scholarly journals Use of multiple anticholinergic medications can predispose patients to severe non-exertional hyperthermia

2021 ◽  
Vol 14 (3) ◽  
pp. e239873
Author(s):  
Ahila Manivannan ◽  
Dana Kabbani ◽  
Diane Levine
Keyword(s):  
Intensive Care Unit ◽  
Altered Mental Status ◽  
Blood Cultures ◽  
Oral Temperature ◽  
Anticholinergic Effects ◽  
Quick Recovery ◽  
Presenting Symptoms ◽  
Anticholinergic Medications ◽  
Cooling Mechanism ◽  
Staphylococcus Hominis

We present a case of a 64-year-old woman who developed severe non-exertional hyperthermia (NEHT) due to excessive anticholinergic effects from her psychiatric medications. The patient was found unresponsive in a non-air-conditioned room where the outside temperature was over 33°C. She presented with altered mental status, hypotension and an oral temperature of 42°C. Drug–drug interactions from her home medications for depression, bipolar disorder and seizures (amitriptyline, cyclobenzaprine, benztropine, topiramate, clonazepam, trazodone) were suspected. Blood cultures grew Staphylococcus hominis. The patient quickly returned to baseline with supportive care in the intensive care unit. She was treated for the Staph hominis bacteraemia with a 7-day course of vancomycin. Due to her quick recovery and lack of neurological findings, severe NEHT with associated bacteraemia was determined to have caused her presenting symptoms. This patient’s multiple anticholinergic medications increased her susceptibility to develop NEHT by inhibited sweating, this patient’s natural cooling mechanism.

scholarly journals Presenting Symptoms in the Emergency Department as Predictors of Intensive Care Unit Admissions and Hospital Mortality in a Comprehensive Cancer Center

2016 ◽  
Vol 12 (5) ◽  
pp. e554-e563 ◽  
Author(s):  
Ahmed F. Elsayem ◽  
Kelly W. Merriman ◽  
Carmen E. Gonzalez ◽  
Sai-Ching J. Yeung ◽  
Patrick S. Chaftari ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Hospital Mortality ◽  
Respiratory Distress ◽  
Altered Mental Status ◽  
Hematologic Malignancies ◽  
Cancer Center ◽  
Hospital Death ◽  
Icu Admission ◽  
Patients With Cancer ◽  
Presenting Symptoms

Purpose: The identification of patients at high risk for poor outcomes may allow for earlier palliative care and prevent futile interventions. We examined the association of presenting symptoms on risk of intensive care unit (ICU) admission and hospital death among patients with cancer admitted through an emergency department (ED). Methods: We queried MD Anderson Cancer Center databases for all patients who visited the ED in 2010. Presenting symptoms, ICU admissions, and hospital deaths were reviewed; patient data analyzed; and risk factors for ICU admission and hospital mortality identified. Results: The main presenting symptoms were pain, fever, and respiratory distress. Of the patients with cancer who visited the ED, 5,362 (58%) were admitted to the hospital at least once (range, 1 to 13 admissions), 697 (13%) were admitted to the ICU at least once, and 587 (11%) died during hospitalization (31% of 233 patients with hematologic malignancies and 27% of 354 patients with solid tumors died in the ICU; P < .001). In multivariable logistic regression, presenting symptoms of respiratory distress or altered mental status; lung cancer, leukemia, or lymphoma; and nonwhite race were independent predictors of hospital death. Patients who died had a longer median length of hospital stay than patients discharged alive (14 v 6 days for hematologic malignancies and 7 v 5 days for solid tumors; P < .001). Conclusion: Patients with cancer admitted through an ED experience high ICU admission and hospital mortality rates. Patients with advanced cancer and respiratory distress or altered mental status may benefit from palliative care that avoids unnecessary interventions.

Dexmedetomidine Infusion as Adjunctive Therapy to Benzodiazepines for Acute Alcohol Withdrawal

2008 ◽  
Vol 42 (11) ◽  
pp. 1703-1705 ◽  
Author(s):  
Jamil Darrouj ◽  
Nitin Puri ◽  
Erin Prince ◽  
Anthony Lomonaco ◽  
Antoinette Spevetz ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Alcohol Withdrawal ◽  
Delirium Tremens ◽  
Poor Response ◽  
Altered Mental Status ◽  
Primary Treatment ◽  
Respiratory Drive ◽  
Medical Unit ◽  
Pubmed Database

Objective: To report a case of alcohol withdrawal and delirium tremens successfully treated with adjunctive dexmedetomidine. Case Summary: A 30–year-old man with a history of alcohol abuse was admitted to the general medical unit because of altered mental status and agitation. He was initially treated for alcohol withdrawal with benzodiazepines; his condition then deteriorated and he was transferred to the intensive care unit. Because of the patient's poor response to benzodiazepines (oxazepam and lorazepam, with midazolam the last one used), intravenous dexmedetomidine was started at an initial dose of 0.2 µg/kg/h and titrated to 0.7 µg/kg/h to the patient's comfort. Midazolam was subsequently tapered to discontinuation due to excessive sedation. In the intensive care unit, the patient's symptoms remained controlled with use of dexmedetomidine alone. He remained in the intensive care unit for 40 hours; dexmedetomidine was then tapered to discontinuation and the patient was transferred back to the general medical unit on oral oxazepam and thiamine, which had been started in the emergency department. He was discharged after 5 days. Discussion: A review of the PubMed database (1989-2007} failed to identify any other instances of dexmedetomidine having been used as the principal agent to treat alcohol withdrawal. The use of sedative to treat delirium tremens Is well documented, with benzodiazepines being the agents of choice. The clinical utility of benzodiazepines is limited by their stimulation of the γ-aminobutyric acid receptors, an effect not shared by dexmedetomidine, a central α2-receptor agonist that induces a state of cooperative sedation and does not suppress respiratory drive. Conclusions: In patients with delirium tremens, dexmedetomidine should be considered as an option for primary treatment. This case illustrates the need for further studies to investigate other potential uses for dexmedetomidine.

Staphylococcus epidermidis Bacteremia in Neonates: Further Observations and the Occurrence of Focal Infection

PEDIATRICS ◽  
1984 ◽  
Vol 74 (5) ◽  
pp. 832-837 ◽  
Author(s):  
Gary J. Noel ◽  
Paul J. Edelson
Keyword(s):  
Intensive Care Unit ◽  
New York ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Staphylococcus Epidermidis ◽  
Neonatal Intensive Care ◽  
Blood Cultures ◽  
Focal Infection ◽  
Clinically Significant ◽  
Vascular Catheters

The frequency and clinical significance of Staphylococcus epidermidis isolates from blood cultures of neonates collected during a 17-month period in The New York Hospital neonatal intensive care unit (NICU) were reviewed. Twenty-three episodes of clinically significant S epidermidis bacteremia were detected using the criteria of isolation from 3/3 blood culture bottles from a single culture, or isolation from two or more blood cultures taken at different times, or simultaneous isolation from blood and fluid, pus or vascular catheter. Of these 23 episodes of S epidermidis bacteremia, ten were associated with colonized vascular catheters, and four episodes occurred in infants with necrotizing enterocolitis. Focal S epidermidis infection occurred in ten episodes, and persistent bacteremia occurred frequently in this setting. S epidermidis was the most frequent cause of bacteremia in the Neonatal Intensive Care Unit during the period reviewed. Of the isolates determined to be clinically significant, 74% were resistant to methicillin and cephalothin and 91% were resistant to gentamicin. All isolates were sensitive to vancomycin. In addition to removing vascular catheters suspected of being colonized and searching for potential sites of focal infection, an antibiotic regimen that includes vancomycin should be initiated once significant S epidermidis bacteremia has been recognized in the neonate.

Influence of Selective Bowel Decontamination on the Organisms Recovered During Bacteremia in Neutropenic Patients

2004 ◽  
Vol 25 (8) ◽  
pp. 685-689 ◽  
Author(s):  
Florian Daxboeck ◽  
Werner Rabitsch ◽  
Alexander Blacky ◽  
Maria Stadler ◽  
Paul A. Kyrle ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Staphylococcus Aureus ◽  
Bone Marrow ◽  
Anaerobic Bacteria ◽  
Blood Cultures ◽  
University Teaching ◽  
Coagulase Negative Staphylococci ◽  
Gram Negative ◽  
Neutropenic Patients ◽  
Care Ward

AbstractObjective:To assess the influence of prophylactic selective bowel decontamination (SBD) on the spectrum of microbes causing bloodstream infection (BSI).Design:The microbes causing BSI in neutropenic patients of a hematologic ward (HW) and a bone marrow transplantation unit (BMTU), respectively, were compared by retrospective analysis of blood culture results from January 1996 to June 2003.Setting:A 30-bed HW (no SBD) and a BMTU including a 7-bed normal care ward and an 8-bed intensive care unit (SBD used) of a 2,200-bed university teaching hospital.Results:The overall incidences of bacteremia in the HW and the BMTU were similar (72.6 vs 70.6 episodes per 1,000 admissions; P = .8). Two hundred twenty episodes of BSI were recorded in 164 neutropenic patients of the HW and 153 episodes in 127 neutropenic patients of the BMTU. Enterobacteriaceae (OR, 3.14; CI95, 1.67–5.97; P = .0002) and Streptococcus species (OR, 2.04; CI95, 1.14–3.70; P = .015) were observed more frequently in HW patients and coagulase-negative staphylococci more frequently in BMTU patients (OR, 0.15; CI95, 0.09–0.26; P< .00001). No statistically significant differences were found for gram-negative nonfermentative bacilli (P = .53), Staphylococcus aureus (P = .21), Enterococcus species (P = .48), anaerobic bacteria (P = .1), or fungi (P = .50).Conclusions:SBD did not lead to a significant reduction in the incidence of bacteremia, but significant changes in microbes recovered from blood cultures were observed. SBD should be considered when empiric antimicrobial therapy is prescribed for suspected BSI.

scholarly journals A Fatal Case of Primary Amoebic Meningoencephalitis from Recreational Waters

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Edward Hamaty ◽  
Saif Faiek ◽  
Minesh Nandi ◽  
David Stidd ◽  
Manish Trivedi ◽  
...  
Keyword(s):  
United States ◽  
Mortality Rate ◽  
Bacterial Meningitis ◽  
Fatal Case ◽  
Altered Mental Status ◽  
The United States ◽  
Recreational Waters ◽  
Primary Amoebic Meningoencephalitis ◽  
Presenting Symptoms ◽  
Amoebic Meningoencephalitis

Background. Naegleria Fowleri is a single-cell, thermophilic amphizoid amoeba, and a rare known causative agent for primary amoebic meningoencephalitis with >97% mortality rate. The amoeba resides in freshwater lakes and ponds but can also survive in inadequately chlorinated pools and recreational waters. The mode of infection includes activities such as diving or jumping into freshwater or submerging the head under the water. Although most commonly seen in the southern United States, it is essential to keep this clinical suspicion in mind regardless of geography, as presenting symptoms can be very similar to classic bacterial meningitis. Case Summary. We report the first-ever case in the state of New Jersey of a 29-year-old male presented after a visit to a recreational water park in Texas five days before his presentation with altered mental status. In ICU, his ICP remained refractory to multiple therapies, including antibiotics and antivirals, external ventriculostomy drain, hypertonic saline, pentobarbital-induced coma, and bilateral hemicraniectomies. The CSF analysis revealed trophozoites indicating a protozoan infection, which we diagnosed in the neurocritical unit, and the patient was then immediately started with treatment that included amphotericin B, rifampin, azithromycin, and fluconazole. This suspicion was promptly confirmed by the Center for Disease Control (CDC). Unfortunately, despite all the aggressive intervention by the multidisciplinary team, the patient did not survive. Conclusion. As per the CDC, only four people out of 143 known infected individuals in the United States from 1962 to 2017 have survived. Symptoms start with a median of 5 days after exposure to contaminated water. Given the rarity of this case and its very high mortality rate, it is crucial to diagnose primary amoebic meningoencephalitis accurately as its presentation can mimic bacterial meningitis. It is vital to obtain a careful and thorough history, as it can aid in prompt diagnosis and treatment.

Radiographically Confirmed Community-Acquired Pneumonia in Pediatric Patients Prior to Pneumococcal Vaccination in Nepal

2017 ◽  
Vol 13 (01) ◽  
pp. 057-062
Author(s):  
Dhruba Shrestha ◽  
Ganendra Raya ◽  
Amar Prajapati ◽  
Suruchi Dhaubhadel ◽  
Sushmita Puri ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pleural Effusion ◽  
Intensive Care Unit Admission ◽  
Pneumococcal Vaccination ◽  
Community Acquired Pneumonia ◽  
Blood Cultures ◽  
Hospital Treatment ◽  
High Morbidity ◽  
Rural Nepal

Background The massive burden of pediatric pneumonia is associated with high morbidity and mortality, particularly in developing countries where immunization programs are absent or recently been implemented. The objective of this study was to describe the number of hospitalizations and outcomes of children aged 1 month to 10 years with community-acquired pneumonia (CAP) between January 1, 2014, and June 30, 2015, in semi-rural Nepal. Methods This retrospective study was undertaken prior to the implementation of the pneumococcal conjugate vaccination (PCV) program in Bhaktapur district of Nepal. Chart review of children with CAP, defined as the presence of symptoms, physical examination findings compatible with bacterial pneumonia together with lobar consolidation on chest X-ray (CXR), was performed. Data extracted included laboratory parameters and blood cultures on admission, antibiotic treatment, and length of hospital stay, as well as complications, such as death, intensive care unit admission, pleural effusion, and empyema. Outcomes assessed were clinical improvement accompanied by radiological improvement of consolidation. Results During the study period, 367 patients were admitted with pneumonia, of which, 74 (20%) had definite CXR evidence of lobar pneumonia. A total of 86.5% of the cases were children < 5 years of age. Admission blood cultures from all patients were negative. More than 80% of patients had white blood cell (WBC) counts >11,000/mm3 and ≥ 75% neutrophils. The highest number of cases presented between February and July. Forty-three of 45 patients responded to crystalline penicillin (CP), and 25/27 patients treated with cefotaxime also responded; the mean duration of treatment was 10 ± 2.3 days. There were no deaths. None of the patients developed empyema, sepsis, or pleural effusion or required intensive care unit admission. Conclusions CAP in pre-PCV semi-rural Nepal mostly affects male children < 5 years old and peaks between March and May. In-hospital treatment with CP or cefotaxime is effective.

scholarly journals Ten years of blood cultures surveillance in an intensive care unit of a tertiary hospital in Israel

Critical Care ◽  
10.1186/cc799 ◽  
2000 ◽  
Vol 4 (Suppl 1) ◽  
pp. P79
Author(s):  
R Kitzes ◽  
S De Myttenaere-Bursztein ◽  
A Sheskin ◽  
Z Stoler
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Tertiary Hospital ◽  
Blood Cultures

Fever and Leukocytosis in Critically Ill Trauma Patients: It is Not the Blood

2009 ◽  
Vol 75 (5) ◽  
pp. 405-410 ◽  
Author(s):  
Jeffrey A. Claridge ◽  
Joseph F. Golob ◽  
Adam M. A. Fadlalla ◽  
Mark A. Malangoni ◽  
Jeffrey Blatnik ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Injury Severity ◽  
Leukocyte Count ◽  
Cohort Analysis ◽  
Clinical Signs ◽  
Blood Cultures ◽  
Daily Temperature ◽  
Trauma Patients

The diagnosis of bacteremia in critically ill patients is classically based on fever and/or leukocytosis. The objectives of this study were to determine 1) if our intensive care unit obtains blood cultures based on fever and/or leukocytosis over the initial 14 days of hospitalization after trauma; and 2) the efficacy of this diagnostic workup. An 18-month retrospective cohort analysis was performed on consecutively admitted trauma patients. Data collected included demographics, injuries, and the first 14 days maximal daily temperature, leukocyte count, and results of blood and catheter tip cultures. Fever was defined as a maximum daily temperature of 38.5°C or greater and leukocytosis as a leukocyte count 12,000/mm3 or greater of blood. Five hundred ten patients were evaluated for a total of 3,839 patient-days. The mean age and injury severity score were 49 ± 1 years and 19 ± 1, respectively. Four hundred twenty-five blood culture episodes were obtained and 25 (6%) bacteremias were identified in 23 patients (5%). A significant association was found between obtaining blood cultures in patients with fever (relative risk [RR], 7.7), leukocytosis (RR, 1.3), and fever + leukocytosis (RR, 3.2). However, no significant association was found between these clinical signs and the diagnosis of bacteremia. In fact, fever alone was inversely associated with bacteremia. Our intensive care unit follows the common “fever workup” practice and obtains blood cultures based on the presence of fever and leukocytosis. However, fever and leukocytosis were not associated with bacteremia, suggesting inefficiency and that other factors are more important after trauma.

scholarly journals Antimicrobial Stewardship Opportunities in Patients with Bacteremia Not Identified by BioFire FilmArray

2019 ◽  
Vol 57 (5) ◽  
Author(s):  
P. Ny ◽  
A. Ozaki ◽  
J. Pallares ◽  
P. Nieberg ◽  
A. Wong-Beringer
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Culture ◽  
Intensive Care Unit Admission ◽  
Clinical Characteristics ◽  
Length Of Hospital Stay ◽  
Blood Cultures ◽  
Rapid Diagnostics ◽  
Admission Data ◽  
Culture Identification

ABSTRACTA subset of bacteremia cases are caused by organisms not detected by a rapid-diagnostics platform, BioFire blood culture identification (BCID), with unknown clinical characteristics and outcomes. Patients with ≥1 positive blood culture over a 15-month period were grouped by negative (NB-PC) versus positive (PB-PC) BioFire BCID results and compared with respect to demographics, infection characteristics, antibiotic therapy, and outcomes (length of hospital stay [LOS] and in-hospital mortality). Six percent of 1,044 positive blood cultures were NB-PC. The overall mean age was 65 ± 22 years, 54% of the patients were male, and most were admitted from home; fewer NB-PC had diabetes (19% versus 31%,P= 0.0469), although the intensive care unit admission data were similar. Anaerobes were identified in 57% of the bacteremia cases from the NB-PC group by conventional methods:Bacteroidesspp. (30%),Clostridium(11%), andFusobacteriumspp. (8%). Final identification of the NB-PC pathogen was delayed by 2 days (P< 0.01) versus the PB-PC group. The sources of bacteremia were more frequently unknown for the NB-PC group (32% versus 11%,P< 0.01) and of pelvic origin (5% versus 0.1%,P< 0.01) compared to urine (31% versus 9%,P< 0.01) for the PB-PC patients. Fewer NB-PC patients received effective treatment before (68% versus 84%,P= 0.017) and after BCID results (82% versus 96%,P= 0.0048). The median LOS was similar (7 days), but more NB-PC patients died from infection (26% versus 8%,P< 0.01). Our findings affirm the need for the inclusion of anaerobes in BioFire BCID or other rapid diagnostic platforms to facilitate the prompt initiation of effective therapy for bacteremia.

Sign in / Sign up

Export Citation Format

Share Document