scholarly journals Tatalaksana Neuroleptik Malignant Syndrome di Intensif Care Unit Dengan Impending Organ Failure

2021 ◽  
Vol 6 (2) ◽  
pp. 96-107
Author(s):  
Andi Muhammad Fadrial ◽  
Faisal Muchtar ◽  
Muhammad Rum ◽  
Hisbullah Hisbullah
Keyword(s):  
Organ Failure ◽  
Neuroleptic Malignant Syndrome

Neuroleptic Malignant Syndrome adalah sebuah sindrom khas dan merupakan komplikasi pengobatan antipsikotik yang mengancam jiwa. Neuroleptic Malignant Syndrome memberikan gambaran klinis seperti rigiditas, hipertermia, dan perubahan status mental. Morbiditas dan mortalitas pada Neuroleptic Malignant Syndrome sering akibat sekunder dari komplikasi jantung, paru-paru dan ginjal sehingga diperlukan perawatan intensif. Penatalaksanaan Neuroleptic Malignant Syndrome adalah menghentikan semua antipsikotik dan melakukan terapi suportif. Prognosis pasien Neuroleptic Malignant Syndrome akan mengalami perbaikan gejala dalam waktu dua minggu dan beberapa pasien sembuh tanpa gejala sisa neurologis. Telah dilakukan perawatan terhadap pasien perempuan usia 21 tahun dengan Neuroleptic Malignant Syndrome. Selama di ICU pasien mengalami demam, kekakuan otot, tremor dan mioglobinuria. Perawatan yang dilakukan berupa monitoring pernafasan, monitoring hemodinamik, dan terapi supportif. Selama perawatan di ICU kondisi pasien cenderung membaik dan kembali ke bangsal setelah perawatan hari ke sebelas. Tujuan penulisan laporan kasus ini adalah mengetahui pentingnya tatalaksana yang tepat pada pasien Neuroleptic Malignant Syndrome sehingga dapat menghindari kerusakan organ yang berat dan irreversible di ICU.

Neuroleptic Malignant Syndrome: A Potential Etiology of Multisystem Organ Failure in a Burn Patient

2020 ◽  
pp. 000313482094524 ◽  
Author(s):  
Hannah M. Ficarino ◽  
Michael Z. Caposole ◽  
S. Noelle Davis ◽  
Mackenzie N. Krebsbach ◽  
Emily F. McGowin ◽  
...  
Keyword(s):  
Creatine Kinase ◽  
Organ Failure ◽  
Neuroleptic Malignant Syndrome ◽  
Total Body Surface Area ◽  
Elevated Serum ◽  
Trauma Patients ◽  
Antipsychotic Therapy ◽  
Coronary Syndrome ◽  
Multisystem Organ Failure ◽  
Patient Reported

Neuroleptic malignant syndrome (NMS) is described in the medical literature but rarely seen among acutely ill trauma patients. A 44-year-old man with burns to the hands and back after a chemical explosion was transported to an outside facility where he received treatment for presumed acute coronary syndrome after developing ventricular tachycardia and elevated serum troponins after the exposure. His cardiac catheterization was unremarkable, but an echocardiogram revealed severe cardiomyopathy, and he was also in multisystem organ failure. He was transferred to our facility after hospital day 2 for treatment of his multisystem organ failure and 2% total body surface area burns. His laboratory results were remarkable for a creatine kinase of >100 000 units/L, and he required 14 g of intravenous calcium. Upon further investigation, the patient reported taking ziprasidone for his bipolar disorder, and he had a core temperature of 103.5 °F on his initial presentation to the outside facility. As he convalesced, the unifying diagnosis was NMS. NMS is a side effect of antipsychotic therapy and is manifested by hyperpyrexia, rigidity, autonomic instability, and altered consciousness. An elevated creatine kinase >100 000 units/L is almost pathognomonic for NMS. Patients can also present with leukocytosis, organ failure, and electrolyte disturbances including hypocalcemia. We hypothesized that dehydration, the warm environmental conditions at our patient’s job, and immense stress resulting in a catecholamine surge following his trauma were inciting triggers to this event. This case highlights the importance of considering alternate diagnoses in patients whose clinical presentation does not fit the most “obvious cause.”

Combination of Antibiotic Treatment with the Thrombin Inhibitor Recombinant Hirudin for the Therapy of Experimental Klebsiella pneumoniae Sepsis

1994 ◽  
Vol 71 (06) ◽  
pp. 768-772 ◽  
Author(s):  
Gerhard Dickneite ◽  
Jörg Czech
Keyword(s):  
Septic Shock ◽  
Klebsiella Pneumoniae ◽  
Organ Failure ◽  
Therapeutic Effect ◽  
Disseminated Intravascular Coagulation ◽  
Post Infection ◽  
Thrombin Inhibitor ◽  
Bolus Administration ◽  
Bacterial Burden ◽  
Recombinant Hirudin

SummaryRats which were infected with the gramnegative pathogen Klebsiella pneumoniae develop disseminated intravascular coagulation (DIC), multi-organ failure (MOF) and finally die in a septic shock. We investigated the therapeutic effect of antibiotic (tobramycin) treatment combined with the infusion of the highly specific thrombin inhibitor rec. hirudin. Although administration of 2 mg/kg tobramycin alone leads to a decrease of the bacterial burden, DIC could not be prevented. Infusion of rec. hirudin (0.25 mg/kg x h) for 4 h (start of treatment 1 h post infection), in addition to a bolus administration of tobramycin, led to an amelioration of DIC parameters as fibrinogen, thrombin-antithrombin complex (TAT) and platelets. Serum transaminase levels (GOT, GPT) as a marker of MOF were significantly improved by rec. hirudin, the T50 value increased from 17 h in the tobramycin group to 42 h in the tobramycin + rec. hirudin giuup, muilality rates were 90% or 60%, respectively. Combination of heparin (10011/kg x h) and tobramycin was not effective on survival.

Plasma Level of IL-1β in Disseminated Intravascular Goagulation

1991 ◽  
Vol 65 (04) ◽  
pp. 364-368 ◽  
Author(s):  
Hideo Wada ◽  
Shigehisa Tamaki ◽  
Motoaki Tanigawa ◽  
Mikio Takagi ◽  
Yoshitaka Mori ◽  
...  
Keyword(s):  
Endothelial Cells ◽  
Tumor Necrosis Factor ◽  
Plasma Level ◽  
Organ Failure ◽  
Tumor Necrosis ◽  
Mononuclear Cells ◽  
Solid Cancer ◽  
Normal Individuals ◽  
The Relationship ◽  
Necrosis Factor

SummaryThe plasma level of interleukin-1β (IL-1β) was determined in normal individuals, patients with disseminated intravascular coagulation (DIC), patients in the pre-DIC period (within 7 days before the onset of DIC), and non-DIC patients to examine the relationship between DIC and the plasma ILlp level. The plasma IL-1β level was 0-0.085 ng/ml in normal individuals, with little difference being seen according to related age. It was significantly higher in the DIC group (0.19 ± 0.19 ng/ml) than in the pre-DIC group (0.05 ± 0.08 ng/ml) or the non-DIC group (0.09 ± 0.01 ng/ml). The plasma IL-1β level was not markedly elevated in leukemia patients, even in the DIC group, but it was significantly increased in the DIC group of solid cancer patients and was generally elevated in patients with sepsis. It was markedly elevated to 0.39 ± 0.26 ng/ml in patients with organ failure. When mononuclear cells were incubated with lipopolysaccharide, it was found that IL-1β, tumor necrosis factor, and tissue factor (TF) were released into the medium, and there was an increase of TF release from endothelial cells incubated with this medium. These results suggest that the increase in IL-Iβ reflected the activation of monocytes and may be an important factor in DIC and its associated organ failure.

Thirty-eight-negative-kinase-1 is a major mediator of trauma-induced intestinal injury and multi-organ failure

2018 ◽  
Vol 56 (08) ◽  
pp. e205-e206
Author(s):  
M Armacki ◽  
AK Trugenberger ◽  
A Ellwanger ◽  
T Eiseler ◽  
L Bettac ◽  
...  
Keyword(s):  
Organ Failure ◽  
Intestinal Injury ◽  
Multi Organ Failure ◽  
Major Mediator

NEUROLEPTIC MALIGNANT SYNDROME IN CHILDREN

2006 ◽  
Vol 37 (S 1) ◽  
Author(s):  
JW Miller-Horn ◽  
S Kumar ◽  
T Soman ◽  
DS Khurana ◽  
A Legido ◽  
...  
Keyword(s):  
Neuroleptic Malignant Syndrome

Clinical case of periostitis in pregnant women complicated by sepsis

2020 ◽  
pp. 61-63
Author(s):  
S. Sh. Kakvaeva ◽  
M. A. Magomedova ◽  
A. N. Dzhalilova
Keyword(s):  
Pregnant Woman ◽  
Multiple Organ Failure ◽  
Pregnant Women ◽  
Organ Failure ◽  
Clinical Case ◽  
Clinical Observation ◽  
Infectious Agent ◽  
Modern Medicine ◽  
Multiple Organ ◽  
Number Of Patients

One of the most serious problems of modern medicine is sepsis. The number of patients undergoing this complication is 20–30 million (WHO) annually and has no tendency to decrease. Sepsis is characterized by severe multiple organ failure due to a violation of the response of the macroorganism to an infectious agent. Moreover, it is dangerous with high mortality. Sepsis often develops in patients with immunodeficiency conditions, which primarily include pregnant women. The article presents a clinical observation of a case of periostitis in a pregnant woman complicated by a septic state.

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