scholarly journals Metformin Associated Lactic Acidosis in the Intensive Care Unit: A Rare Condition Mimicking Sepsis

Cureus ◽  
2020 ◽  
Author(s):  
Selin Sendil ◽  
Keerthi Yarlagadda ◽  
Halimat Lawal ◽  
Vinod Nookala ◽  
Hiren Shingala
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Lactic Acidosis ◽  
Rare Condition

scholarly journals Metformin-associated lactic acidosis in an intensive care unit

Critical Care ◽  
2008 ◽  
Vol 12 (6) ◽  
pp. R149 ◽  
Author(s):  
Nicolas Peters ◽  
Nicolas Jay ◽  
Damien Barraud ◽  
Aurélie Cravoisy ◽  
Lionel Nace ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Lactic Acidosis

Patients with Severe Lactic Acidosis in the Intensive Care Unit: A Retrospective Study of Contributing Factors and Impact of Renal Replacement Therapy

2021 ◽  
pp. 1-7
Author(s):  
Lyssa Van De Ginste ◽  
Floris Vanommeslaeghe ◽  
Eric A.J. Hoste ◽  
Jan M. Kruse ◽  
Wim Van Biesen ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Lactic Acidosis ◽  
Replacement Therapy ◽  
Lactate Level ◽  
Cohort Analysis ◽  
Adverse Outcomes ◽  
Contributing Factors ◽  
Severe Lactic Acidosis

<b><i>Introduction:</i></b> Hyperlactatemia is a regular condition in the intensive care unit, which is often associated with adverse outcomes. Control of the triggering condition is the most effective treatment of hyperlactatemia, but since this is mostly not readily possible, extracorporeal renal replacement therapy (RRT) is often tried as a last resort. The present study aims to evaluate the factors that may contribute to the decision whether to start RRT or not and the potential impact of the start of RRT on the outcome in patients with severe lactic acidosis (SLA) (lactate ≥5 mmol/L). <b><i>Materials and Methods:</i></b> We conducted a retrospective single-center cohort analysis over a 3-year period including all patients with a lactate level ≥5 mmol/L. Patients were considered as treated with RRT because of SLA if RRT was started within 24 h after reaching a lactate level ≥5 mmol/L. <b><i>Results:</i></b> Overall, 90-day mortality in patients with SLA was 34.5%. Of the 1,203 patients who matched inclusion/exclusion criteria, 11% (<i>n</i> = 133) were dialyzed within 24 h. The propensity to receive RRT was related to the lactate level and to the SOFA renal and cardio score. The most frequently used modality was continuous RRT. Patients who were started on RRT versus those who did not have 2.3 higher odds of mortality, even after adjustment for the propensity to start RRT. <b><i>Conclusions:</i></b> Our analysis confirms the high mortality rate of patients with SLA. It adds that odds for mortality is even higher in patients who were started on RRT versus not. We suggest keeping an open mind to the factors that may influence the decision to start dialysis and bear in mind that without being a bridge to correction of the underlying condition, dialysis is unlikely to affect the outcome.

scholarly journals Severe Metformin Associated Lactic Acidosis: A Case Series Of An Intensive Care Unit

10.3823/1834 ◽  
2015 ◽  
Author(s):  
Nuno Ribeiro Ferreira ◽  
Liliana Fernandes ◽  
Rosa Cardiga ◽  
Catarina Zilhão ◽  
Joana Silvestre ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Lactic Acidosis ◽  
Case Series

scholarly journals Severe Type B Lactic Acidosis in a Rare and Aggressive HIV-Related Lymphoma

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
John Harwood Scott ◽  
Ashish P. S. Bains ◽  
Timothy D. Lindsay ◽  
Xiaofeng Zhao ◽  
Michael E. Bromberg
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Lactic Acidosis ◽  
Rare Complication ◽  
Definitive Treatment ◽  
Close Monitoring ◽  
Type B ◽  
Output State ◽  
Tissue Hypoperfusion ◽  
Aggressive Clinical Course

We describe the prognostic implication and aggressive clinical course of lymphoma-related lactic acidosis in a rare HIV-related lymphoma. Patient was diagnosed with plasmablastic lymphoma and developed severe lactic acidosis, and was treated on the medical floor and in the medical intensive care unit. Her lactic acidosis was considered to be type B, secondary to her underlying lymphoma since she never had an infectious source, hypovolemic state, or low/high cardiac-output state. The mechanism of the lymphoma-related lactic acidosis is from altered cellular metabolism, thought to aid in lymphoma proliferation, rather than tissue hypoperfusion. It is a rare complication of aggressive lymphomas and signifies a poor prognosis. Patients having this complication should be considered for close monitoring and management in an intensive care unit until definitive treatment (i.e., chemotherapy) can be implemented.

scholarly journals Lightning Maculopathy: A Case Report

2019 ◽  
Vol 2 (1) ◽  
pp. 98-101
Author(s):  
Ruchi Shrestha ◽  
Ritesh Kumar Shah ◽  
Purushottam Joshi
Keyword(s):  
Intensive Care Unit ◽  
Optical Coherence Tomography ◽  
Intensive Care ◽  
Case Report ◽  
Rare Condition ◽  
Optical Coherence ◽  
Threatening Condition ◽  
Cystic Changes ◽  
Life Threatening ◽  
Lightning Injury

Lightning induced maculopathy is a very rare condition and there are barely any published reports on lightning induced maculopathy in our country. Here we present a case of twenty three years female who presented with lightning induced burns on the neck, chest and abdomen. She had unconsciousness for 3 days after lightening injury for which she was treated in intensive care unit. She presented with complain of diminution of vision in both eyes after 2 weeks. Optical Coherence tomography revealed cystic changes in fovea in right eye and a macular hole in left eye. Lightning injury is a life threatening condition. Lightning maculopathy should always be ruled out which can be best detected on optical coherence tomography. Keywords: foveal cyst; lightning injury; maculopathy; optical coherence tomography.

scholarly journals Lactate in intensive care unit

2017 ◽  
Vol 60 (4) ◽  
pp. 553
Author(s):  
K. PAVLIDOU (Κ. ΠΑΥΛΙΔΟΥ) ◽  
I. SAVVAS (Ι. ΣΑΒΒΑΣ) ◽  
G. KAZAKOS (Γ. ΚΑΖΑΚΟΣ)
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Lactic Acidosis ◽  
Intensive Care Units ◽  
White Blood Cells ◽  
Lactate Concentration ◽  
Gastric Volvulus ◽  
Prognostic Index ◽  
Glycolytic Flux ◽  
Arterial Blood

Lactate is produced in cells under anaerobic conditions. Hyperlactatemia is the increase of the plasma lactateconcentration and lactic acidosis is the elevation in lactate concentration with a decrease in arterial pH. Hyperlactatemia and lactic acidosis are common in shock, but may also occur in many other clinical syndromes. Clinical studies in humans have reported that lactate concentration may contribute to the diagnosis of diseases in an intensive care unit and the estimation of the prognosis. In veterinary literature, clinical trials on lactate concentration in critical patients are rare, however, there are reports indicating its potential significance. Moreover, the severity of disease is linked to high lactate concentrations in the arterial blood, which is considered to be a negative prognostic index, at least in dogs. Lactate is formed in skeletal muscles, brain, heart, skin, intestinal tract, red and white blood cells. In the liver and kidneys it is metabolized up to 50%. In most human cases in intensive care units, hyperlactatemia and lactic acidosis are the result of hypoxia and tissue hypoperfusion. These patients are in a great risk of developing multi-organ failure and they present with high mortality rates. The persistent systemic acidosis affects myocardial contractility, reduces cardiac output and organ perfusion and leads to severe hypoxia. The causes of hyperlactatemia are: high glycolytic flux (alkalosis, release of catecholamine), high production of pyruvate acid and increased metabolic state conditions. Lactic acidosis may be of type A or type B. Lactate concentration can be measured either in whole blood or plasma by two methods: enzymatic chromatography and enzymatic amperometry. The lactate measurement in intensive care units is important, as it can be used to assess organ hypoperfusion and hypoxia, effectiveness of treatment and prognosis of various pathological conditions, such as septic peritonitis, gastric volvulus, pyometra and babesiosis. The treatment of lactic acidosis depends on the severity and management of the underlying disease. The goal of treatment is adequate tissue perfusion and oxygenation, which is achieved by ventilation and fluid therapy. The microbial infections are treated with antibiotics. The use of bicarbonate is still controversial.

scholarly journals Prevalence and Characteristics of Hypoxic Hepatitis in COVID-19 Patients in the Intensive Care Unit: A First Retrospective Study

2021 ◽  
Vol 7 ◽  
Author(s):  
Haijun Huang ◽  
Hong Li ◽  
Shanshan Chen ◽  
Xianlong Zhou ◽  
Xuan Dai ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Retrospective Study ◽  
Rare Condition ◽  
Multiple Organ ◽  
Dynamic Changes ◽  
Hypoxic Hepatitis ◽  
Reactive Protein ◽  
Immune Mediated ◽  
Normal Alt

Purpose: Coronavirus disease 2019 (COVID-19) has been associated with acute liver injury in reports worldwide. But no studies to date have described hypoxic hepatitis (HH) in patients with COVID-19. We aim to identify the prevalence of and possible mechanisms of HH in COVID-19 patients in the Intensive Care Unit (ICU).Methods: This retrospective study was conducted on 51 patients with confirmed SARS-CoV-2 infection in the ICU at Zhongnan Hospital of Wuhan University from December 21, 2019, to March 11, 2020. Information on clinical features of enrolled patients was collected for analysis.Results: HH was observed in 5.88% of the ICU patients with SARS-CoV-2 infection. All HH patients were progressing to respiratory failure and peak alanine aminotransferase (ALT) values were 1665, 1414, and 1140 U/L during hospitalization, respectively. All patients with HH died as a result of the deterioration of multiple organ failure (MOF). The dynamic changes of ALT, aspartate transaminase (AST), and total bilirubin (TBIL) levels were more dramatic in HH groups. Levels of TBIL, C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6(IL-6) showed statistically significant elevation in HH cases compared with that in non-HH cases (P &lt; 0.001). Besides, the median survival time of the HH group was significantly shorter than the non-HH group (P &lt; 0.05).Conclusions: In ICU, HH was not a rare condition in patients with severe COVID-19 and has a high mortality. The main causes of HH are respiratory and cardiac failure and may be associated with the immune-mediated inflammatory response. Clinicians should search for any underlying hemodynamic or respiratory instability even in patients with normal ALT levels on admission.

The Psychosocial Aspects of Feeding in the Neonatal Intensive Care Unit and Beyond

2019 ◽  
Vol 4 (6) ◽  
pp. 1507-1515
Author(s):  
Lauren L. Madhoun ◽  
Robert Dempster
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Hospital Discharge ◽  
Neonatal Intensive Care ◽  
Oral Feeding ◽  
Medical Attention ◽  
Primary Role ◽  
Speech Language Pathologists ◽  
The Family

Purpose Feeding challenges are common for infants in the neonatal intensive care unit (NICU). While sufficient oral feeding is typically a goal during NICU admission, this can be a long and complicated process for both the infant and the family. Many of the stressors related to feeding persist long after hospital discharge, which results in the parents taking the primary role of navigating the infant's course to ensure continued feeding success. This is in addition to dealing with the psychological impact of having a child requiring increased medical attention and the need to continue to fulfill the demands at home. In this clinical focus article, we examine 3 main areas that impact psychosocial stress among parents with infants in the NICU and following discharge: parenting, feeding, and supports. Implications for speech-language pathologists working with these infants and their families are discussed. A case example is also included to describe the treatment course of an infant and her parents in the NICU and after graduation to demonstrate these points further. Conclusion Speech-language pathologists working with infants in the NICU and following hospital discharge must realize the family context and psychosocial considerations that impact feeding progression. Understanding these factors may improve parental engagement to more effectively tailor treatment approaches to meet the needs of the child and family.

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