scholarly journals Acute Esophageal Necrosis (Gurvits Syndrome): A Rare Complication of Diabetic Ketoacidosis in a Critically Ill Patient

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Linda P. Vien ◽  
Ho-Man Yeung
Keyword(s):  
Diabetic Ketoacidosis ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Rare Complication ◽  
Oral Intake ◽  
Critically Ill Patient ◽  
Dependent Diabetes Mellitus ◽  
Upper Gastrointestinal Endoscopy ◽  
Acute Esophageal Necrosis ◽  
Esophageal Necrosis

Acute esophageal necrosis (AEN) is a rare clinical diagnosis that primarily affects the distal third of the esophagus. AEN causes odynophagia, leading to decreased oral intake and food avoidance. AEN can arise in critically ill patients with multiple comorbidities and is an uncommon complication of diabetic ketoacidosis (DKA). We present a case of a young female with poorly controlled, insulin-dependent diabetes mellitus type 2 who developed odynophagia, small volume coffee-ground emesis, and inability to tolerate oral intake after resolution of DKA. She was found to have esophagitis with esophageal necrosis in the middle third of the esophagus on upper gastrointestinal endoscopy. She was subsequently treated with fluid resuscitation and gastric acid suppression and improved clinically with slow advancements in her diet. The location of her lesion in the more vascularized middle one-third of the esophagus and lack of significant blood pressure variations during her hospital stay make her case unique. Thus, AEN should be considered in the differential diagnosis for critically ill patients who present with vague symptoms such as odynophagia and gastrointestinal bleeding.

scholarly journals Acute Esophageal Necrosis: A View in the Dark

2019 ◽  
Vol 13 (1) ◽  
pp. 25-31 ◽  
Author(s):  
Hafiz Khan ◽  
Moiz Ahmed ◽  
Magda Daoud ◽  
Jobin Philipose ◽  
Saba Ahmed ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Upper Gastrointestinal Bleeding ◽  
Low Flow ◽  
Esophageal Disease ◽  
Esophageal Mucosa ◽  
Acute Esophageal Necrosis ◽  
Esophageal Necrosis ◽  
Upper Gastrointestinal

Acute esophageal necrosis (AEN), also known as Gurvits syndrome, black esophagus, or acute necrotizing esophagitis, is a rare clinical entity and an unusual reason for upper gastrointestinal bleeding. It is typically described in critically ill patients with multiple medical conditions, arising from a combination of ischemic insult to the esophageal mucosa due to low-flow vascular states, corrosive injury caused by reflux of acid and pepsin, and decreased function of the mucosal barrier systems and reparative mechanisms as occurs in malnourished and debilitated physical states. Patients with AEN tend to be older men, as medical comorbidities including vascular disease, diabetes, hypertension, renal insufficiency, cardiac disease, pulmonary disease, stroke, and cirrhosis may be more common. Typically, patients present with upper gastrointestinal bleeding, and hematemesis or melena is seen in up to 90% of cases. Herein we present 3 cases of AEN in critically ill patients. We also provide a review of the literature to highlight what is currently known about this relatively uncommon esophageal disease.

scholarly journals Acute esophageal necrosis: A rare case of upper gastrointestinal bleeding from diabetic ketoacidosis

2020 ◽  
Vol 10 (2) ◽  
Author(s):  
Dustin J. Uhlenhopp ◽  
Gregory Pagnotta ◽  
Tagore Sunkara
Keyword(s):  
Diabetic Ketoacidosis ◽  
Gastroesophageal Junction ◽  
Stable Condition ◽  
Rare Condition ◽  
Critically Ill Patient ◽  
Acute Esophageal Necrosis ◽  
Esophageal Necrosis ◽  
Black Esophagus ◽  
Acute Necrotizing ◽  
Upper Gastrointestinal

Acute esophageal necrosis, also known as black esophagus or acute necrotizing esophagitis is a rare condition with roughly 154 cases reported in the literature. This condition is classically diagnosed on its endoscopic findings of a circumferentially black esophagus that abruptly ends at the gastroesophageal junction and transitions to normal gastric mucosa. When present, acute esophageal necrosis potentially signifies a poor prognosis with an overall mortality up to 36%. This case report describes a critically ill patient with multiple comorbidities that was found to have acute esophageal necrosis the entire length of the esophagus secondary to ischemia/hypoperfusion that was caused by diabetic ketoacidosis. The patient had a prolonged hospitalization but was ultimately discharged in stable condition. We also review the literature of this rare esophageal condition.

scholarly journals Impact of Renal Replacement Therapy on Mortality in Critically Ill Patients—The Nephrologist’s View within an Interdisciplinary Intensive Care Team

2021 ◽  
Vol 10 (15) ◽  
pp. 3379
Author(s):  
Matthias Klingele ◽  
Lea Baerens
Keyword(s):  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Positive Impact ◽  
Kidney Injury ◽  
Care Team ◽  
Critically Ill Patient ◽  
Late Start

Acute kidney injury (AKI) is a common complication in critically ill patients with an incidence of up to 50% in intensive care patients. The mortality of patients with AKI requiring dialysis in the intensive care unit is up to 50%, especially in the context of sepsis. Different approaches have been undertaken to reduce this high mortality by changing modalities and techniques of renal replacement therapy: an early versus a late start of dialysis, high versus low dialysate flows, intermittent versus continuous dialysis, anticoagulation with citrate or heparin, the use of adsorber or special filters in case of sepsis. Although in smaller studies some of these approaches seemed to have a positive impact on the reduction of mortality, in larger studies these effects could not been reproduced. This raises the question of whether there exists any impact of renal replacement therapy on mortality in critically ill patients—beyond an undeniable impact on uremia, hyperkalemia and/or hypervolemia. Indeed, this is one of the essential challenges of a nephrologist within an interdisciplinary intensive care team: according to the individual situation of a critically ill patient the main indication of dialysis has to be identified and all parameters of dialysis have to be individually chosen with respect to the patient’s situation and targeting the main dialysis indication. Such an interdisciplinary and individual approach would probably be able to reduce mortality in critically ill patients with dialysis requiring AKI.

Pediatric Diabetic Ketoacidosis and Hypoglycemia

2020 ◽  
Author(s):  
Rachel J Williams ◽  
Samantha L. Wood
Keyword(s):  
Emergency Department ◽  
Key Words ◽  
Diabetic Ketoacidosis ◽  
Critically Ill ◽  
Cerebral Edema ◽  
Critically Ill Patients ◽  
Pediatric Patients ◽  
Serum Glucose ◽  
Neurologic Function ◽  
Threat To Life

Abnormalities of serum glucose in pediatric patients are commonly encountered in the emergency department and represent an acute threat to life and neurologic function. Rapidly identifying and aggressively treating hyperglycemia with diabetic ketoacidosis and hypoglycemia are critical to ensure the best possible outcome. This review will guide the emergency provider in the identification, resuscitation, workup, and disposition of these critically ill patients. This review contains 6 figures, 13 tables, and 50 reviews. Key Words: Cerebral edema, diabetic ketoacidosis, hyperglycemia, hypoglycemia

The ART of Antiretroviral Therapy in Critically Ill Patients With HIV

2018 ◽  
Vol 34 (11-12) ◽  
pp. 897-909 ◽  
Author(s):  
Tyler Finocchio ◽  
William Coolidge ◽  
Thomas Johnson
Keyword(s):  
Intensive Care ◽  
Antiretroviral Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Care Setting ◽  
Critically Ill Patient ◽  
Intensive Care Setting ◽  
Antiretroviral Medications ◽  
Immunodeficiency Virus ◽  
Inflammatory Syndrome

The management of patients with human immunodeficiency virus (HIV) can be a complicated specialty within itself, made even more complex when there are so many unanswered questions regarding the care of critically ill patients with HIV. The lack of consensus on the use of antiretroviral medications in the critically ill patient population has contributed to an ongoing clinical debate among intensivists. This review focuses on the pharmacological complications of antiretroviral therapy (ART) in the intensive care setting, specifically the initiation of ART in patients newly diagnosed with HIV, immune reconstitution inflammatory syndrome (IRIS), continuation of ART in those who were on a complete regimen prior to intensive care unit admission, barriers of drug delivery alternatives, and drug-drug interactions.

scholarly journals T3 as predictor of mortality in any cause non-critically ill patient

2021 ◽  
Author(s):  
Erika Biegelmeyer ◽  
Iury Scanagata ◽  
Laura Alves ◽  
Murilo Reveilleau ◽  
Fernando Pereira Schwengber ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Critically Ill Patient ◽  
Total Serum ◽  
Population Total ◽  
Low T3 ◽  
Serum T3 ◽  
Overall Mortality

Background: Low T3 syndrome refers to a set of thyroid hormone metabolism alterations present in disease state. A correlation between low T3 and poor clinical outcomes in the intensive care unit is more established. Nonetheless, studies on non-critically ill patients are few and controversial. Objective: To evaluate the prevalence and predictive value of low T3 levels on 30 days- and six month-term mortality in non-critically ill patients. Secondary outcomes evaluated length of hospital stay, overall mortality, and hospital readmission. Design: Prospective cohort study. Methods: 345 consecutive patients from Internal medicine ward of a tertiary hospital in southern Brazil included from October 2018 to April 2019 and followed for 6 months. Levels of total serum T3 were measured weekly, from admission to discharge, and correlated with 30-day hospital mortality. Results: Prevalence of low T3 was 36.6%. Low T3 levels were associated with higher 30-days hospital mortality (15.1% versus 4.1%, p<0.001) and higher 6-months overall mortality (31.7% versus 13.2%, p<0.001). Total serum T3 at admission was an independent predictor of 30-days hospital mortality. Conclusion: Low T3 levels are a prevalent condition among non-critically ill patients and this condition is associated with poor clinical outcomes in this population. Total serum T3 levels, alone or in association with other predictive scores, were demonstrated to be an easy and valuable tool for risk stratification, and should be further employed in this setting.

scholarly journals Znacaj profilakse akutne mukozne lezije kod pacijenata u jedinici intenzivnog lecenja

2007 ◽  
Vol 54 (1) ◽  
pp. 47-50 ◽  
Author(s):  
N.M. Popovic
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Direct Consequence ◽  
Severe Trauma ◽  
Mucosal Lesion ◽  
Critically Ill Patient ◽  
Multiple Risk Factors ◽  
Massive Gastrointestinal Bleeding ◽  
Mucosal Lesions ◽  
Clinically Significant

At least three-quarters of critically ill patients develop mucosal lesion as a direct consequence of stress within the first 24 hours following the admission to intensive care unit. These mucosal lesions occur as superficial or deep mucosal lesions which can lead to massive gastrointestinal bleeding and it can put at risk the life of critically ill patient. There are multiple risk factors for the occurence of mucosal lesion such as: respiratory failure requiring mechanical ventilation, sepsis, hypotension, burns, severe trauma, neurotrauma, ileus, coagulopathy, renal and hepatic failure, myocardial infarction etc. The incidence of silent (ocult) bleeding in critically ill patients is almost 100%, but only about 5% of patients have clinically apparent (overt) hemorrhage and 1-2% have clinically significant bleeding which requires blood transfusions. In patients who are at the greatest risk of developing mucosal lesion, prophylactic treatment ought to be started immediately in order to achieve pH4 with adequate perfusion and coagulation. Today several groups of medications are used for the prevention of mucosal gastrointestinal lesion and they include: antacids, sucralfate, hisamine-2 receptor antagonists and proton pump inhibitors.

A Case of Acute Esophageal Necrosis in a Patient with Diabetic Ketoacidosis

2012 ◽  
Vol 83 (1) ◽  
pp. 117 ◽  
Author(s):  
Jae Hyoung Im ◽  
Min Su Kim ◽  
Seung Yoen Lee ◽  
So Hun Kim ◽  
Seong Bin Hong ◽  
...  
Keyword(s):  
Diabetic Ketoacidosis ◽  
Acute Esophageal Necrosis ◽  
Esophageal Necrosis

Cardiovascular System in the Critically Ill Patient

2019 ◽  
pp. 26-34
Author(s):  
Juan G. Ripoll Sanz ◽  
Norlalak Jiramethee ◽  
Jose L. Diaz-Gomez
Keyword(s):  
Cardiac Output ◽  
Cardiovascular System ◽  
Critically Ill ◽  
Fluid Responsiveness ◽  
Critically Ill Patients ◽  
Integrated System ◽  
Critically Ill Patient ◽  
Cardiovascular Disorders ◽  
Output Control ◽  
System 2

This chapter provides an overview of fundamental pathophysiologic concepts for the diagnosis and management of cardiovascular disorders in critically ill patients. Three major topics are presented: 1) the importance of vascular–cardiac pump coupling as an integrated system, 2) practical considerations of ventricular dysfunction, and 3) systemic vessels as a crucial factor for cardiac output control and fluid responsiveness.

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