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

2020 ◽  
Vol 42 (1) ◽  
pp. 106-112 ◽  
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.

Practice Guidelines for the Diagnosis of COVID-19-Associated Pulmonary Aspergillosis in an Intensive Care Setting

2021 ◽  
pp. 088506662110471
Author(s):  
Zia Hashim ◽  
Zafar Neyaz ◽  
Rungmei S.K. Marak ◽  
Alok Nath ◽  
Soniya Nityanand ◽  
...  
Keyword(s):  
Intensive Care ◽  
Practice Guidelines ◽  
Clinical Management ◽  
Care Setting ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Third Wave ◽  
Intensive Care Setting ◽  
Pulmonary Aspergillosis

Coronavirus disease-2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) is a new disease characterized by secondary Aspergillus mold infection in patients with COVID-19. It primarily affects patients with COVID-19 in critical state with acute respiratory distress syndrome, requiring intensive care and mechanical ventilation. CAPA has a higher mortality rate than COVID-19, posing a serious threat to affected individuals. COVID-19 is a potential risk factor for CAPA and has already claimed a massive death toll worldwide since its outbreak in December 2019. Its second wave is currently progressing towards a peak, while the third wave of this devastating pandemic is expected to follow. Therefore, an early and accurate diagnosis of CAPA is of utmost importance for effective clinical management of this highly fatal disease. However, there are no uniform criteria for diagnosing CAPA in an intensive care setting. Therefore, based on a review of existing information and our own experience, we have proposed new criteria in the form of practice guidelines for diagnosing CAPA, focusing on the points relevant for intensivists and pulmonary and critical care physicians. The main highlights of these guidelines include the role of CAPA-appropriate test specimens, clinical risk factors, computed tomography of the thorax, and non-culture-based indirect and direct mycological evidence for diagnosing CAPA in the intensive care unit. These guidelines classify the diagnosis of CAPA into suspected, possible, and probable categories to facilitate clinical decision-making. We hope that these practice guidelines will adequately address the diagnostic challenges of CAPA, providing an easy-to-use and practical algorithm to clinicians for rapid diagnosis and clinical management of the disease.

The ART of Antiretroviral Therapy in Critically Ill Patients With HIV

2018 ◽  
Vol 34 (11-12) ◽  
pp. 897-909 ◽  
Author(s):  
Tyler Finocchio ◽  
William Coolidge ◽  
Thomas Johnson
Keyword(s):  
Intensive Care ◽  
Antiretroviral Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Care Setting ◽  
Critically Ill Patient ◽  
Intensive Care Setting ◽  
Antiretroviral Medications ◽  
Immunodeficiency Virus ◽  
Inflammatory Syndrome

The management of patients with human immunodeficiency virus (HIV) can be a complicated specialty within itself, made even more complex when there are so many unanswered questions regarding the care of critically ill patients with HIV. The lack of consensus on the use of antiretroviral medications in the critically ill patient population has contributed to an ongoing clinical debate among intensivists. This review focuses on the pharmacological complications of antiretroviral therapy (ART) in the intensive care setting, specifically the initiation of ART in patients newly diagnosed with HIV, immune reconstitution inflammatory syndrome (IRIS), continuation of ART in those who were on a complete regimen prior to intensive care unit admission, barriers of drug delivery alternatives, and drug-drug interactions.

scholarly journals Therapeutic Management of a Patient with Necrotizing Fasciitis Resulting in Quadrilateral Amputation and Critical Illness Myopathy in the Intensive Care Setting: A Case Report.

2021 ◽  
Author(s):  
Mallory Kargela ◽  
Annette Siebens
Keyword(s):  
Intensive Care ◽  
Critical Illness ◽  
Necrotizing Fasciitis ◽  
Care Setting ◽  
Assistive Device ◽  
Critical Illness Myopathy ◽  
Critically Ill Patient ◽  
Close Monitoring ◽  
Intensive Care Setting ◽  
Acute Setting

Purpose: The purpose of this case is to illustrate the best available evidence to provide early therapeutic intervention for a critically ill patient presenting with cardiovascular and pulmonary complications due to multi-system compromise. Case Description: A 19-year-old male was admitted to the hospital with the diagnosis of necrotizing fasciitis and necrotizing pneumonia. He experienced numerous additional medical complications ultimately leading to tracheostomy, delirium, critical illness myopathy, and quadrilateral amputation secondary to necrotizing fasciitis and critical limb ischemia following prolonged veno-venous extracorporeal membrane oxygenation (VV-ECMO). Outcomes: Patient was discharged to an outside rehabilitation hospital after 103 days in the acute setting (56 days in the ICU) and was able to tolerate 40 minutes sitting edge of bed with supervision, perform bed mobility with supervision, and propel a standard wheelchair up to 50 feet independently. At 10 months’ post-discharge from the acute setting, the patient was ambulating independently up to 150 feet without assistive device using bilateral lower extremity prosthetics, able to propel a lightweight wheelchair community distances, independent in all transfers, and returned to school and work. Discussion: These findings suggest that clinicians may want to consider examining and combining the best available evidence of multiple medical conditions to provide a well-rounded therapeutic approach including but not limited to, close monitoring of vitals and early mobilization, to managing complex patients in the intensive care setting.

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

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
M. Piastra ◽  
V. Ferrari ◽  
E. Picconi ◽  
T. C. Morena ◽  
L. Pezza ◽  
...  
Keyword(s):  
Intensive Care ◽  
Care Setting ◽  
Group A Streptococcus ◽  
Clinical Approach ◽  
Aggressive Treatment ◽  
Intensive Care Setting ◽  
Healthy Infants ◽  
Life Threatening ◽  
Streptococcal Sepsis ◽  
Clinical Pictures

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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