Life-threatening complications of streptococcal sepsis: a PICU contemporary series

Abstract Background Life-threatening streptococcal sepsis nowadays represents an uncommon event in previously healthy infants and children. Critically ill patients suffering from severe streptococcal sepsis complications may present with pre-antibiotic era clinical pictures and require a timely clinical approach to achieve restitutio ad integrum. Results We report a series of four patient groups affected by an uncommon life-threatening streptococcal sepsis, each of them exhibiting some distinct features. Streptococcus Agalactiae sepsis was associated with cerebral thrombotic/ischaemic lesions, whereas severe cardiogenic shock was prominent in the Streptococcus Viridans group; Streptococcus Faecalis and β-hemolytic group A Streptococcus patients mostly reported lung complications. Conclusions Previous antibiotic treatments should not delay aggressive treatment in the intensive care setting. Early diagnostic suspicion, as well as appropriate and aggressive treatment provided within an intensive care setting are crucial for the clinical outcome.

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The role of urea-induced osmotic diuresis and hypernatremia in a critically ill patient: case report and literature review

Brazilian Journal of Nephrology ◽

10.1590/2175-8239-jbn-2018-0226 ◽

2020 ◽

Vol 42 (1) ◽

pp. 106-112 ◽

Cited By ~ 4

Author(s):

Jesiree Iglésias Quadros Distenhreft ◽

Júlia Guasti Pinto Vianna ◽

Gabriela S. Scopel ◽

Jayme Mendonça Ramos ◽

Antonio Carlos Seguro ◽

...

Keyword(s):

Intensive Care ◽

Care Setting ◽

Free Water ◽

Recovery Phase ◽

Critically Ill Patient ◽

Clinical Approach ◽

Intensive Care Setting ◽

Osmotic Diuresis ◽

Free Water Clearance

Abstract Hypernatremia is a common electrolyte problem at the intensive care setting, with a prevalence that can reach up to 25%. It is associated with a longer hospital stay and is an independent risk factor for mortality. We report a case of hypernatremia of multifactorial origin in the intensive care setting, emphasizing the role of osmotic diuresis due to excessive urea generation, an underdiagnosed and a not well-known cause of hypernatremia. This scenario may occur in patients using high doses of corticosteroids, with gastrointestinal bleeding, under diets and hyperprotein supplements, and with hypercatabolism, especially during the recovery phase of renal injury. Through the present teaching case, we discuss a clinical approach to the diagnosis of urea-induced osmotic diuresis and hypernatremia, highlighting the utility of the electrolyte-free water clearance concept in understanding the development of hypernatremia.

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Three case reports of the use of haemodiafiltration in the treatment of salicylate overdose

Human & Experimental Toxicology ◽

10.1191/096032701682693071 ◽

2001 ◽

Vol 20 (9) ◽

pp. 491-495 ◽

Cited By ~ 20

Author(s):

G Wrathall ◽

R Sinclair ◽

A Moore ◽

D Pogson

Keyword(s):

Intensive Care ◽

Acetylsalicylic Acid ◽

Care Setting ◽

Case Reports ◽

Intensive Care Setting ◽

Small Reduction ◽

First Case ◽

Salicylate Poisoning ◽

Life Threatening

Aspirin (acetylsalicylic acid) is widely available without prescription. Although self-poisoning is rare, if severe it may be life threatening. Haemodialysis has been recommended in severe cases when salicylate levels exceed 7.3 mmol l-1. We describe three cases of severe salicylate poisoning, which were treated with continuous veno-venous haemodiafiltration (CVVHDF). All patients survived. The first case had already undergone haemodialysis before transfer to the ICU, where CVVHDF was commenced because salicylism persisted at 3 mmol l-1. A small reduction in serum salicylate was noted. In the second case, serum salicylate decreased from 8.5 to 3.5 mmol l-1 after 3 h of CVVHDF even though only minimal urine was produced. Our third case is a chronic overdose in whom serum salicylate decreased from 6.2 to 4 mmol l-1 after 4 h and to 1.4 mmol l-1 after a further 7 h. No bicarbonate was administered to this patient and elimination can only be attributed to CVVHDF and urinary clearance, which is known to be slow. We discuss the pathogenesis of severe salicylate toxicity and postulate that CVVHDF, which is widely used in the intensive care setting, may be a useful therapy in severely poisoned patients who are unstable and cannot undergo haemodialysis or in situations where haemodialysis is unavailable.

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Severe Snakebite Envenoming in Intensive Care

Prague Medical Report ◽

10.14712/23362936.2016.16 ◽

2016 ◽

Vol 117 (4) ◽

pp. 153-163 ◽

Cited By ~ 1

Author(s):

Jiří Valenta ◽

Zdeněk Stach ◽

Pavel Michálek

Keyword(s):

Native American ◽

Intensive Care ◽

Care Setting ◽

Kidney Injury ◽

Coagulation Disorder ◽

Intensive Care Setting ◽

Muscle Paralysis ◽

Clinical Syndromes ◽

Life Threatening ◽

Low Incidence

Snakebites by exotic venomous snakes can cause serious or even life-threatening envenoming. In Europe and North America most victims are breeders, with a few snakebites from wild native American rattlesnakes. The envenomed victims may present in organ and/or system failure with muscle paralysis, respiratory failure, circulatory instability, acute kidney injury, severe coagulation disorder, and local disability – compartment syndrome and necrosis. Best managed by close collaboration between clinical toxicology and intensive care, most severe envenomings are managed primarily by intensive care physicians. Due to the low incidence of severe envenoming, the clinical course and correct management of these cases are not intrinsically familiar to most physicians. This review article summarizes the clinical syndromes caused by severe envenoming and the therapeutic options available in the intensive care setting.

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