scholarly journals Seizures, Metabolic Acidosis and Coma Resulting from Acute Isoniazid Intoxication

2005 ◽  
Vol 33 (4) ◽  
pp. 518-520 ◽  
Author(s):  
I. Topcu ◽  
E. A. Yentur ◽  
A. Kefi ◽  
N. Z. Ekici ◽  
M. Sakarya
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Metabolic Acidosis ◽  
Sodium Bicarbonate ◽  
Successful Treatment ◽  
Ventilatory Support ◽  
Anticonvulsant Therapy ◽  
Dose Equivalent ◽  
Adult Case ◽  
Clinical Triad

Isoniazid is an anti-tuberculosis drug, used commonly for treatment and prophylaxis of tuberculosis. Acute isoniazid intoxication is characterized by a clinical triad consisting of metabolic acidosis resistant to treatment with sodium bicarbonate, seizures which may be fatal and refractory to standard anticonvulsant therapy, and coma. Treatment requires admission to the intensive care unit for ventilatory support, management of seizures and metabolic acidosis. Pyridoxine, in a dose equivalent to the amount of isoniazid ingested, is the only effective antidote. We report the successful treatment of two isoniazid intoxication cases: the case of a child developing an accidental acute isoniazid intoxication and an adult case of isoniazid intoxication with the intent of suicide.

Weaning From Noninvasive Ventilatory Support in Infants With Severe Bronchiolitis: An Observational Study

2021 ◽  
Author(s):  
Julie Cassibba ◽  
Claire Freycon ◽  
Julia Doutau ◽  
Isabelle Pin ◽  
Alexandre Bellier ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Observational Study ◽  
Pediatric Intensive Care Unit ◽  
Positive Airway Pressure ◽  
Ventilatory Support ◽  
Winter Season ◽  
Pediatric Intensive Care ◽  
High Flow Nasal Cannula ◽  
Tertiary Center

Abstract Background: The aim of the study was to analyze the weaning success, the type of weaning procedures, and weaning duration in consecutive infants hospitalized over a winter season in a Pediatric Intensive Care Unit.Methods: A retrospective observational study in a pediatric intensive care unit in a tertiary center. Infants hospitalized for a severe bronchiolitis were included and the weaning procedure from continuous positive airway pressure (CPAP), noninvasive ventilation (NIV) or high flow nasal cannula (HFNC) was analyzed.Results: Data from 95 infants (median age 47 days) were analyzed. On admission, 26 (27%), 46 (49%) and 23 (24%) infants were supported by CPAP, NIV and HFNC, respectively. One (4%), nine (20%) and one (4%) infants failed weaning while supported by CPAP, NIV or HFNC, respectively (p=0.1). In infants supported by CPAP, CPAP was stopped directly in 5 patients (19%) while HFNC was used as an intermediate ventilatory support in 21 (81%). The duration of weaning was shorter for HFNC (17 hours, [IQR 0-26]) than for CPAP (24 hours, [14-40]) and NIV (28 hours, [19-49]) (p<0.01).Conclusions: The weaning phase represent a large proportion of noninvasive ventilatory support duration in infants with bronchiolitis. The weaning procedure following a “step down” strategy may lead to an increase in duration of weaning.

scholarly journals Adaptive Support Ventilation as a Sole Mode of Mechanical Ventilation-An Observational Study

2017 ◽  
Vol 1 (1) ◽  
pp. 8-12
Author(s):  
L.K. Rajbanshi ◽  
M. Dali ◽  
S.B. Karki ◽  
K. Khanal ◽  
B. Aryal ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Observational Study ◽  
Ventilatory Support ◽  
Control Mode ◽  
Adaptive Support Ventilation ◽  
Support Ventilation ◽  
Adaptive Support ◽  
The Mean

Introduction Adaptive support ventilation (ASV) is a close loop dual control mechanical ventilation mode. This mode can automatically change its parameters to weaning mode once the patient is actively breathing converting volume targeted pressure control mode to volume targeted pressure support mode. We aimed to observe the outcome of the patients ventilated with ASV as a sole mode in terms of duration of mechanical ventilation, duration of weaning from the ventilatory support and length of Intensive care unit (ICU) stay.Methodology We conducted a prospective observational study for the duration of six months (Sept 2015 to Feb 2016) to assess the clinical outcome of the patients ventilated by ASV as a sole mode of ventilation. The study conducted observation of 78 patients without chronic respiratory, renal, hepatic and neurological disease who were admitted in our intensive care unit for invasive ventilatory support.Results Out of the 187 patients who required invasive and noninvasive ventilation, only 78 patients fulfilled the criteria to be included in the study. It was observed that the mean duration of mechanical ventilation was 5.4 days while weaning as well as tracheal extubation was successful within 13 hours of initiation of weaning. The mean duration of ICU stay was found to be 6.3 days.Conclusion We concluded that the patient ventilated by ASV mode were effectively weaned without the need of changing the ventilator mode. However, the safety of ASV mode needs to be established by large randomized control trail in a wide spectrum of patients.Birat Journal of Health Sciences 2016 1(1): 8-12

scholarly journals Profile of Intensive Care Unit admission and Outcomes of Medical and Surgical patients at A Tertiary Government Hospital: A 5 Year Trend Analysis

2018 ◽  
Vol 29 (2) ◽  
pp. 59-62
Author(s):  
Shakera Ahmed ◽  
Omar Faruque Yusuf ◽  
AKM Shamsul Alam ◽  
Anisul Awal
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Mortality Rate ◽  
Ventilatory Support ◽  
Surgical Patients ◽  
College Hospital ◽  
Medical College ◽  
Advanced Airway ◽  
Medical Discipline ◽  
Record Review

Background: The intensive care unit (ICU) is that part of the hospital where critically ill patients that require advanced airway, respiratory and haemodynamic supports are usually admitted. Intensive care unit admissions which aim at achieving an outcome better than if the patients were admitted into other parts of the hospital however come at a huge cost to the hospital, the personnel and patients’ relations.Objective: To audit the 5 year bed occupancy rate and outcome of medicine and surgical patients admitted into the ICU of the Chittagong Medical College Hospital, Chittagong, Bangladesh.Design: A 5 years retrospective study (Record review) from January 2012 to December 2016. Method: Data were extracted from the ICU records of the patient and analyzed.Results: During this study period, the frequency of admission into ICU was significantly more (p<0.001) from medical discipline (55.20%) than surgical disciplines (44.80%). The incidence of survival was significantly lower (p<0.001) from medical discipline (37.68%), than from surgical disciplines (49.05%). Occurrence of total ventilatory support provided in all disciplines was 60.32% and it was significantly higher for the surgical patients. Overall mortality rate was 57.23%.Conclusion: During prioritizing the patients for ICU admission surgical cases should get preference. It is primarily necessary to optimize patient to doctor ratio and patient to nurse ratio and providing the service by critical care physicians (“intensivists”) to reduce the mortality rate of ICU.Bangladesh J Medicine Jul 2018; 29(2) : 59-62

scholarly journals Study of effect of serum magnesium concentration on clinical outcome of critically sick patients in medical intensive care unit

2021 ◽  
Vol 8 (12) ◽  
pp. 1812
Author(s):  
Ganedi S. Kumari
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Serum Magnesium ◽  
Ventilatory Support ◽  
Magnesium Level ◽  
Cardiac Insufficiency ◽  
Electrolyte Imbalance ◽  
Magnesium Concentration ◽  
Ventilator Support ◽  
Male Predominance

Background: Deficiency of magnesium is common and often ignored. It is associated with cardiac irregularity, cardiac insufficiency, seizure and electrolyte imbalance. As this element has multiple functions in our body it is important in the pathophysiology of several critical illnesses in intensive care unit (ICU). Hence the present study was undertaken to determine the usefulness of admission serum magnesium levels with regards to patient outcome considering mortality, need and duration of ventilator support, and acute physiologic assessment and chronic health evaluation 2 (APACHE 2) score.Methods: Demographic data such as age and sex were recorded. Patients were assessed for presenting complaints, history of other diseases and habits through an interview with the patients or care giver. These findings were recorded on a predesigned proforma patients was followed up for the outcomes such as mortality, need of ventilator support, duration of ICU stay and APACHE 2 score.Results: Regarding comparison between outcome of patients between two groups, 44% patients with magnesium level <1.7 mg/dl have improved and 72% patient didn’t improve. 44% patients with magnesium level >1.7 mg/dl have improved and 28% patient didn’t improve.Conclusions: From present observational study we can conclude that hypomagnesaemia is more common in patients more than 50 years of age and with male predominance. Pneumonia with septicaemia and cerebrovascular accident (CVA) was commonly associated with hypomagnesaemia. In present study we have observed that hypomagnesaemia is associated with high APACHE 2 score, poor outcome and more requirement of ventilatory support.

Skin Integrity in Critically Ill and Injured Children

2007 ◽  
Vol 16 (6) ◽  
pp. 568-574 ◽  
Author(s):  
Christine A. Schindler ◽  
Theresa A. Mikhailov ◽  
Kay Fischer ◽  
Gloria Lukasiewicz ◽  
Evelyn M. Kuhn ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Ventilatory Support ◽  
Pediatric Intensive Care ◽  
Cost Of Care ◽  
Respiratory Illnesses ◽  
Skin Breakdown ◽  
Potential Risk Factors

Background Skin breakdown increases the cost of care, may lead to increased morbidity, and has negative psychosocial implications because of secondary scarring or alopecia. The scope of this problem has not been widely studied in critically ill and injured children. Objectives To determine the incidence of skin breakdown in critically ill and injured children and to compare the characteristics of patients who experience skin breakdown with those of patients who do not. Methods Admission and follow-up data for a 15-week period were collected retrospectively on children admitted to a large pediatric intensive care unit. The incidence of skin breakdown was calculated. The risk for skin breakdown associated with potential risk factors (relative risk) and 95% confidence intervals were determined. Results The sample consisted of 401 distinct stays in the intensive care unit for 373 patients. During the 401 stays, skin breakdown occurred in 34 (8.5%), redness in 25 (6.2%), and breakdown and redness in 13 (3.2%); the overall incidence was 18%. Patients who had skin breakdown or redness were younger, had longer stays, and were more likely to have respiratory illnesses and require mechanical ventilatory support than those who did not. Patients who had skin breakdown or redness had a higher risk of mortality than those who did not. Conclusions Risk factors for skin breakdown were similar to those previously reported. Compared with children of other ages, children 2 years or younger are at higher risk for skin breakdown.

scholarly journals Perioperative metabolic acidosis: The Bradford Anaesthetic Department Acidosis Study

2018 ◽  
Vol 20 (1) ◽  
pp. 11-17 ◽  
Author(s):  
TO Lawton ◽  
A Quinn ◽  
SJ Fletcher
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Metabolic Acidosis ◽  
Early Phase ◽  
Time Course ◽  
Late Phase ◽  
Common Finding ◽  
Major Surgery ◽  
Arterial Blood ◽  
Early Fluid

Metabolic acidosis is considered deleterious but is common in post-surgical patients admitted to intensive care unit. We evaluated the prevalence and time course of metabolic acidosis in elective major surgery, and generated hypotheses about causes, by hourly arterial blood sampling in 92 patients. Metabolic acidosis began before incision and most had occurred by the next hour. Seventy-eight per cent of patients had a significant metabolic acidosis post-operatively. Two overlapping phases were observed. The early phase started before incision, characterised by a rising chloride and falling anion gap, unrelated to saline use. The late phase was partly associated with lactate, related to surgery type, and early fluids appeared protective. There was a trend towards longer intensive care unit (+1.3 days) and hospital (+3.2 days) stay with metabolic acidosis. This is the first large study of the evolution of this common finding, demonstrating a pre-incision component. The early phase appears unavoidable or unpredictable, but the late phase might be modified by early fluid administration. It remains unclear whether acidosis of this type should be avoided.

Ventilatory support in the intensive care unit

2016 ◽  
Vol 17 (10) ◽  
pp. 520-525
Author(s):  
Martin Hughes ◽  
Laura Strachan
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Ventilatory Support

Caring for “Socially Undesirable” Patients

1996 ◽  
Vol 5 (4) ◽  
pp. 500-510 ◽  
Author(s):  
Nancy S. Jecker
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Metabolic Acidosis ◽  
Renal Insufficiency ◽  
Suicide Attempts ◽  
University Hospital ◽  
Healthcare Team ◽  
Local Hospital ◽  
The University ◽  
Osmolar Gap

Mr. Bernard was a homeless man, aged 58. His medical history revealed alcohol abuse, seizure disorder, and two suicide attempts. Brought to the emergency room at a local hospital after being found “semi-comatose,” his respiratory distress led to his being intubated and placed on a ventilator. The healthcare team suspected the patient ingested antifreeze. Transferred from that hospital to the intensive care unit (ICU) of the university hospital, his diagnosis was “high osmolar gap with high-anion gap metabolic acidosis, most likely secondary to ethylene glycol ingestion and renal insufficiency.”

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