LATE ONSET OHSS AND PREGNANCY OUTCOME: A CASE REPORT

Ovulation induction has been an important mode of treatment of infertility.Ovarian stimulation may result in a supraphysiologic response leading to an iatrogenic complication known as the ovarian hyperstimulation syndrome(OHSS) . This syndrome is a potentially lethal condition,the pathophysiologic hallmark of which is the accumulation of massive extravascular exudate combined with profound intravascular volume depletion and hemoconcentration.we report a case of severe OHSS with very large ovaries in a 38yr old case of G2A1 with 4weeks 5days GA ,ICSI conception with TCTA triplets presented to the emergency department with abdominal pain,ascites and respiratory distress . The patient was managed symptomatically with no complications. Although ovarian hyperstimulation is a rare entity ,it is important that the physician recognizes this condition.prompt diagnosis and successful management is likely to avoid serious and rapid development of complications.

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OVARIAN HYPERSTIMULATION SYNDROME;

The Professional Medical Journal ◽

10.29309/tpmj/2014.21.03.2146 ◽

2014 ◽

Vol 21 (03) ◽

pp. 580-582

Author(s):

ASMA Batool ◽

Saima Perveen ◽

Mussarat Sultana

Keyword(s):

Abdominal Pain ◽

Ovulation Induction ◽

Ovarian Hyperstimulation Syndrome ◽

Ovarian Hyperstimulation ◽

Rare Entity ◽

Ovulatory Cycle ◽

Successful Management ◽

Multiple Gestations ◽

Prompt Diagnosis ◽

Ovarian Syndrome

It is known that most cases of Ovarian Hyperstimulation Syndrome (OHSS) areassociated with the therapies for ovulation induction. However, OHSS may rarely be associatedwith a spontaneous ovulatory cycle, usually in the case of multiple gestations, hypothyroidism orpolycystic ovarian syndrome. We report a case of moderate OHSS in spontaneously conceivedtwin pregnancy in a 24 years old woman. The clinical picture showed amenorrhea,nausea,vomiting, abdominal pain and moderate ascites. After examinations, imaging and laboratoryinvestigations, the diagnosis was established. The patient was managed expectantly with nocomplications. Although spontaneous ovarian hyperstimulation is a rare entity, it is important thatthe physician recognizes this condition. Prompt diagnosis and successful management is likelyto avoid serious complications, which may develop rapidly.

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Pyloric Stenosis

10.1093/med/9780190226459.003.0083 ◽

2017 ◽

Author(s):

John J. Freely Jr ◽

Michel Sabbagh

Keyword(s):

Pyloric Stenosis ◽

Perioperative Care ◽

Outlet Obstruction ◽

Definitive Treatment ◽

Current Evidence ◽

Anesthetic Technique ◽

Intravascular Volume ◽

Volume Depletion ◽

Young Infants ◽

Intravascular Volume Depletion

Pyloric stenosis is one of the most common surgical conditions affecting neonates and young infants. Hypertrophy of the pyloric muscular layers results in gradual gastric outlet obstruction. Persistent episodic projectile vomiting and dehydration as well as hypochloremic, hypokalemic metabolic alkalosis are cardinal features. Definitive treatment is surgical pyloromyotomy, but it is not a surgical emergency. Emergency medical intervention is often required to correct intravascular volume depletion and electrolyte disturbances. Morbidity and mortality should be limited due to advancements in surgical and perioperative care. Morbidity can occur due to poor preoperative resuscitation, anesthetic management difficulties, or postoperative complications. The following manuscript is a review of current evidence-based perioperative care of infants with pyloric stenosis. It reviews the pathophysiology that results in metabolic disturbances and intravascular volume depletion. It focuses on preoperative assessment and correction of electrolyte abnormalities and anesthetic technique including airway management and postoperative analgesia.

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Defining the role of albumin infusion in cirrhosis-associated hyponatremia

AJP Gastrointestinal and Liver Physiology ◽

10.1152/ajpgi.00424.2013 ◽

2014 ◽

Vol 307 (2) ◽

pp. G229-G232 ◽

Cited By ~ 7

Author(s):

Minhtri K. Nguyen ◽

Vahram Ornekian ◽

Liyo Kao ◽

Anthony W. Butch ◽

Ira Kurtz

Keyword(s):

Sodium Concentration ◽

Albumin Concentration ◽

Intravascular Volume ◽

Volume Depletion ◽

Vitro Assay ◽

Albumin Infusion ◽

Donnan Equilibrium ◽

Intravascular Volume Depletion

The presence of negatively charged, impermeant proteins in the plasma space alters the distribution of diffusible ions in the plasma and interstitial fluid (ISF) compartments to preserve electroneutrality and is known as Gibbs-Donnan equilibrium. In patients with hypoalbuminemia due to underlying cirrhosis, the decrease in the plasma water albumin concentration ([Alb−]pw) would be expected to result in a decrease in the plasma water sodium concentration ([Na+]pw) due to an alteration in the distribution of Na+ between the plasma and ISF. In addition, cirrhosis-associated hyponatremia may be due to the renal diluting defect resulting from the intravascular volume depletion due to gastrointestinal losses and overdiuresis and/or decreased effective circulatory volume secondary to splanchnic vasodilatation. Therefore, albumin infusion may result in correction of the hyponatremia in cirrhotic patients either by modulating the Gibbs-Donnan effect due to hypoalbuminemia or by restoring intravascular volume in patients with intravascular volume depletion due to gastrointestinal losses and overdiuresis. However, the differential role of albumin infusion in modulating the [Na+]pw in these patients has not previously been analyzed quantitatively. In the present study, we developed an in vitro assay system to examine for the first time the quantitative effect of changes in albumin concentration on the distribution of Na+ between two compartments separated by a membrane that allows the free diffusion of Na+. Our findings demonstrated that changes in [Alb−]pw are linearly related to changes in [Na+]pw as predicted by Gibbs-Donnan equilibrium. However, based on our findings, we predict that the improvement in cirrhosis-associated hyponatremia due to intravascular volume depletion results predominantly from the restoration of intravascular volume rather than alterations in Gibbs-Donnan equilibrium.

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Usefulness of non-invasive cardiac output monitoring in elderly patients undergoing monopolar transurethral resection of the prostate: a pilot study

Journal of International Medical Research ◽

10.1177/0300060520922422 ◽

2020 ◽

Vol 48 (5) ◽

pp. 030006052092242

Author(s):

Hae Keum Kil ◽

In Kyeong Park ◽

Min Sup Song ◽

Jin Ha Park

Keyword(s):

Cardiac Output ◽

Cardiac Index ◽

Elderly Patients ◽

Transurethral Resection ◽

Cardiac Output Monitoring ◽

Intravascular Volume ◽

Volume Depletion ◽

Non Invasive ◽

Intravascular Volume Depletion ◽

Output Monitoring

Objective To assess the impact of irrigating fluid on hemodynamic profiles using real-time non-invasive cardiac output monitoring (NICOM) in elderly patients undergoing monopolar transurethral resection of the prostate (TURP). Methods Twenty patients between 65 and 80 years of age who were scheduled for monopolar TURP and received spinal anesthesia up to T10 were enrolled. Irrigating fluid (2.7% sorbitol with 0.5% mannitol solution) was used. Hemodynamic profiles including cardiac index, and stroke volume variation (SVV) using NICOM were obtained. Estimated irrigating fluid absorption was indirectly calculated. Results The median amount of irrigating fluid used was 6000 mL. The median SVV was 11%, which increased to 12% at 10 minutes after initiating surgery. No significant changes in the cardiac index were observed. The estimated absorption of irrigating fluid was almost zero. Conclusions Although the estimated amount of irrigating fluid that was absorbed was negligible, the increase in SVV may indicate intravascular volume depletion with diuresis resulting from mannitol in the irrigating fluid early during irrigation. Therefore, even during short irrigating times, intensive hemodynamic monitoring should be performed to monitor the possibility of intravascular volume depletion as well as volume overload, especially immediately after large amounts of irrigating fluid are used.

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Intravascular Volume Depletion in a 24-Hour Porcine Model of Intra-abdominal Hypertension

Journal of Trauma and Acute Care Surgery ◽

10.1097/01.ta.0000042020.09010.d7 ◽

2003 ◽

Vol 55 (4) ◽

pp. 734-740 ◽

Cited By ~ 56

Author(s):

Alexander Schachtrupp ◽

Juergen Graf ◽

Christian Tons ◽

Joerg Hoer ◽

Volker Fackeldey ◽

...

Keyword(s):

Porcine Model ◽

Intravascular Volume ◽

Volume Depletion ◽

Abdominal Hypertension ◽

Intravascular Volume Depletion

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Salt appetite and intravascular volume depletion following colloid dialysis in hamsters

Behavioral and Neural Biology ◽

10.1016/s0163-1047(82)91436-4 ◽

1982 ◽

Vol 34 (1) ◽

pp. 75-88 ◽

Cited By ~ 6

Author(s):

Douglas A. Fitts ◽

Eric S. Corp ◽

John B. Simpson

Keyword(s):

Salt Appetite ◽

Intravascular Volume ◽

Volume Depletion ◽

Intravascular Volume Depletion

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DYNASCENE: An Approach to Computer-Based Intelligent Cardiovascular Monitoring Using Sequential Clinical “Scenes”

Methods of Information in Medicine ◽

10.1055/s-0038-1634774 ◽

1990 ◽

Vol 29 (02) ◽

pp. 122-131 ◽

Cited By ~ 23

Author(s):

A. I. Cohnl ◽

S. Rosenbauml ◽

M. Factor ◽

P. L. Millerl

Keyword(s):

Parallel Programming ◽

Hemodynamic Monitoring ◽

Intravascular Volume ◽

Cardiovascular Monitoring ◽

Volume Depletion ◽

Natural Approach ◽

Temporal Relationships ◽

Intravascular Volume Depletion ◽

Computer Based

AbstractHemodynamic abnormalities such as hypovolemia typically progress through a sequence of discrete clinical phases or “scenes” (e. g., intravascular volume depletion, vasoconstriction, hypotension). Each scene can be defined by a cluster of hemodynamic trends. A natural approach to modeling the process of hemodynamic monitoring involves identifying these scenes and the temporal relationships among them. This approach has been utilized in the development of DYNASCENE, a parallel programming implementation of a computer-based intelligent hemodynamic monitor. This paper discusses: (1) The rationale for utilizing sequential clinical scenes to represent knowledge of hemodynamic behavior, (2) the design of the DYNASCENE system, and (3) preliminary tests of the DYNASCENE system.

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Fluid Resuscitation in Sepsis: Reexamining the Paradigm

BioMed Research International ◽

10.1155/2014/984082 ◽

2014 ◽

Vol 2014 ◽

pp. 1-9 ◽

Cited By ~ 6

Author(s):

Poorna Madhusudan ◽

Bharath Kumar Tirupakuzhi Vijayaraghavan ◽

Matthew Edward Cove

Keyword(s):

Fluid Resuscitation ◽

Inflammatory Responses ◽

Organ Injury ◽

Intravascular Volume ◽

Myocardial Depression ◽

Volume Depletion ◽

The Past ◽

Intravascular Volume Depletion ◽

Current Concerns ◽

Surrounding Fluid

Sepsis results in widespread inflammatory responses altering homeostasis. Associated circulatory abnormalities (peripheral vasodilation, intravascular volume depletion, increased cellular metabolism, and myocardial depression) lead to an imbalance between oxygen delivery and demand, triggering end organ injury and failure. Fluid resuscitation is a key part of treatment, but there is little agreement on choice, amount, and end points for fluid resuscitation. Over the past few years, the safety of some fluid preparations has been questioned. Our paper highlights current concerns, reviews the science behind current practices, and aims to clarify some of the controversies surrounding fluid resuscitation in sepsis.

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