scholarly journals Using pCO2 Gap in the Differential Diagnosis of Hyperlactatemia Outside the Context of Sepsis: A Physiological Review and Case Series

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Petr Waldauf ◽  
Katerina Jiroutkova ◽  
Frantisek Duska
Keyword(s):  
Cardiac Output ◽  
Lactic Acidosis ◽  
Critically Ill ◽  
Case Reports ◽  
Case Series ◽  
Type A ◽  
Physiological Data ◽  
Type B ◽  
Central Venous ◽  
Content Difference

Introduction. There is an inverse relationship between cardiac output and the central venous-arterial difference of partial pressures of carbon dioxide (pCO2 gap), and pCO2 gap has been used to guide early resuscitation of septic shock. It can be hypothesized that pCO2 gap can be used outside the context of sepsis to distinguish type A and type B lactic acidosis and thereby avoid unnecessary fluid resuscitation in patients with high lactate, but without organ hypoperfusion. Methods. We performed a structured review of the literature enlightening the physiological background. Next, we retrospectively selected a series of case reports of nonseptic critically ill patients with elevated lactate, in whom both arterial and central venous blood gases were simultaneously measured and the diagnosis of either type A or type B hyperlactataemia was conclusively known. In these cases, we calculated venous-arterial CO2 and O2 content differences and pCO2 gap. Results. Based on available physiological data, pCO2 can be considered as an acceptable surrogate of venous-arterial CO2 content difference, and it should better reflect cardiac output than central venous saturation or indices based on venous-arterial O2 content difference. In our case report of nonseptic patients, we observed that if global hypoperfusion was present (i.e., in type A lactic acidosis), pCO2 gap was elevated (>1 kPa), whilst in the absence of it (i.e., in type B lactic acidosis), pCO2 gap was low (<0.5 kPa). Conclusion. Physiological rationale and a small case series are consistent with the hypothesis that low pCO2 gap in nonseptic critically ill is suggestive of the absence of tissue hypoperfusion, mandating the search for the cause of type B lactic acidosis rather than administration of fluids or other drugs aimed at increasing cardiac output.

Comparative analysis of spinal extradural arteriovenous fistulas with or without intradural venous drainage: a systematic literature review

2012 ◽  
Vol 32 (5) ◽  
pp. E8 ◽  
Author(s):  
Keisuke Takai ◽  
Makoto Taniguchi
Keyword(s):  
Comparative Analysis ◽  
Signal Intensity ◽  
Case Reports ◽  
Case Series ◽  
Venous Drainage ◽  
Type A ◽  
Mass Effect ◽  
Type B ◽  
Venous Plexus ◽  
Arteriovenous Fistulas

Object Spinal arteriovenous malformations (AVMs) are classified into types according to anatomical characteristics: dural arteriovenous fistulas (AVFs), intramedullary AVMs, perimedullary AVFs, and extradural AVFs. Spinal extradural AVFs are much rarer than other types of spinal AVMs, and the available literature on this clinical entity has been based only on case reports or small case series. To investigate the clinical characteristics of patients with spinal extradural AVFs, the authors systematically reviewed the associated literature in the MRI era. Methods The PubMed database was searched for all relevant English-language case reports and case series published from 1990 to 2011. The clinical differences between Type A with and Type B without intradural venous drainage were statistically compared, especially regarding clinical features and angiographic and MRI findings. Results Forty-five cases of spinal extradural AVFs were found. Type A spinal extradural AVFs were diagnosed in patients with a significantly older age (mean 63.5 years) as compared with Type B AVFs (mean 34.3 years, p < 0.0001). Most cases of Type A spinal extradural AVFs exhibited a diffuse high signal intensity of the spinal cord on T2-weighted MR images and no mass effect (p < 0.0001), and they commonly occurred in the thoracolumbar and lumbar regions (p < 0.0001). On the other hand, cases of Type B lesions exhibited a normal signal intensity of the cord with severe mass effect due to an enlarged extradural venous plexus, and they commonly occurred in the cervical and upper thoracic regions (p < 0.0001), frequently in patients with neurofibromatosis Type 1 (p = 0.049). Because Type B AVFs consisted of high-flow, multiple complex anastomoses between arteries and the epidural venous plexus, patients with these lesions tended to undergo multisession treatments, and the rate of partial AVF occlusion was significantly higher than for Type A AVFs (p = 0.018), although there was no difference in symptom outcomes between the 2 groups. Conclusions To the best of the authors' knowledge, a comparative analysis of the clinical differences in patients with extradural AVFs with or without intradural venous drainage has yet to be described in the literature. They concluded that in the diagnosis of spinal extradural AVF, evaluation of intradural venous drainage is important because the cause of myelopathy determines the treatment goals.

scholarly journals Pregnancy outcomes following botulinum toxin type A exposure: A systematic review

2018 ◽  
Vol 6 (05) ◽  
Author(s):  
Noha Abdelkader ◽  
Elif Keskin Arslan ◽  
Hilal Erol- Coskun ◽  
Gözde Küçüksolak ◽  
Yusuf Cem Kaplan
Keyword(s):  
Botulinum Toxin ◽  
Pregnancy Outcomes ◽  
Congenital Malformations ◽  
Case Reports ◽  
Botulinum Toxin Type A ◽  
Case Series ◽  
Fetal Loss ◽  
Type A ◽  
Botulinum Toxin Type ◽  
Major Congenital Malformations

Objective: To evaluate the available human data to-date in order to assess whether the prenatal exposure to botulinum toxin type A (BTX-A) is associated with major congenital malformations and other adverse pregnancy outcomes. Methods: Searches were conducted in PubMed/MEDLINE and Reprotox in November  2017. Cohort and case-control studies, case series, case reports were the primary data of interest. Results: No controlled studies but case series and case reports of therapeutic BTX-A administration during pregnancy were identified. Case reports regarding pregnant women with botulism were also reviewed. Conclusions: Limited data suggests that BTX-A exposure for therapeutic indications during pregnancy does not seem to be associated with an increase in risk of major congenital malformations. Rates of fetal loss were substantially different between prospective and retrospective data. Controlled epidemiological studies are needed to refute or support our findings.

scholarly journals Lactic Acidosis Update for Critical Care Clinicians

2001 ◽  
Vol 12 (suppl 1) ◽  
pp. S15-S19 ◽  
Author(s):  
FRIEDRICH C. LUFT
Keyword(s):  
Lactic Acid ◽  
Lactic Acidosis ◽  
Pyruvate Dehydrogenase ◽  
Case Reports ◽  
Survival Rates ◽  
Lactate Production ◽  
Type A ◽  
Individual Case ◽  
The Body ◽  
Lactate Removal

Abstract. Lactic acidosis is a broad-anion gap metabolic acidosis caused by lactic acid overproduction or underutilization. The quantitative dimensions of these two mechanisms commonly differ by 1 order of magnitude. Overproduction of lactic acid, also termed type A lactic acidosis, occurs when the body must regenerate ATP without oxygen (tissue hypoxia). Circulatory, pulmonary, or hemoglobin transfer disorders are commonly responsible. Overproduction of lactate also occurs with cyanide poisoning or certain malignancies. Underutilization involves removal of lactic acid by oxidation or conversion to glucose. Liver disease, inhibition of gluconeogenesis, pyruvate dehydrogenase (thiamine) deficiency, and uncoupling of oxidative phosphorylation are the most common causes. The kidneys also contribute to lactate removal. Concerns have been raised regarding the role of metformin in the production of lactic acidosis, on the basis of individual case reports. The risk appears to be considerably less than with phenformin and involves patients with underlying severe renal and cardiac dysfunction. Drugs used to treat lactic acidosis can aggravate the condition. NaHCO3 increases lactate production. Treatment of type A lactic acidosis is particularly unsatisfactory. NaHCO3 is of little value. Carbicarb is a mixture of Na2CO3 and NaHCO3 that buffers similarly to NaHCO3 but without net generation of CO2. The results from animal studies are promising; however, clinical trials are sparse. Dichloroacetate stimulates pyruvate dehydrogenase and improves laboratory values, but unfortunately not survival rates, among patients with lactic acidosis. Hemofiltration has been advocated for the treatment of lactic acidosis, on the basis of anecdotal experiences. However, kinetic studies of lactate removal do not suggest that removal can counteract lactate production in any meaningful way. The ideal treatment is to stop acid production by treating the underlying disorder.

Bidirectional Irrigation System to Treat a Difficult Wound: A Case Series

2020 ◽  
pp. 153473462097455
Author(s):  
Li-Yung Chen ◽  
Jin-De Hou ◽  
Chian-Ze Peng
Keyword(s):  
Healing Rate ◽  
Irrigation System ◽  
Recovery Period ◽  
Case Series ◽  
Type A ◽  
Type B ◽  
Wound Irrigation ◽  
Secondary Infections ◽  
Case Series Study ◽  
The Stability

Aims To date, there is no distinct principle determining whether to use irrigation under negative-pressure wound therapy (NPWT). We developed a new economical device to manage difficult wounds, employing 1 of 2 techniques depending on the wound condition. Methods This case series study was conducted in 12 patients with difficult wound, from 2017 to 2018. Four patients were treated with Type A bidirectional irrigation system (wound irrigation), while 8 patients were treated with Type B bidirectional irrigation system (wound irrigation combined with NPWT). Results In the Type A device group, inflammatory profiles in case I, case IV, and case VIII were not monitored due to the stability of their wound. The mean recovery period was 3.75 weeks (2-8 weeks), with decreases in 100% healing rate. In the Type B device group, we noted an average of 71% reduction in inflammatory profiles. All patients’ infections were resolved or were healing, and 7 patients recovered satisfactorily. The recovery period ranged from 4 to 17 weeks, with a median value of 7 weeks. Conclusion Bidirectional irrigation system decreases secondary infections and complications, and increases the healing rate in patients with difficult wound.

scholarly journals Chronic Skull Base Erosion from Temporomandibular Joint Disease Causes Generalized Seizure and Profound Lactic Acidosis

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Mark A. Dobish ◽  
David A. Wyler ◽  
Christopher J. Farrell ◽  
Hermandeep S. Dhami ◽  
Victor M. Romo ◽  
...  
Keyword(s):  
Lactic Acidosis ◽  
Skull Base ◽  
Temporomandibular Joint ◽  
Case Series ◽  
Type A ◽  
Oxidative Capacity ◽  
Joint Disease ◽  
Rare Presentation ◽  
Cellular Energy ◽  
Ph Range

This report displays a rare presentation of lactic acidosis in the setting of status epilepticus (SE). The differential diagnosis of lactic acidosis is broad and typically originates from states of shock; however, this report highlights an alternative and rare etiology, SE, due to chronic skull base erosion from temporomandibular joint (TMJ) disease. Lactic acidosis is defined by a pH below 7.35 in the setting of lactate values greater than 5 mmol/L. Two broad classifications of lactic acidosis exist: a type A lactic acidosis which stems from global or localized tissue hypoxia or a type B lactic acidosis which occurs once mitochondrial oxidative capacity is unable to match glucose metabolism. SE is an example of a type A lactic acidosis in which oxygen delivery is unable to meet increased cellular energy requirements. This report is consistent with a prior case series that consists of five patients experiencing generalized tonic-clonic (GTC) seizures and lactic acidosis. These patients presented with a pH range of 6.8-7.41 and lactate range of 3.8-22.4 mmol/L. Although severe lactic acidosis following GTC has been described, this is the first report in the literature of chronic skull base erosion from TMJ disease causing SE.

Lactic Acidosis and the Cardiovascular System in the Dog

1983 ◽  
Vol 64 (6) ◽  
pp. 573-580 ◽  
Author(s):  
Allen I. Arieff ◽  
Edward W. Gertz ◽  
Robert Park ◽  
Will Leach ◽  
Virginia C. Lazarowitz
Keyword(s):  
Heart Rate ◽  
Blood Flow ◽  
Cardiac Output ◽  
Lactic Acid ◽  
Lactic Acidosis ◽  
Cardiac Function ◽  
Myocardial Dysfunction ◽  
Left Ventricular ◽  
Control Group ◽  
Type B

1. Lactic acidosis is a clinical syndrome characterized by metabolic acidaemia (pH < 7.25) and hyperlactaemia (lactate >5 mmol/l). Many patients with type B lactic acidosis have no evidence of tissue hypoxia or myocardial dysfunction when first evaluated. Although it is considered that cardiac dysfunction is secondary to the systemic effects of lactic acidosis, the reverse may sometimes be true. To evaluate this possibility, studies were carried out in 43 dogs consisting of a control group and three groups which had hyperlactataemia and metabolic acidaemia related to either: (1) phenformin infusion; (2) hepatectomy; (3) lactic acid infusion. Serial studies of cardiac function, as well as measurements of GFR (glomerular filtration rate) and hepatic portal vein (HPV) blood flow, were carried out. 2. in dogs infused with phenformin for 99 min, the arterial pH, lactate, bicarbonate, heart rate and mean blood pressure (BP) were normal. However, there was significant deterioration (P < 0.01) in several indices of cardiac function, including the peak positive dP/dt, cardiac output, LVEDP (left ventricular end-diastolic pressure) and percentage extraction of oxygen and lactate by the heart. After 3 h of phenformin, the blood lactate exceeded 5 mmol/l and there were further significant decrements (P < 0.01) in cardiac output, LVEDP and dP/dt, as well as BP and heart rate. in dogs subjected to hepatectomy, the decrement in cardiac output was similar to that with phenformin infusion. However, in animals infused with lactic acid, despite a similar blood pH and lactate, cardiac output was unaffected. Although percentage myocardial oxygen extraction declined in phenformin-infused animals, there was a concomitant increase in coronary sinus blood flow such that myocardial oxygen utilization was probably unaltered. 3. Thus, in certain types of experimental type B lactic acidosis, myocardial dysfunction may be a primary event, with other associated systemic manifestations being secondary.

scholarly journals Deglutition Syncope: Two Case Reports Attributed to Vagal Hyperactivity

2017 ◽  
Vol 2017 ◽  
pp. 1-3 ◽  
Author(s):  
Sukhdeep Bhogal ◽  
Pooja Sethi ◽  
Yasir Taha ◽  
Muralidhar Papireddy ◽  
Akhilesh Mahajan ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Atrioventricular Block ◽  
Case Reports ◽  
Pacemaker Implantation ◽  
Case Series ◽  
Vagal Reflex

Deglutition syncope is a relatively rare cause of syncope that belongs to the category of neurally mediated reflex syncopal syndromes. The phenomenon is related to vagal reflex in context to deglutition causing atrioventricular block and acute reduction in cardiac output leading to dizziness or syncope. We present case series of two cases of deglutition syncope, of which first was managed medically and second with pacemaker implantation.

scholarly journals A Challenging Case of Coexisting Type A and Type B Lactic Acidosis: A Case Report

Cureus ◽  
2019 ◽  
Author(s):  
Monider Singh ◽  
Aman N Ajmeri ◽  
Mohamed S Suliman ◽  
Kamran Zaheer ◽  
Amro K Al-Astal
Keyword(s):  
Case Report ◽  
Lactic Acidosis ◽  
Type A ◽  
Type B
Sign in / Sign up

Export Citation Format

Share Document