 24 h as a maximum in the same time when antibiotic treatment is started. A short-term control of serum electrolytes is an important premise for a sufficient treatment. Increased sodium concentrations in urine of more than 50 mmol/l or again increasing concentrations beyond the second day of life can be appreciated as early signs of neonatal sepsis.
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PMID:[Sodium homeostasis in neonatal infection of eutrophic premature infants]. 361 48

The changes in water and electrolyte metabolism associated with severe injury and sepsis are well recognized but changes in tissue content have seldom been available. This report combines the experience obtained from muscle biopsies of such patients performed in two centers; one located in Sweden and one in the U.S. Normal values for muscle water and electrolytes in each center are in close agreement. Needle biopsies of muscle were performed in 45 Swedish patients and 17 U.S. patients at intervals after injury or infection from the second to the thirtieth day. The patients' nutrition varied from brief periods of hypocaloric intake to prolonged high calorie parenteral nutrition with and without amino acids, as well as with and without fat. Prominent changes appeared during the first week and persisted up to 30 days regardless of the associated nutritional intake. These changes included an increased total muscle water, extracellular water, sodium and chloride and a decrease in muscle potassium and magnesium. This study demonstrates a simultaneous expansion of extracellular volume and a loss of intracellular components. This is in contrast to the experiences reported with less severe injury such as elective operation, where a more modest expansion of extracellular volume is seen and which is not associated with any loss of potassium or magnesium. The magnitude and persistence of these changes in muscle tissue deserve further study, both as to mechanism and implications for therapy.
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PMID:Influence of injury and nutrition on muscle water and electrolytes: effect of severe injury, burns and sepsis. 363 May 23

Fifteen patients with septic shock and perfusion failure received a 20-min infusion of glucose-insulin-potassium (GIK, glucose 50%, 1 g/kg body weight; insulin 1.5 U/kg, potassium, 10 mMol) after volume loading and vasoactive medication had failed to eliminate hypotension and lactacidemia. Hemodynamic and oxygen measurements were obtained before, immediately and 30 min after GIK infusion. GIK improved hemodynamic status, at least temporarily, in 14 of 15 patients. Cardiac index (CI) increased simultaneously with an increase in cardiac filling pressure. Systemic vascular resistance decreased, particularly in patients with an initially low CI (less than 4 L/min X m2). Mean arterial and pulmonary artery pressures did not change. After 30 min, cardiac filling pressure fell while CI was still elevated, but this decrease was only significant for those with an initially low CI. Although arterial oxygen content decreased after GIK, oxygen consumption did not fall. Serum lactate increased. Six patients died because of ongoing sepsis. Nine patients survived at least 48 h, showing further clinical improvement. Only four patients were hospital survivors. Because GIK increased cardiac output and possibly oxygen consumption, its administration may be considered in the treatment of septic shock when conventional therapy fails.
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PMID:Use of glucose-insulin-potassium (GIK) in human septic shock. 389 Dec 30

In ICU patients suffering from abdominal sepsis acute renal failure (ARF) is a common (50% incidence) and often lethal (more than 80% mortality) complication. Continuous monitoring of renal function is necessary for both adequate fluid replacement and early detection of ARF. Using a programmable handheld computer the following parameters are calculated at least daily: creatinine, osmolal and free water clearance, fractional excretion of sodium and potassium and non-saline loss. The clearance values are corrected to 1.73 m2 body surface area. Free water clearance proved to be a particularly valuable guide for fluid therapy as well as for early diagnosis of ARF. In all septic patients renal function is impaired to some degree, since despite increased cardiac output creatinine clearance is only normal or even decreased. More than 50% of our patients with abdominal sepsis develop ARF, resulting in a dramatic increase in mortality. Goal of renal monitoring in sepsis is to detect ARF as early as possible and to differentiate between extrarenal and septic origin to enable immediate surgical treatment.
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PMID:[Monitoring kidney function in abdominal infection]. 408 36

296 nonhospital abortions using an abortifacient paste method are examined in support of the outpatient abortion. Patients ranged in age from 11 to 47 years, 20% were married, and 98% were in the poverty or lower income level. The patients were seen at 2 1/2 months gestation. Under sterile conditions in a doctor's office 10-40 cc of a high viscosity paste - potassium neutral soap with KI and thymol, borne in a multitincture menstruum - was admitted by syringe into the internal os. The method paralleled the Luenbach paste method but abrasives were absent. The paste impaired circulation between zygote and chorion frondosum. On the 2nd day ergotrate was given. Flow lasted 3-7 days. There was frequent follow-up by phone. Check-up vaginals were done at 1 and 3 weeks. 78% had excellent results. 11% needed 2-3 weeks treatment with carbazochrome salicylate, vitamin K, or medrozyprogesterone acetate. 3% required dilatation and curettage. The 6% failures should be considered operator failures in misjudging length of gestation. Sepsis, serious complications, or fatality were absent with this method. Preliminary history omitted cases from this method that might preclude complications. The success with these cases indicates that the nonhospital, paste-induced abortion can be both effective and safe.
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PMID:Looking back at Luenbach: 296 non-hospital abortions. 491 44

Various metabolic, cellular, and subcellular alterations in cell function and morphology occur during shock or low-flow conditions. In attempting to find treatment programs that would be beneficial following shock, various substrates have been used. Infusion of hypertonic glucose during shock has been shown to improve survival; however, it is unlikely that the effect of glucose is by provision of energy until the circulation is restored. Infusion of glucose--insulin--potassium during shock has also been reported to be beneficial in certain clinical situations. Controversies exist concerning the efficacy of infusions of cyclic AMP, nicotinamide, and Krebs cycle intermediates during shock. Pretreatment of kidneys with inosine or raising glycogen stores of the myocardium have been shown to have protective effects of kidneys and myocardium during ischemia and these procedures may be suitable for organ preservation. Pretreatment with allopurinol has been shown to be beneficial in shock; however, it is unlikely that allopurinol by itself if given following shock would have any salutary effects. Treatment with ATP-MgCl2 has been shown to be beneficial following hemorrhagic shock, sepsis, endotoxin shock, burns, postischemic hepatic failure, and postischemic renal failure. Thus, provision of energy directly in the form of ATP during adverse circulatory conditions appears to be the most advantageous and direct method for the treatment of shock.
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PMID:The use of substrates and energy in the treatment of shock. 627 59

Untreated septic shock results in depletion of extracellular fluid, cellular swelling, increased intracellular sodium, and decreased intracellular potassium concentrations in primate skeletal muscle. The Langer rabbit heart interventricular septal preparation was used to determine whether similar changes occur in cardiac muscle during sepsis. Rabbit septa (n = 17) were perfused with control and septic rabbit plasma plus red blood cells. Tissue contractility (developed tension [DT] and rate of tension change [dP/dt]) was followed, plasma cations were measured (Na+, K+, Ca2+, H+), perfusion pressure (PP) was monitored, and 42K efflux was determined. The effect on 42K efflux caused by the addition of potassium chloride to control plasma was determined. During perfusion with septic plasma there was significant decline of septal function (P less than 0.001). In 12/17 experiments DT fell 77.8 +/- 21.4% and dP/dt fell 75.8 +/- 24.8% from control values (means +/- 1 SD). All septa recovered when perfusion with control plasma was resumed. If [K+] was increased in control plasma during 42K washout, the percentage increase of effluent counts per minute per minute correlated with the percentage rise of control plasma [K+] (r = 0.95, P less than 0.001). During perfusion with septic plasma there was no similar correlation (r = 0.277). 42K efflux increased during septic plasma perfusion independent of the differences between control and septic plasma [K+], demonstrating abnormal myocardial K+ efflux. An abnormal efflux of K+ is seen during septic plasma perfusion similar to that described in primate skeletal muscle. It is associated with and may be a mechanism of action for the observed fall of contractility.
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PMID:Altered potassium flux and myocardial dysfunction during sepsis. 638 64

The chemistry, microbiology, pharmacokinetics, therapeutic use, adverse effects, and dosage of amoxicillin-potassium clavulanate, a beta-lactamase-resistant antibiotic combination, are reviewed. Clavulanic acid is a "suicide" inhibitor of bacterial beta-lactamase enzymes and has been effective in preventing destruction of penicillins by these enzymes. Clavulanic acid alone has weak antibacterial activity against most organisms. After oral administration, clavulanic acid is rapidly absorbed; amoxicillin appears to increase its absorption. Absorption of amoxicillin-clavulanic acid is not affected by food. Amoxicillin-clavulanic acid is effective in treating both acute uncomplicated and complicated urinary-tract infections and exacerbations of chronic bronchitis caused by amoxicillin-resistant organisms in adults. It appears to be comparable in efficacy to cefaclor for treating uncomplicated urinary-tract infections in adults and children, acute bronchitis and bronchopneumonia, and acute sinusitis, otitis media, and skin and soft-tissue infections in children. Other infections for which the combination has been effective include cellulitis and intra-abdominal and pelvic sepsis caused by mixed aerobic/anaerobic organisms. Amoxicillin-clavulanic acid has also successfully cured urethritis in men caused by penicillinase-producing Neisseria gonorrhoeae and is superior to amoxicillin alone for beta-lactamase-positive Haemophilus ducreyi infections (chancroid). Diarrhea or loose stools is the most common side effect seen with amoxicillin-clavulanic acid; nausea, vomiting, and skin rash may also occur. Nausea, vomiting, and diarrhea may be lessened by taking the combination with food.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Amoxicillin-potassium clavulanate, a beta-lactamase-resistant antibiotic combination. 639 83

Mucormycosis in two patients with multiple-organ failure appeared as a cutaneous lesion and spread rapidly. In the first case, wet mounts and potassium hydroxide preparations were unhelpful, but a punch biopsy specimen established the diagnosis. Prompt and extensive debridement and amphotericin B administration arrested the infection. In the second case, virulent progression of the lesion occurred despite limited amputation, debridement, transfer factor, and amphotericin B, but finally responded to further amputation. Diagnosis was made by histologic examination of infected tissue. Both patients shared the following predisposing factors: sepsis, low blood flow, acidosis, multiple-organ failure, and multiple-antibiotic therapy. Although the mucormycosis was controlled, as confirmed in the first case at autopsy and in the second case by clear margins following reamputation, the outcome was fatal in both cases due to other features of multiple-organ failure.
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PMID:Mucormycosis in patients with multiple-organ failure. 647 4

The first reported case, in an adult, of cholestyramine induced hyperchloremic metabolic acidosis is a 70 year old female with a two year history of primary biliary cirrhosis confirmed by histologic and immunologic criteria. After taking cholestyramine II sachets twice daily for two months she presented with lethargy, confusion and drowsiness. Examination revealed confusion, jaundice, signs of chronic liver disease, portal hypertension and hepatic encephalopathy. Laboratory investigations confirmed a metabolic acidosis (pH 7.15) and hyperchloremia. Multiple cultures failed to reveal sepsis and a urinary pH of 4.85 together with tests of renal acidification, excluded renal tubular acidosis. She received 600 mEq of sodium bicarbonate intravenously over 36 hours by which time her mentation, electrolytes and pH were normal. It is presumed that her hyperchloremic metabolic acidosis was secondary to cholestyramine because of the similarity to pediatric reports; the rapid and lasting response to intravenous sodium bicarbonate; the absence of another etiology; normal serum potassium, chloride and bicarbonate despite continued spironolactone therapy after recovery.
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PMID:Cholestyramine induced hyperchloremic metabolic acidosis. 659 13


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