scholarly journals Severe Metformin Poisoning Successfully Treated with Simultaneous Venovenous Hemofiltration and Prolonged Intermittent Hemodialysis

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Dovile Leonaviciute ◽  
Bo Madsen ◽  
Anne Schmedes ◽  
Niels H. Buus ◽  
Bodil S. Rasmussen
Keyword(s):  
Mortality Rate ◽  
Lactic Acidosis ◽  
Intermittent Hemodialysis ◽  
Continuous Venovenous Hemofiltration ◽  
Cardiovascular Collapse ◽  
Circulatory Collapse ◽  
Patient Case ◽  
Threatening Condition ◽  
Life Threatening ◽  
Lactate Acidosis

Metformin poisoning is a life-threatening condition with a high mortality rate. We present a patient case of metformin poisoning following intake of 80 g metformin resulting in severe lactate acidosis with a nadir pH of 6.73 and circulatory collapse, successfully treated with addition of prolonged intermittent hemodialysis (HD) to continuous venovenous hemofiltration (CVVH). The patient’s pH became normal 48 hours after metformin ingestion during simultaneous CVVH and addition of 22 hours of intermittent HD in the ICU. The highest metformin level was found to be 991 μmol/L (therapeutic range 3.9–23.2 μmol/L). We conclude that in cases of severe metformin poisoning with circulatory shock and extreme lactic acidosis, the usual CVVH modality might not efficiently clear metformin. Therefore, additional prolonged HD should be considered even in the state of cardiovascular collapse with vasopressor requirement.

PS02.056: TIMELY LIGATION OF THORACIC DUCT IN POST ESOPHAGECTOMY CHYLE LEAK: KEY TO SUCCESSFUL MANAGEMENT

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 136-136
Author(s):  
Sanjeev Parshad ◽  
Parvinder Sandu ◽  
Shekar Gogna ◽  
Abhijeet Beniwal ◽  
Rajendra Karwasra
Keyword(s):  
Mortality Rate ◽  
Thoracic Duct ◽  
Conflicts Of Interest ◽  
Surrounding Tissue ◽  
Chyle Leak ◽  
Threatening Condition ◽  
Life Threatening ◽  
Carcinoma Esophagus ◽  
Esophagectomy For Cancer

Abstract Background Chyle leak after esophagectomy for carcinoma esophagus is a rare but life threatening condition with reported an incidence of 1–6%. Mortality rate of up to 50% have been reported. Management of chyle leak is controversial. We reviewed our experience with iatrogenic chylothorax after esophagectomy for carcinoma esophagus. Methods From 2003 to 2017, 560 patients underwent esophagectomy for cancer at our department of oncosurgery. Eight patients developed post operative chyle leak. Transthoracic or transabdominal ligation of duct was done in six patients with in first week. 100 ml of cream was given 30 min before induction to visualize the leak intraoperatively. We used 4–0 prolene pledgeted suture to ligate the duct. Results Six patients who underwent early ligation could be salvaged and the two who were managed conservatively succumbed. Oringer et al. pointed towards conservative treatment having little place in the management of chylothorax in nutritionally depleted patients. Hence, prompt ligation of thoracic duct decreases morbidity and mortality of chylothorax. Thus the role of early surgery needs to stressed. There is a wide difference of mortality rate of conservative management of 82% with respect to the mortality rate of surgery of 10–16%. Though no conclusion data are available regarding the indication and time point of surgical ligation of the thoracic duct, it is important not to procrastinate while the condition deteriorates to a level at which surgery would be detrimental.Administration of cream to the patient (through feeding jejunostomy) around half an hour before surgery makes identification of site of leak simpler.The importance of pledgeted sutures cannot be denied as the thoracic duct is paper thin and chyle contains no fibrin. Thus non pledgeted sutures will tear it further. Infact, stitching should not be done through the duct but into the surrounding tissue around the duct and should allow the pledgets to close the duct. Conclusion Disclosure All authors have declared no conflicts of interest.

A rare case of rhabdomyolysis and acute renal failure following spinal surgery

2008 ◽  
Vol 9 (4) ◽  
pp. 387-389 ◽  
Author(s):  
Michael Papadakis ◽  
George Sapkas ◽  
Apostolos Tzoutzopoulos
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Spinal Surgery ◽  
Rare Case ◽  
Neurogenic Claudication ◽  
Intermittent Hemodialysis ◽  
Lumbar Surgery ◽  
Adequate Treatment ◽  
Threatening Condition ◽  
Life Threatening

Spinal surgery–associated rhabdomyolysis, although rare, is a life-threatening condition. Presented here is the case of a middle-aged, overweight man who underwent posterior lumbar surgery because of pain and neurogenic claudication. His postoperative course was complicated by the occurrence of rhabdomyolysis. Despite adequate treatment, acute renal failure developed as a sequela. His condition was grave enough to require the administration of intermittent hemodialysis. After a prolonged hospitalization and 5 sessions of hemodialysis, the patient achieved a full recovery. In view of the fact that rhabdomyolysis-induced acute renal failure is associated with a mortality rate of 20–50%, the outcome was favorable.

Catastrophic antiphospholipid syndrome (Ronald Asherson syndrome) and obstetric pathology

2018 ◽  
Vol 46 (4) ◽  
pp. 387-400 ◽  
Author(s):  
Alexander D. Makatsariya ◽  
Jamilya Khizroeva ◽  
Viktoriya O. Bitsadze
Keyword(s):  
Mortality Rate ◽  
Antiphospholipid Syndrome ◽  
Antiphospholipid Antibodies ◽  
Multiorgan Failure ◽  
Multiple Organ ◽  
Catastrophic Antiphospholipid Syndrome ◽  
Small Vessels ◽  
Threatening Condition ◽  
Life Threatening ◽  
Large Vessels

Abstract Background: Catastrophic antiphospholipid syndrome (CAPS) is an uncommon, often fatal, variant of the antiphospholipid syndrome (APS) that results in a widespread coagulopathy and high titres of antiphospholipid antibodies (aPL) and affects predominantly small vessels supplying organs with the development of multiorgan failure. It remains unclear why some patients develop the typical clinical picture of APS (thrombosis of large vessels), whereas others show the development of progressive microthrombosis, which the authors called “thrombotic storm” and multiple organ failure, that is, CAPS. Materials and methods: Since 2001–2016, we discovered 17 patients with CAPS development. Conclusion: CAPS is life-threatening condition, but optimal treatment for CAPS is not developed yet and the mortality rate is as high as 30%–40%.

scholarly journals Tatalaksana Penurunan Kesadaran Pada Penderita Diabetes Mellitus

Medicinus ◽  
2018 ◽  
Vol 6 (1) ◽  
Author(s):  
Ian Huang
Keyword(s):  
Diabetes Mellitus ◽  
Mortality Rate ◽  
Lactic Acidosis ◽  
Diabetic Ketoacidosis ◽  
Complications Of Diabetes ◽  
Uremic Encephalopathy ◽  
Hyperosmolar Hyperglycemic State ◽  
Life Threatening

Hyperglycemic crisis (diabetic ketoacidosis or hyperosmolar hyperglycemic state), lactic acidosis, hypoglycemia, and uremic encephalopathy are life-threatening complications of diabetes mellitus (DM). Specific therapies of each condition are essential in reducing mortality rate of the complications.

scholarly journals Evaluation of outcome in Mesenteric Ischemia

2017 ◽  
Vol 5 (2) ◽  
pp. 13
Author(s):  
Samad Shams Vahdati ◽  
Ozgur Tatli ◽  
Mohammad Taghizadieh ◽  
Roshan Fahimi ◽  
Neda Gholamzadeh ◽  
...  
Keyword(s):  
Emergency Department ◽  
Mortality Rate ◽  
Early Diagnosis ◽  
Physical Examination ◽  
Mesenteric Ischemia ◽  
Clinical Signs ◽  
Acute Mesenteric Ischemia ◽  
P Value ◽  
Threatening Condition ◽  
Life Threatening

Background: Acute mesenteric ischemia (AMI) is an infrequent but a complicated life threatening condition. It is the leading causes of mortality with the rate of 60-100%. The purpose of our study is to investigate demographic outcomes of the patients referred to the emergency department of Imam Reza hospital with the diagnosis of AMI. Methods and materials: All patients with the diagnosis of AMI from March 2014 to March 2016 who were referred to emergency department of Imam Reza hospital, were studied. Demographic characteristics (age, sex, the period from symptom onset till laparotomy), risk factors and the last outcomes of patients were noted in the check lists for each patient. P value less than 0.05 was determined as significant. Results: from 111 patients, 76 cases (68.8%) were male, 35 cases (31.5%) were female. Chief complaint of all patients was stomachache. Period of arriving to the emergency room in 5 cases (4.5%) was 1-6 hours, in 3 cases (2.7%) was 6-12 hours, and in 103 cases (92.8%) has taken more than 12 hours. In 55 cases (49.5%), there was a significant relationship between clinical signs and physical examination findings, whereas in 56 cases (50.5%) there was no relation. In our study 42 cases (37.8%) were treated, whereas the morbidity and mortality rate were respectively 7 (6.3%) and 62 (55.9%). According to the results of our study the most important finding was pain which was disproportionate to physical examination findings (P value< 0.052). Conclusion: Acute mesenteric ischemia is a severe and progressive disease so early diagnosis and appropriate treatment are very important. One of the main reasons of higher mortality rate in AMI is difficulty in early diagnosis, before necrosis occurrence. Major factor that determines the survival rate is the accurate diagnosis before necrosis and peritonitis happens.  

Evaluation and Anesthetic Management for Patients With Cardiac Trauma

2019 ◽  
pp. 348-359
Author(s):  
Daniel Smith ◽  
Eric Ness ◽  
Amanda M. Kleiman
Keyword(s):  
Anesthetic Management ◽  
Clinical Suspicion ◽  
Operating Conditions ◽  
Mechanical Support ◽  
Cardiovascular Collapse ◽  
Cardiac Trauma ◽  
Complex Patients ◽  
Threatening Condition ◽  
Life Threatening ◽  
High Level

Cardiac trauma, either blunt or penetrating, is a life-threatening condition often requiring immediate intervention. Cardiac trauma causes varied hemodynamic effects, from stable arrhythmia to cardiovascular collapse. The diagnosis of cardiac trauma relies on a high level of clinical suspicion paired with imaging, including transthoracic echocardiography. Anesthetic management for cardiac trauma focuses primarily on maintenance of preload and cardiac function while optimizing operating conditions for surgical repair. Depending on the injuries involved, support that includes inotropes, vasopressors, and potentially mechanical support may be required. This chapter discusses the pathophysiology and presentation of cardiac trauma and explores the intricate anesthetic management of these complex patients.

scholarly journals PREDISOPSING FACTORS; MANAGMENT AND OUTCOMES OF NECROTIZING FASCITIS Among patients who admitted to surgical ward at Al-Thawra hospital; January 2020 to January 2021: العوامل المسببة؛ إدارة ونتائج التفتت الناخر؛ لدى عينة من المرضى في قسم الجراحة بمستشفى الثورة بصنعاء

2021 ◽  
Vol 5 (3) ◽  
pp. 118-99
Author(s):  
Yasser Abdurabo Obadiel, Mohammed Hamood Alyan Yasser Abdurabo Obadiel, Mohammed Hamood Alyan
Keyword(s):  
Mortality Rate ◽  
Necrotizing Fasciitis ◽  
Soft Tissues ◽  
Perianal Abscess ◽  
Deep Fascia ◽  
Surgical Department ◽  
Incidence And Mortality ◽  
Threatening Condition ◽  
Life Threatening ◽  
Necrotizing Fascitis

  Background: Necrotizing fasciitis is a serious infection of skin and soft tissues that rapidly progresses along the deep fascia. It’s a fatal infection with high mortality if treatment delayed. Early diagnosis, surgical debridement and broad-spectrum antibiotic therapy are the optimal treatments to reduce the mortality. Objective: The aims were to identify risk factors for Necrotizing fasciitis and to describe the outcome of management. Methods: A prospective descriptive study was conduted at AL-THAWRA HOSIPTAL located in Sana’a, Yemen. All medical records of patients with confirmed NF who admitted to surgical department between January 2020 and January 2021 were reviewed. Results: The study enrolled 54 patients diagnosed with Necrotizing fasciitis. Male patients were 43 patients (79.6%) and female patients were 11 patients (20.3%). The age rang was 9 – 75 years old and the peak age incidence was at 46–60 years (33.3%). The incidence of NF increases with aging, male gander (79.6%), in comorbid patients (64.9%) especially DM (37%). The etiologies of NF were trauma in (16.6%) and perianal abscess in (14.8%), but (27.7%) of NF patients hadn’t specific cause. The defected wound was treated by skin graft in (32.5%) and primary closure in (27.5%). The mortality rate was (27.7% n=15); (60%) of them died on first 5 days. Septic shock was the reason of death in (73.2%). The higher mortality rate was seen at male gander (66.6%), age group > 60 years (46.6%), in patients who presented in shocked state (73.3%) and in comorbid patients (73.3%). Conclusion: Necrotizing fasciitis represents a life threatening condition with challenges in diagnosis. Incidence and mortality of NF are common in male gander, an elderly patient, or in who suffers of comorbidities; especially DM.

Lipidcsökkentés Covid-19-járvány alatt

2021 ◽  
Vol 31 (5-6) ◽  
pp. 185-190
Author(s):  
László Márk
Keyword(s):  
Mortality Rate ◽  
Meta Analysis ◽  
Lipid Lowering ◽  
Evidence Based ◽  
Clinical Experiences ◽  
Angiotensin Converting Enzyme 2 ◽  
Cholesterol Levels ◽  
Threatening Condition ◽  
Life Threatening ◽  
Based Medicine

The COVID-19 pandemic posed significant challenges to all healthcare systems of the world as created a new situations above the large number of people infected, solutions of which were lacking any previous patterns. Former experiences were specifically needed among physicians who practised usually with therapies supported by evidence based clinical experiences thus they were working along the principles of Evidence-Based Medicine. The new observations and recommendations for treating infected patients increased gradually, however they were not always well-founded by the general urgency. In this situation, physicians faced often problems of the patient’s former medications since they had to focus on the therapy of the prevalent life-threatening condition. In such cases, therapy as lipid lowering, which is inherently inimically and lightly taken, may be omitted even more often. Basic drugs of lipid lowering are statins. They are used to reduce cholesterol levels and the risk of cardiovascular events, but they have also been described as having beneficial effect on the new viral infection. In this effect, the statins beyond the well-known anti-inflammatory impact and increasing the expression of angiotensin-converting enzyme-2 further mechanisms can take part as well. These may include among others the promoted breakdown of lipid rafts, which directly inhibits the entry of coronavirus into the cell through the S protein by decreasing the level of cholesterol required for this proceeding. In a group of more than 1200 statin treated and SARS-COV-2 infected patients the overall mortality rate by the 28th day was 48% lower than among the non-statin-users. According to a meta-analysis of nearly nine thousand COVID-19-infected statin users, they had 30% lower mortality rate or serious complications. Up to date observational studies suggest that statin therapy and the administration of other lipid lowering drugs should be continued or initiated according to the guidelines also during the COVID-19 infection.

scholarly journals Soliris to Stop Immune-Mediated Death in COVID-19 (SOLID-C19)—A Compassionate-Use Study of Terminal Complement Blockade in Critically Ill Patients with COVID-19-Related Adult Respiratory Distress Syndrome

Viruses ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 2429
Author(s):  
Thomas C. Pitts
Keyword(s):  
Mortality Rate ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Standard Of Care ◽  
Mechanically Ventilated ◽  
Immune Mediated ◽  
Threatening Condition ◽  
Life Threatening ◽  
Terminal Complement

Eculizumab, a terminal complement (C5)-inhibiting monoclonal antibody, was administered in five mechanically ventilated patients in life-threatening condition due to COVID-19-related acute respiratory distress syndrome (ARDS) between 23 March 2020 and 3 April 2020. Their clinical progress was monitored. The primary endpoint was mortality. One patient was excluded while two passed away. The remaining two patients survived. At the time of this study, the mortality rate in mechanically ventilated COVID-19 patients suffering from ARDS receiving the standard of care as their therapeutic regimen was reportedly as high as 97%. This pilot study demonstrates a 50% mortality rate in patients receiving eculizumab therapy.

Lemierre syndrome – a forgotten complication of acute tonsillitis

1995 ◽  
Vol 109 (7) ◽  
pp. 657-661 ◽  
Author(s):  
C. B. Koay ◽  
T. Heyworth ◽  
P. Burden
Keyword(s):  
Young Adults ◽  
Mortality Rate ◽  
Clinical Picture ◽  
Clinical Presentation ◽  
Clinical Course ◽  
Disease Process ◽  
Acute Tonsillitis ◽  
Lemierre Syndrome ◽  
Threatening Condition ◽  
Life Threatening

AbstractLemierre syndrome, also known as postanginal sepsis, is an illness characterized by the development of a fusobacterial septicaemia with multiple metastatic foci following an attack of acute tonsillitis. It typically affects previously healthy adolescents and young adults who, following an attack of sore throat, become acutely ill with hyperpyrexia, rigors and multiple metastatic abscesses. The clinical picture tends to vary widely because of the possible involvement of a number of body systems and organs in the disease process. This serious complication of oropharyngeal sepsis had a mortality rate in excess of 90 percent in the pre-antibiotic era. Although now rarely seen and often forgotten, it remains a potentially life-threatening condition. We present four cases of post-tonsillitis fusobacterial septicaemia to illustrate the variability of the clinical presentation and stormy clinical course frequently associated with this rare syndrome.

Sign in / Sign up

Export Citation Format

Share Document