scholarly journals Myxedema Coma in a Hypothermic, Obtunded Patient with Post-renal Acute Kidney Injury and Bacteremia in the Intensive Care Unit

2019 ◽  
Vol 14 (2) ◽  
pp. 38-41
Author(s):  
Hernan Dario Franco Lopez ◽  
Sameer Sharif ◽  
John Centofanti
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Obstructive Uropathy ◽  
Clinical Signs ◽  
Kidney Injury ◽  
Signs And Symptoms ◽  
Initial Diagnosis ◽  
Hypothyroid Patient ◽  
Profound Hypothermia ◽  
Myxedema Coma

We present a case of a hypothermic, unconscious patient transferred to our Intensive Care Unit with sepsis requiring mechanical ventilation. The absence of any known past medical history as well as concurrent obstructive uropathy and bacteremia made initial diagnosis challenging. He was eventually found to be in myxedema coma in light of evolving signs and laboratory investigations. This case emphasizes the need to consider myxedema coma in the differential diagnosis of profound hypothermia, especially when other clinical signs and symptoms may obscure its initial diagnosis, and lead clinicians to focus on the triggering event in isolation rather than concurrently managing hypothyroidism. This case highlights a challenging presentation of an uncommon, but life-threatening condition. We discuss the signs and symptoms present in the hypothyroid patient with myxedema coma; emphasize the pathophysiology of myxedema coma as well as the evidence-based acute management of this condition.

Pathogens in Early-Onset and Late-Onset Intensive Care Unit–Acquired Pneumonia

2007 ◽  
Vol 28 (4) ◽  
pp. 389-397 ◽  
Author(s):  
K. M. C. Verhamme ◽  
W. De Coster ◽  
L. De Roo ◽  
H. De Beenhouwer ◽  
G. Nollet ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Early Onset ◽  
Late Onset ◽  
Clinical Signs ◽  
Positive Culture ◽  
Signs And Symptoms ◽  
Positive Culture Result ◽  
Multiple Drugs

Objectives.To compare the type of pathogens isolated from patients with early-onset intensive care unit (ICU)-acquired pneumonia with those isolated from patients with late-onset ICU-acquired pneumonia and to study risk factors for the isolation of pathogens that are potentially resistant to multiple drugs.Design.Prospective cohort study.Setting.Patients admitted to the ICU of a 677-bed, university-affiliated teaching hospital in Belgium during 1997-2002.Methods.ICU-acquired pneumonia was defined as a case of pneumonia that occurred 2 days or more after admission to the ICU in combination with a positive results of radiologic analysis, clinical signs and symptoms, and a positive culture result. All cases of pneumonia were categorized as either early onset (within 7 days after admission) and late onset (7 days or more after admission), with or without previous antibiotic treatment, and the corresponding pathogens were analyzed. Risk factors for the isolation of pathogens potentially resistant to multiple drugs (ie, Pseudomonas aeruginosa, Serratia marcescens, Enterobacter species, Morganella morganii, methicillin-resistant Stapylococcus aureus, Citrobacter species, Acinetobacter species, Burkholderia species, extended-spectrum β-lactamase–producing pathogens, and Stenotrophomonas maltophilia) were analyzed using logistic regression analysis.Results.A total of 4,200 patients stayed at the ICU for 2 or more days, 298 of whom developed ICU-acquired pneumonia, for an overall incidence of 13 cases (95% confidence interval [CI], 11-14 cases) per 1,000 ICU-days. Pathogens potentially resistant to multiple drugs were isolated from 52% of patients with early-onset pneumonia. Risk factors for the isolation of these pathogens were greater age and previous receipt of antibiotic prophylaxis (adjusted odds ratio [aOR], 4.6 [95% CI, 1.6-13.0]) or antibiotic therapy (aOR, 8.2 [95% CI, 2.8-23.8]). The length of ICU admission and hospital stay were weaker risk factors for the isolation of these pathogens.Conclusions.Pathogens potentially resistant to multiple drugs were isolated in 52% of cases of early-onset ICU-acquired pneumonia. Previous antibiotic use (both prophylactic and therapeutic) is the main risk factor for the isolation of these pathogens.

Colon perforation during colonoscopy – the role of an anaesthesiologist in patient management. A case report

Nowa Medycyna ◽  
2020 ◽  
Vol 27 (3) ◽  
Author(s):  
Jacek Wadełek
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Anaesthetic Management ◽  
Successful Outcome ◽  
Colon Perforation ◽  
Emergency Laparotomy ◽  
Good General Condition ◽  
Clinical Signs And Symptoms

Colon perforation is a serious complication of colonoscopy. Clinical signs and symptoms depend on the specific characteristics of the perforation (e.g., size, location, and aetiology) and patient’s general status. The paper presents a case of an 81-year-old man who underwent diagnostic colonoscopy with perforation of the sigmoid diverticulum. The endoscopist was unsuccessful in ceiling the sigmoid perforation by clipping. Therefore, emergency laparotomy was performed, during which the perforation was repaired. Postoperatively, the patient was cared for in an intensive care unit. He was discharged from the intensive care unit to general surgery on day 3 postoperatively in a good general condition. Colon perforation at colonoscopy is one of the most serious complications, with early diagnosis and surgical repair being the key to successful outcome. Proper anaesthetic management is centred around correction of metabolic, cardiovascular and respiratory derangements, which is also crucial for patient outcomes.

scholarly journals POS-004 HYPOALBUMINEMIA AND ACUTE KIDNEY INJURY IN PATIENTS ADMITTED TO INTENSIVE CARE UNIT

2021 ◽  
Vol 6 (4) ◽  
pp. S2
Author(s):  
A. BACA ◽  
M. Carmoma Antonio ◽  
M. Wasung ◽  
P. Visoso ◽  
M. Sebastian Alberto
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Kidney Injury

scholarly journals Dosing of daptomycin in intensive care unit patients with acute kidney injury undergoing extended dialysis--a pharmacokinetic study

2009 ◽  
Vol 25 (5) ◽  
pp. 1537-1541 ◽  
Author(s):  
J. T. Kielstein ◽  
C. Eugbers ◽  
S. M. Bode-Boeger ◽  
J. Martens-Lobenhoffer ◽  
H. Haller ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Pharmacokinetic Study ◽  
Kidney Injury

scholarly journals Intensive care unit physician-delivered point of care renal tract ultrasound in acute kidney injury is feasible

2018 ◽  
Vol 19 (4) ◽  
pp. 313-318 ◽  
Author(s):  
Prashant Parulekar ◽  
Ed Neil-Gallacher ◽  
Alex Harrison
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Point Of Care ◽  
Kidney Injury ◽  
Diagnostic Quality ◽  
The Core ◽  
Low Incidence

Acute kidney injury is common in critically ill patients, with ultrasound recommended to exclude renal tract obstruction. Intensive care unit clinicians are skilled in acquiring and interpreting ultrasound examinations. Intensive Care Medicine Trainees wish to learn renal tract ultrasound. We sought to demonstrate that intensive care unit clinicians can competently perform renal tract ultrasound on critically ill patients. Thirty patients with acute kidney injury were scanned by two intensive care unit physicians using a standard intensive care unit ultrasound machine. The archived images were reviewed by a Radiologist for adequacy and diagnostic quality. In 28 of 30 patients both kidneys were identified. Adequate archived images of both kidneys each in two planes were possible in 23 of 30 patients. The commonest reason for failure was dressings and drains from abdominal surgery. Only one patient had hydronephrosis. Our results suggest that intensive care unit clinicians can provide focussed renal tract ultrasound. The low incidence of hydronephrosis has implications for delivering the Core Ultrasound in Intensive Care competencies.

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