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

One of the dangers of topical therapy in thermal injuries is absorption of the therapeutic agent with subsequent metabolic and toxic complications. Two patients, one 30 years old with a 75% burn, the second 72 years old with a 35% burn, were treated topically with povidone-iodine ("Betadine", pH 2.43). In both patients severe metabolic acidosis developed which could not be attributed to sepsis, hypovolaemia, renal failure, diabetes, lactic acidaemia, &c. The acidosis associated with the 75% burn required large amounts of sodium bicarbonate to maintain pH at 7.35 and a serum-bicarbonate concentration of 15 mmol/l (meq/l); serum-iodine was 48000 mug/dl (normal 4-8.5mug/dl). Acidosis in the second patient was not as severe, and serum-iodine concentration reached 17600 mug/dl. The rate of urinary excretion of iodine was 50.8 +/- 7.4 mg/dl and seemed to be fixed. Haemodialysis was very effective in reducing serum-iodine concentration. Povidone was also systemically absorbed. The persistent acidosis could be caused by absorption of the iodine or the acidic povidone-iodine. Until the aetiology of the acidosis and renal damage is more clear, iodophors should not be used topically for burns greater than 20% of the body surface or in the presence of renal failure.
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PMID:Complications of povidone-iodine absorption in topically treated burn patients. 5 90

The inhibitory effect of sodium acetate on microorganism growth in protein hydrolysate solutions was studied. Solutions of 5% protein hydrolysate and 5% dextrose in water (seven parts) and 50% dextose in water (three parts) containing 0, 30, 50 and 90 mEq/liter of sodium acetate were inoculated with Staphylococcus aureus, Escherichia coli, Candida albicans and Pseudomonas aeruginosa. The number of colony-forming units in the solutions after inoculation was compared with that after incubation for 24 hours at 37 C. Sodium acetate inhibited growth of S aureus and E coli. Growth of P aeruginosa was inhibited in protein hydrolysate solutions with and without sodium acetate; inhibition could not be attributed solely to sodium acetate and may have been releated to pH of the solutions (4.7 to 5.4). Growth of C albicans was not inhibited by sodium acetate. Sodium acetate reduced growth of some common contaminants of protein hydrolysates. Sodium acetate is known to reduce metabolic acidosis, a reported complication of parenteral nutrient therapy and a possible predisposing factor in C albicans sepsis. Addition of sodium acetate to protein hydrolysate solutions should be considered seriously.
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PMID:Sodium acetate as a preservative in protein hydrolysate solutions. 11 72

Acid-base alterations in Streptococcus pneumoniae infection were studied in 80 male albino rats. Hematocrit and concentrations of plasma electrolytes, glucose, and total protein were also measured. At 3-h intervals throughout a 27-h study, four control and four infected rats were anesthetized with ether, and blood samples were taken. Arterial blood pH, Po2, and hematocrit increased in the infected group, whereas arterial Pco2, HCO3-, and venous Po2 decreased. Plasma K+ concentration increased slightly and glucose levels decreased in the infected rats as the sepsis progressed. No significant changes were observed in venous blood pH, HCO3-, and Pco2. Plasma Na+, Cl-, and total protein remained unchanged. The increase in arterial blood pH and decrease in arterial Pco2 and HCO3- indicated respiratory alkalosis, which was present in rats infected with S. pneumoniae.
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PMID:Changes in blood pH in rats after infection with Streptococcus pneumoniae. 23 92

Numerous studies have demonstrated that reticuloendothelial system (RES) depression induced by colloid blockade increases susceptibility to circulatory shock following trauma and sepsis. Recent data have suggested that this may relate to the failure of the RES to clear potentially embolic material derived from activation of the hemostatic system. The present study thus compared the hypotensive response precipitated by trauma or sepsis with that resulting from induction of intravascular coagulation. Mean arterial blood pressure (MABP) was monitored for 120 minutes after sublethal NCD trauma and after intra-aortic injection of live E coli (approximately 10(10) organisms per rat), E coli endotoxin (0.1 mg/100 gm), or bovine thrombin (10 units/100 gm) in 400-500 gm rats 30 minutes after RE blockade (50 mg/100 gm gelatinized lipid colloid) or saline injection. All rats were anesthetized with sodium pentobarbital. No hypotension was observed in blockaded control rats. After trauma, MABP decreased by 20 minutes after injury and recovered to normal levels by 1 hour post-trauma. MABP decreased in blockaded rats after trauma and remained diminished through 2 hours. After live E coli endotoxin or thrombin, both the normal and the blockaded groups underwent an initial hypotension of similar magnitude. A second period of hypotension was much more pronounced in the RE-blockaded animals. Reduced MABP persisted in these animals through 2 hours. These data indicate that RE blockade enhances the hypotensive response to intravascular coagulation and that resulting from trauma or sepsis. This effect was especially apparent during the second phase of hypotension during sepsis and intravascular coagulation. It was suggested that the RES manifests some protective effect against the agents inducing this secondary hypotensive response.
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PMID:Effect of reticuloendothelial blockade on the development of hypotension after trauma, sepsis, and intravascular coagulation. 26 5

Patients with refractory ascites and HRS should be considered to present an urgent indication for peritoneovenous shunting. The shunt offers a method of continuous reinfusion of ascitic fluid which corrects avid sodium retention, oliguria and azotemia. Severe encephalopathy, jaundice or peritoneal sepsis--common complications of cirrhosis--contraindicate installation of the shunt before improvement occurs. Associated cardiac disease does not contraindicate the use of the shunt provided that ascitic fluid is removed at the time of operation and large amounts of diuretics are used. This operation has also proved useful in ascites attributed to causes other than cirrhosis. The main complications include disseminated intravascular coagulopathy, hepatic coma and sepsis in a few patients. Results of a randomized prospective study indicate that the shunt should probably be considered in patients with diet-resistant massive ascites even before they prove to be refractory to diuretic therapy.
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PMID:Ascites: its correction by peritoneovenous shunting. 37 15

Alterations occur in human muscle electrolyte and water composition in response to infection. There appear to be at least two basic mechanisms; the first is an exchange of sodium for potassium without alteration in water content of muscle. The second is an increase in cellular Na and water without a loss of K on a dry weight basis. In a series of studies in monkeys, Salmonella typhimurium sepsis was induced as an experimental model. Both patterns of muscle response to infection were detected. Electron probe microanalysis revealed that the loss of K concentration was due to an accumulation of intracellular saline which dilute the K content. The mechanism of this is unclear; however, a concomitant increase in undertermined osmoles in the serum suggests that there may be an increase in organic osmoles within the cell which leads to the dilution of intracellular K concentration.
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PMID:Sequential changes in body composition during infection: electron probe study IV. 40 71

Septic thrombosis of central veins is rarely diagnosed during life and nearly always proves fatal. We have recently successfully treated a patient with a 75% body surface burn in whom septic thrombosis of the inferior vena cava developed associated with high-grade candidemia as a complication of parenteral nutrition. Signs of venous thrombosis and candidemia persisted after catheter removal. Prompt and intensive therapy with amphotericin B, monitored by fungicidal assays of serum, resulted in cure. Generous hydration and directed supplementation of sodium bicarbonate permitted us to administer a large total dose of amphotericin over a relatively brief period of time with no nephrototoxic effect whatsoever. Septic central venous thrombosis mandates a pharmacologic approach to therapy similar to that used for infective endocarditis, with the addition of anticoagulation. Should sepsis prove refractory to this program of it pulmonary embolization occurs, operative intervention is indicated despite the high risks involved.
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PMID:Management of septic thrombosis of the inferior vena cava caused by Candida. 41

The reported complication rate from T-tube infusion of sodium cholate for dissolution of retained biliary stones is low. Among 84 patients reported in the English-language literature, and 10 additional cases of our own, there have been no deaths, an incidence of liver enzyme elevation in 7%, fever in 5%, cholangitis in 2%, and pancreatitis in 2%. Recently, we have infused 100mM sodium cholate at 30 cc/hr into patients through transhepatic biliary stents in an effort to rid the intrahepatic biliary tree of retained stones and biliary sludge. Appropriate precautions were taken to prevent increased biliary pressures by the insetion of a 30 cm manometer into the perfusion system. During four transhepatic infusions in three patients, all experienced nausea and vomiting, and two of the three patients developed diarrhea and abdominal pain. Liver enzymes became elevated during all four infusions, and two of the three patients became septic and died shortly after their infusions. Experimental work in animals suggests that intrahepatic sodium cholate infusion results in injury to the ductal epithelium and predisposes patients to bactermia and sepsis. Even though T-tube infusion of sodium cholate into the common bile duct is well tolerated, direct infusion into the intrahepatic biliary tree through a transhepatic tube is not and carries a high risk of sepsis and death.
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PMID:Sodium cholate dissolution of retained biliary stones: mortality rate following intrahepatic infusion. 43 6

The role of antibiotic therapy in open fractures is secondary to adequate debridement, irrigation, and definitive wound care. Experimental and clinical studies indicate that parenteral administration of appropriate antibiotics within three hours after injury helps to prevent wound sepsis. Intial wound cultures of 158 open fracture wounds revealed bacterial growth in 70.3%. Eighty-six were Gram-positive, 57 were Gram-negative, and 32 yielded mixed bacterial growth. Sensitivity studies of these organisms suggest that cephalothin sodium is the most effective antibiotic for prophylaxis. In a prospective study from 1969 to 1975, treatment of 520 patients was as follows: debridement, copious irrigation, and primary closure for types 1 and 2 fractures and secondary closure for type 3 fractures. No primary internal fixation was done except in vascular injuries. Cultures were taken of all wounds and antibiotics were given before surgery and for three days postoperatively. In type 3 open fractures, severe soft tissue injury, and segmental or traumatic amputation, the infection rate was 9%, compared to a 44% infection rate in the retrospective study from 1955 to 1968.
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PMID:Use of antimicrobials in the management of open fractures. 45 75

Over a period of 2 years, 82 patients out of 2,390 (3.43%) admitted to an intensive care unit developed acute renal failure (ARF). The diagnosis of ARF was based on the usual criteria of oliguria, a rising blood urea nitrogen and creatinine, urine sodium concentration greater than 20 mmol/l and a U/P osmolality ratio less than 1.1. In 9.2% of patients the latter two criteria were misleading. Sepsis was the commonest cause of vasomotor nephropathy but in 20.7% potentially nephrotoxic agents had been administered before development of ARF. Overall mortality was 73.2%, with patients older than 50 years of age having the highest mortality. ARF is associated with prolonged bed occupancy--an average of 59.8 days for the dialysed patients with ARF versus an average length of stay of 8.4 days for the hospital overall.
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PMID:Aetiology, diagnosis, treatment and prognosis of acute renal failure in an intensive care unit. 54 32


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