scholarly journals Wernicke’s Encephalopathy after Pancreaticoduodenectomy: A Case Report

2019 ◽  
Vol 2 (1-3) ◽  
pp. 1-7 ◽  
Author(s):  
Kazuteru Monden ◽  
Hiroshi Sadamori ◽  
Masayoshi Hioki ◽  
Satoshi Ohno ◽  
Mitsue Rikimaru ◽  
...  
Keyword(s):  
Lactic Acidosis ◽  
Pancreatic Fistula ◽  
Thiamine Deficiency ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Wernicke’S Encephalopathy ◽  
Wernicke's Encephalopathy ◽  
High Dose ◽  
Blood Gas ◽  
Laboratory Test Results

Background: Wernicke’s encephalopathy (WE) is caused by thiamine deficiency and classically appears as changes in mental status, oculomotor manifestations, and gait ataxia. WE is mostly found in patients with chronic alcoholism and malnutrition, and has rarely been reported following pancreaticoduodenectomy. Case Presentation: A 77-year-old woman was admitted to our hospital complaining of loss of appetite and weakness of the lower extremities. No abnormalities were found on blood examination. One year earlier, she had undergone pancreaticoduodenectomy for bile duct cancer, and pancreatic fistula developed as a postoperative complication. On hospital day 8, her level of consciousness deteriorated, and she experienced difficulty bending the lower limbs and walking. Computed tomography and upper gastrointestinal series showed dilatation of the residual stomach and stenosis of the gastrojejunostomy. Laboratory test results were normal except for blood gas analysis, which revealed severe lactic acidosis. A diagnosis of WE was suspected due to lactic acidosis secondary to thiamine deficiency. Definitive diagnosis was confirmed by magnetic resonance imaging of the brain. Intravenous infusion of high-dose thiamine (1,200 mg/day) was commenced, leading to improvement of her neurological condition. Conclusions: Physicians should recognize that pancreaticoduodenectomy, when complicated by gastrojejunostomy stenosis resulting in pancreatic fistula, can lead to WE. In this case, blood gas analysis was helpful in arriving at the correct diagnosis. A high degree of suspicion should be maintained if any of the classical features of WE are observed following pancreaticoduodenectomy.

scholarly journals Metformin poisoning treated with high dose insulin dextrose therapy: a case series

2019 ◽  
Vol 26 (1) ◽  
pp. 72-78
Author(s):  
Theodore Young ◽  
Joaquim Cevallos ◽  
James Napier ◽  
Juan Martin-Lazaro
Keyword(s):  
Lactic Acidosis ◽  
Case Series ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Independent Effect ◽  
High Dose ◽  
Blood Gas ◽  
Compassionate Use ◽  
Life Threatening ◽  
Dextrose Infusion

Purpose. We describe the compassionate use of high dose insulin dextrose (HID) for life threatening metformin associated lactic acidosis (MALA) in four patients admitted to intensive care. Methods. Patients presenting with refractory lactic acidosis believed to be secondary to metformin poisoning were included. High dose insulin dextrose at 0.5units/kg/hour was infused in 50% dextrose. Frequent blood gas analysis allowed titration of therapy. All patients also received continuous veno-venous haemofiltration. Results. All four patients recovered to normal or near normal lactate and pH between 10 and 24 hours of therapy. Two patients had significant separation in time between initiation of HID and haemofiltration to suggest an independent effect of HID on improving pH and lactate. All patients had at least one episode of hypoglycaemia below 4.0 mmol/L with the lowest glucose in any patient during therapy being 3.0 mmol/L. All episodes were corrected with a dextrose infusion without sequelae. Conclusions. Our study demonstrates that HID therapy appears to be safe in patients with suspected metformin poisoning. It also appears to work to drive down lactate, improve pH and patients’ clinical condition. Further evidence is required to assess the effectiveness of HID therapy in the context of MALA.

scholarly journals Agreement between arterial and capillary pH, pCO2 and lactate in patients in the emergency department

2020 ◽  
Author(s):  
V. Collot ◽  
S. Malinverni ◽  
E. Schweitzer ◽  
J. Haltout ◽  
P. Mols ◽  
...  
Keyword(s):  
Lactic Acidosis ◽  
Sensitivity And Specificity ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Mean Difference ◽  
Blood Gas ◽  
Limits Of Agreement ◽  
Study Objective ◽  
Arterial Blood Gas ◽  
Arterial Blood

AbstractStudy objectiveThe primary objective of the study was a quantitative analysis to assess the mean difference and 95% confidence interval of the difference between capillary and arterial blood gas analyses for pH, pCO2 and lactate. Secondary objective was to measure the sensitivity and specificity of capillary samples to detect altered pH, hypercarbia and lactic acidosis.MethodsAdults admitted to the ED for whom the treating physician deemed necessary an arterial blood gas analysis (BGA) were screened for inclusion. Simultaneous arterial and capillary samples were drawn for BGA. Agreement between the two methods for pH, pCO2 and lactate were studied with Bland-Altman bias plot analysis. Sensitivity, specificity, positive and negative predictive value as well as AUC were calculated for the ability of capillary samples to detect pH values outside normal ranges, hypercarbia and hyperlactatemia.Results197 paired analyses were included in the study. Mean difference for pH, between arterial and capillary BGA was 0.0095, 95% limits of agreement were -0.048 to 0.067. For pCO2, mean difference was -0.3 mmHg, 95% limits of agreement were -8.5 to 7.9 mmHg. Lactate mean difference was -0.93 mmol/L, 95% limits of agreement were -2.7 to 0.8 mmol/L. At a threshold of 7.34 for capillary pH had 98% sensitivity and 97% specificity to detect acidemia; at 45.9 mmHg capillary pCO2 had 89% sensitivity and 96% specificity to detect hypercarbia. Finally at a threshold of 3.5 mmol/L capillary lactate had 66% sensitivity to detect lactic acidosis.ConclusionCapillary measures of pH, pCO2 and lactate can’t replace arterial measurements although there is high concordance between the two methods for pH and pCO2 and moderate concordance for lactate. Capillary blood gas analysis had good accuracy when used as a screening tool to detect altered pH and hypercarbia but insufficient sensitivity and specificity when screening for lactic acidosis.

scholarly journals Establishing and Evaluating Autoverification Rules with Intelligent Guidelines for Arterial Blood Gas Analysis in a Clinical Laboratory

2018 ◽  
Vol 23 (6) ◽  
pp. 631-640
Author(s):  
Jie Wu ◽  
Meichen Pan ◽  
Huizhen Ouyang ◽  
Zhili Yang ◽  
Qiaoxin Zhang ◽  
...  
Keyword(s):  
Error Rate ◽  
Clinical Laboratory ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Clinical Samples ◽  
Blood Gas ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Laboratory Test Results ◽  
Manual Verification

Arterial blood gas (ABG) analysis is important for acutely ill patients and should be performed by qualified laboratorians. The existing manual verifications are tedious, time-consuming, and prone to send wrong reports. Autoverification uses computer-based rules to verify clinical laboratory test results without manual review. To date, no data are available on the use of autoverification for ABG analysis. All autoverification rules were established according to AUTO10-A. Additionally, the rules were established using retrospective patient data, and then validated by actual clinical samples in a “live” environment before go-live. The average autoverification passing rate was 75.5%. The turnaround time (TAT) was reduced by 33.3% (27 min vs 18 min). Moreover, the error rate fell to 0.05% after implementation. Statistical analysis resulted in a kappa statistic of 0.92 ( p < 0.01), indicating close agreement between autoverification and senior technician verification, and the chi-square value was 22.4 ( p < 0.01), indicating that the autoverification error rate was lower than the manual verification error rate. Results showed that implementing autoverification rules with intelligent guidelines for ABG analysis of patients with critical illnesses could decrease the number of samples requiring manual verification, reduce TAT, and eliminate errors, allowing laboratorians to concentrate more time on abnormal samples, patient care, and collaboration with physicians.

Effects of insulin+glucose pretreatment on bupivacaine cardiotoxicity in rats

2017 ◽  
Vol 37 (5) ◽  
pp. 451-457 ◽  
Author(s):  
Ö Pişkin ◽  
BG Aydın
Keyword(s):  
Arterial Pressure ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
High Dose ◽  
Blood Gas ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Cardiovascular Side Effects ◽  
Group I ◽  
Arterial Blood Gas Analysis

A mistaken overdose of bupivacaine into systemic circulation may cause severe cardiovascular side effects. The aim of this study was to assess the effects of pretreatment with combined intra venous lipid emulsion (ILE) and high-dose insulin therapy against cardiotoxicity caused by bupivacaine intoxication. The rats were divided into the following three groups: Group B received a saline pretreatment plus a bupivacaine, group L received ILE pretreatment plus a bupivacaine, and in group I, insulin with glucose was infused intravenously, plus ILE pretreatment plus a bupivacaine. The electrocardiogram tracing, invasive arterial pressure, and heart rate (HR) of rats were monitored continuously. Arterial blood gas analysis was performed in all groups. Arterial blood gas analysis revealed that the baseline pH, PaO2, and PaCO2 values were similar between groups ( p > 0.05). Widening of Q, R, and S wave complex was found 46.8 ± 16.7, 92.0 ± 5.80, and 106.5 ± 17.9 s after initiation of bupivacaine infusion in groups B, L, and I, respectively. Time elapsed until 25% reduction of HR 127.3 ± 17.7, 248.4 ± 34.1, and 260.1 ± 51.3 s for groups B, L, and I, and 25% reduction of mean arterial pressure 107.6 ± 14.1, 253.2 ± 36.3, and 292 ± 57.7 s for groups B, L, and I, respectively. Arrhythmia was observed after 142.2 ± 27.5, 180.7 ± 17.8, and 190.7 ± 19.2 s for groups B, L, and I, respectively. Finally, asystole occurred after 560.1 ± 76.4, 782.4 ± 63.0, and 882.5 ± 105.1 s for groups B, L, and I, respectively. This finding indicates that the survival time of rats administered pretreatment with ILE plus insulin+glucose and those given ILE was observed to be longer.

Acute lactic acidosis with Wernicke's encephalopathy due to acute thiamine deficiency

2002 ◽  
Vol 28 (10) ◽  
pp. 1499-1499 ◽  
Author(s):  
Chadda K. ◽  
Raynard B. ◽  
Antoun S. ◽  
Thyrault M. ◽  
Nitenberg G.
Keyword(s):  
Lactic Acidosis ◽  
Thiamine Deficiency ◽  
Wernicke’S Encephalopathy ◽  
Wernicke's Encephalopathy

Blood gas analysis in newborns with low cardiac output syndrome after cardiac surgery.

2018 ◽  
Vol 19 (5) ◽  
pp. 676-687
Author(s):  
G.G. Khubulava ◽  
A.B. Naumov ◽  
S.P. Marchenko ◽  
O.Yu. Chupaeva ◽  
A.A. Seliverstova ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Cardiac Surgery ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Gas ◽  
Low Cardiac Output Syndrome ◽  
Low Cardiac Output

scholarly journals The effect of clamped and unclamped umbilical cord samples on blood gas analysis

2021 ◽  
Author(s):  
Elisabetta Colciago ◽  
Simona Fumagalli ◽  
Elena Ciarmoli ◽  
Laura Antolini ◽  
Antonella Nespoli ◽  
...  
Keyword(s):  
Blood Gas Analysis ◽  
Cross Sectional Study ◽  
Gas Analysis ◽  
Blood Collection ◽  
Large Sample Size ◽  
Blood Gas ◽  
Delayed Cord Clamping ◽  
Cross Sectional ◽  
High Risk Women ◽  
Significant Difference

Abstract Purpose Delayed cord clamping for at least 60 s is recommended to improve neonatal outcomes. The aim of this study is to evaluate whether there are differences in cord BGA between samples collected after double clamping the cord or without clamping the cord, when blood collection occurs within 60 s from birth in both groups. Methods A cross-sectional study was carried out, collecting data from 6884 high-risk women who were divided into two groups based on the method of cord sampling (clamped vs unclamped). Results There were significant decrease in pH and BE values into unclamped group compared with the clamped group. This difference remained significant when considering pathological blood gas analysis parameters, with a higher percentage of pathological pH or BE values in the unclamped group. Conclusion Samples from the unclamped cord alter the acid–base parameters compared to collection from the clamped cord; however, this difference does not appear to be of clinical relevance. Findings could be due to the large sample size, which allowed to achieve a high power and to investigate very small numerical changes between groups, leading to a statistically significant difference in pH and BE between samples even when we could not appreciate any clinical relevant difference of pH or BE between groups. When blood gas analysis is indicated, the priority should be given to the timing of blood collection to allow reliable results, to assess newborns status at birth and intervene when needed.

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