scholarly journals A Case Report: Diabetic Ketoacidosis in Patient with type 1 Diabetes Mellitus with Complication Septic Shock and AKI Stage III on HD Triggered by Perianal Abscess

2021 ◽  
Vol 1 (1) ◽  
pp. 26-30
Author(s):  
Muhammad Ikhsan Kartawinata ◽  
Yusni Puspita
Keyword(s):  
Diabetes Mellitus ◽  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Diabetic Ketoacidosis ◽  
Perianal Abscess ◽  
Electrolyte Imbalance ◽  
Source Control ◽  
Undiagnosed Diabetes ◽  
High Glucose Level

Introduction. Diabetic ketoacidosis (DKA) is an acute, life-threatening complication in diabetes mellitus. Infection is a common precipitating cause of diabetic ketoacidosis (DKA) in known diabetic patient, and diabetic ketoacidosis (DKA) often presents as the first symptom of an undiagnosed diabetes. diabetic ketoacidosis (DKA) is diagnosed with combination of hyperglicaemia, acidosis metabolic and ketonuria. Case Presentation. A 27 years old male patient, admitted to Intensive Care Unit with decrease level of consciousness (GCS 3), he was intubated and present with respiratory distress, metabolic acidosis, high glucose level, ketonuria with renal failure as a target organ. Patient known has perianal abscess as a triggered of diabetic ketoacidosis (DKA), turn into septic shock and underwent debridement surgery to source control the infection. The patient was treated in intensive care unit for 9 days, and sent to ward with GCS 15 an no sequelae of organ failure. The treatment of diabetic ketoacidosis (DKA) should include correcting the often substantial hypovolemia, the hyperglycemia, electrolyte imbalance and the triggering factor of diabetic ketoacidosis (DKA). Conclusion. Prompt surgical intervention, antibacterial therapy, rapid restoration of glycemic control are crucial to prevent mortality in diabetes mellitus patients complicated with abscess.

scholarly journals A Case Report : Diabetic Ketoacidosis in patient with type 1 Diabetes Mellitus with Complication Septic Shock and AKI Stage III on HD Triggered by Perianal Abscess

2020 ◽  
Vol 1 (1) ◽  
pp. 26-30
Author(s):  
Muhammad Ikhsan Kartawinata ◽  
Yusni Puspita
Keyword(s):  
Diabetes Mellitus ◽  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Diabetic Ketoacidosis ◽  
Perianal Abscess ◽  
Electrolyte Imbalance ◽  
Source Control ◽  
Undiagnosed Diabetes ◽  
High Glucose Level

ABSTRACT Introduction. Diabetic ketoacidosis (DKA) is an acute, life-threatening complication in diabetes mellitus. Infection is a common precipitating cause of diabetic ketoacidosis (DKA) in known diabetic patient, and diabetic ketoacidosis (DKA) often presents as the first symptom of an undiagnosed diabetes. diabetic ketoacidosis (DKA) is diagnosed with combination of hyperglicaemia, acidosis metabolic and ketonuria. Case Presentation. A 27 years old male patient, admitted to Intensive Care Unit with decrease level of consciousness (GCS 3), he was intubated and present with respiratory distress, metabolic acidosis, high glucose level, ketonuria with renal failure as a target organ. Patient known has perianal abscess as a triggered of diabetic ketoacidosis (DKA), turn into septic shock and underwent debridement surgery to source control the infection. The patient was treated in intensive care unit for 9 days, and sent to ward with GCS 15 an no sequelae of organ failure. The treatment of diabetic ketoacidosis (DKA) should include correcting the often substantial hypovolemia, the hyperglycemia, electrolyte imbalance and the triggering factor of diabetic ketoacidosis (DKA). Conclusion. Prompt surgical intervention, antibacterial therapy, rapid restoration of glycemic control are crucial to prevent mortality in diabetes mellitus patients complicated with abscess.

scholarly journals Characteristics of Acute Kidney Injury in the Intensive Care Unit of Dr. Soetomo General Hospital, Surabaya

2021 ◽  
Vol 5 (3) ◽  
pp. 96-99
Author(s):  
Putu Laksmi Febriyani ◽  
Bambang Pujo Semedi ◽  
Widodo Widodo
Keyword(s):  
Diabetes Mellitus ◽  
Intensive Care Unit ◽  
Septic Shock ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Kidney Injury ◽  
Developed Countries ◽  
Primary Diagnosis ◽  
Exposure Factor ◽  
Age Range

Acute Kidney Injury (AKI) is one of the causes of morbidity and mortality among people in both developing and developed countries in the intensive care unit (ICU). In Indonesia, the incidence rate is 0.2% while for the Surabaya, AKI research has not been widely carried out and published. This study aims to determine the characteristics of AKI patients in ICU of Dr. Soetomo hospital covers the data distribution of sociodemographic, risk factors, and mortality. This descriptive study involving 23 inpatients at the ICU with AKI as the sample. Samples were selected using total sampling method. Data were collected from medical records with data collection sheets. The results were then analyzed descriptively and tested bivariate using logistic regression. The results showed that 82.6% of the patients were male with the highest age range of 50-56 years old (30.43%). AKI mortality rate in the intensive care unit was 30.43%. The primary diagnosis was diabetes mellitus (34.78%) and the highest exposure factor was a septic shock (38.70%). Factors associated with AKI mortality were diabetes mellitus (p = 0.000) and exposure to septic shock (p = 0.005). Keywords: acute kidney injury; intensive care unit

Fatores de Risco Associados à Mortalidade em Pacientes com Sepse Grave e Choque Séptico na Unidade de Terapia Intensiva de um Hospital Escola do Sul de Minas Gerais/Risk Factors Associated with Mortality in Patients with Severe Sepsis and Septic Shock in

1970 ◽  
Vol 1 (1) ◽  
pp. 72-77
Author(s):  
Nilo César do Vale Baracho ◽  
Gisela Ferraz Lopes ◽  
Thales Duca Araujo ◽  
Thomas Buissa ◽  
Wagner Kendy Yano
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Intensive Care Unit ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Intensive Care ◽  
Minas Gerais ◽  
Factors Associated ◽  
Terapia Intensiva ◽  
Sepsis And Septic Shock

Introdução: A sepse é uma síndrome clínica de resposta inflamatória sistêmica secundária a um processo infeccioso. Sepse grave e Choque Séptico compreendem suas formas mais graves. Representa a principal causa de morte nas Unidades de Terapia Intensiva (UTIs) em todo o mundo. Os preditores de evolução e mortalidade vêm sendo estudados e aplicados, tanto para definir o melhor gerenciamento de recursos financeiros e alterar a conduta terapêutica, quanto para monitorar o desempenho da UTI. Objetivos: Determinar e relacionar os fatores de risco a mortalidade em pacientes com sepse grave e choque séptico internados na Unidade de Terapia Intensiva de um Hospital Escola do Sul de Minas Gerais. Métodos: O estudo foi do tipo caso-controle aninhado a uma coorte prospectiva e observacional, onde foram incluídos pacientes que apresentavam sepse grave ou choque séptico, no período de 30 de julho de 2005 a 30 de junho de 2009. A análise foi realizada com auxílio do programa Minitab versão 15. Foi utilizado o teste de Qui-quadradode Pearson para associação das variáveis categóricas, sendo rejeitada a independência destas, quando p > 0,05. Resultados: O estudo abrangeu 167 pacientes. Após analise estatística, obteve-se que a maioria dos pacientes sépticos que evoluíram a óbito eram homens, idosos, com comorbidades, que ficaram internados por menos de 72h e tiveram o trato respiratório como principal origem da doença. Conclusão: Os parâmetros associados à maior mortalidade foram a idade do individuo, o órgão de origem da sepse, presença de diabetes mellitus e hipertensão arterial.Risk Factors Associated with Mortality in Patients with Severe Sepsis and Septic Shock in Intensive Care Unit of a Hospital School of Southern Minas GeraisIntroduction: Sepsis is a clinical syndrome of systemic inflammatory response secondary to a infection.  Severe sepsis and septic shock are the most severe forms. It represents the main cause of death in Intensive Care Unit (ICU) patients worldwide. The predictors of mortality and prognosis has been studied to set a better management of financial resources and change the therapeutic, as for to control the development of ICU. Objectives: Establish and  make relations of the risk factors to the mortality in patients who were diagnosed with severe sepsis and septic  shock  hospitalized in a ICU of a Hospital in South of Minas Gerais. Methods: The study is a case-control type made with a foresight and observational coorte, which were included patients with  severe sepsis and septic shock, by the period between June 30th of 2005 to June 30th of 2009. The analysis was made using the program Minitab version 15. It was used the Qui-Quadrado of Pearson test to make associations of the categorical variables, not considering those, when p>0,05. Results: the study encompassed 167 patients. After statistic analysis, it was concluded that  most of septic patients who died were elderly males with co morbidities that were hospitalized less than 72 hours and had as the main infection focus the Respiratory System. Conclusion: The most important items associated with the mortality were the patient’s age, septic original organ, the presence of Diabetes Mellitus and Hypertension.  

scholarly journals Pediatric infection and sepsis in five age subgroups: single-center registry

2020 ◽  
Author(s):  
Michael M. Hermon ◽  
Theresa Etmayr ◽  
Jennifer Bettina Brandt ◽  
Kambis Sadeghi ◽  
Gudrun Burda ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Treatment Options ◽  
Survival Rates ◽  
Treatment Strategies ◽  
Pediatric Intensive Care ◽  
Source Control ◽  
Pediatric Sepsis ◽  
Sepsis And Septic Shock

Summary Background Sepsis is, worldwide, one of the leading causes of death among infants and children. Over the past two decades, mortality rates have declined due to advanced treatment options; however, the incidence of sepsis and septic shock is still on the rise in many hospital settings. The objective of this study was to evaluate the course of this disease in pediatric intensive care patients. Methods An evaluation of pediatric patients in the intensive care unit diagnosed with infections or sepsis between 2005 and 2015 was performed via a retrospective exploratory data analysis. Results During the observational period, 201 patients were diagnosed with infection or sepsis. The study population was divided into five age subgroups. The majority of patients were newborns, infants, and toddlers. Forty percent had sepsis; 6% had septic shock. Viral infection was the most prevalent (59%). The overall survival rate was 83%; newborns and adolescents had the lowest survival rates. Conclusion With this registry, children divided into five age subgroups with infection or sepsis were evaluated and treatment strategies were examined. We have shown that our findings on children treated in our pediatric intensive care unit conform with current literature about pediatric sepsis. In addition to maintaining strict hygiene standards, optimal aspects of sepsis care should be stringently observed, such as the quick administration of empirical broad-spectrum antibiotics, initial adequate fluid resuscitation, and a reliable and frequent routine of source control.

scholarly journals Mortality rates in pediatric septic shock

2017 ◽  
Vol 56 (5) ◽  
pp. 304 ◽  
Author(s):  
Desy Rusmawatiningtyas ◽  
Nurnaningsih Nurnaningsih
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Mortality Rate ◽  
Fluid Overload ◽  
Pediatric Intensive Care ◽  
Developed Countries ◽  
Mortality Rates ◽  
Study Cohort ◽  
Survival Group

Background Septic shock remains a major cause of morbidity and mortality in children admitted to the intensive care unit. Recent investigations from developed countries have reported mortality rates of 20-30%. Few studies have reported mortality rates from pediatric septic shock in intensive care settings in developing countries with limited resources.  Objective  To determine the current mortality rates for pediatric patients with septic shock in a developing country.Methods A retrospective study was conducted in the Pediatric Intensive Care Unit (PICU) at DR. Sardjito General Hospital. Medical records and charts were reviewed and recorded for diagnoses of septic shock, from November 1st, 2011 to June 30th, 2014. Results  A database of all PICU admissions was assembled, and cases with diagnoses of septic shock were reviewed. The final data consisted of 136 patients diagnosed with septic shock. Septic shock was defined as a clinical suspicion of sepsis, manifested by hyperthermia or hypothermia, and accompanied by hypoperfusion  The overall mortality rate for the study cohort was 88.2%.  The median age of patients was 16 months, with 52.2% males. Median initial PRISM III and PELOD scores were 10 and 22, respectively. The median length of PICU stay was 4 days. A total of 48.5% of the subjects were in need of crystalloid and colloid fluid at a median amount of 40 mL/kg. The median time required to complete the initial resuscitation was 60 minutes. Mechanical ventilator support in the first 24 hours was required in 79.4% of the cases. Fluid overload of > 10% (FO>10%) was found in 58.8% of the subjects.Conclusion The mortality rate in pediatric septic shock in our hospital is very high. There is a higher incidence of fluid overload in the non-survival group .

scholarly journals Relationship between the presence of dedicated doctors in rapid response systems and patient outcome: a multicenter retrospective cohort study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Hyung-Jun Kim ◽  
Kyeongman Jeon ◽  
Byung Ju Kang ◽  
Jong-Joon Ahn ◽  
Sang-Bum Hong ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Propensity Score ◽  
Intensive Care Unit Admission ◽  
Hazard Ratio ◽  
Rapid Response ◽  
Admission Rates ◽  
Rapid Response Systems ◽  
Response Systems

Abstract Background Rapid response systems (RRSs) improve patients’ safety, but the role of dedicated doctors within these systems remains controversial. We aimed to evaluate patient survival rates and differences in types of interventions performed depending on the presence of dedicated doctors in the RRS. Methods Patients managed by the RRSs of 9 centers in South Korea from January 1, 2016, through December 31, 2017, were included retrospectively. We used propensity score-matched analysis to balance patients according to the presence of dedicated doctors in the RRS. The primary outcome was in-hospital survival. The secondary outcomes were the incidence of interventions performed. A sensitivity analysis was performed with the subgroup of patients diagnosed with sepsis or septic shock. Results After propensity score matching, 2981 patients were included per group according to the presence of dedicated doctors in the RRS. The presence of the dedicated doctors was not associated with patients’ overall likelihood of survival (hazard ratio for death 1.05, 95% confidence interval [CI] 0.93‒1.20). Interventions, such as arterial line insertion (odds ratio [OR] 25.33, 95% CI 15.12‒42.44) and kidney replacement therapy (OR 10.77, 95% CI 6.10‒19.01), were more commonly performed for patients detected using RRS with dedicated doctors. The presence of dedicated doctors in the RRS was associated with better survival of patients with sepsis or septic shock (hazard ratio for death 0.62, 95% CI 0.39‒0.98) and lower intensive care unit admission rates (OR 0.53, 95% CI 0.37‒0.75). Conclusions The presence of dedicated doctors within the RRS was not associated with better survival in the overall population but with better survival and lower intensive care unit admission rates for patients with sepsis or septic shock.

scholarly journals Study of effect of serum magnesium concentration on clinical outcome of critically sick patients in medical intensive care unit

2021 ◽  
Vol 8 (12) ◽  
pp. 1812
Author(s):  
Ganedi S. Kumari
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Serum Magnesium ◽  
Ventilatory Support ◽  
Magnesium Level ◽  
Cardiac Insufficiency ◽  
Electrolyte Imbalance ◽  
Magnesium Concentration ◽  
Ventilator Support ◽  
Male Predominance

Background: Deficiency of magnesium is common and often ignored. It is associated with cardiac irregularity, cardiac insufficiency, seizure and electrolyte imbalance. As this element has multiple functions in our body it is important in the pathophysiology of several critical illnesses in intensive care unit (ICU). Hence the present study was undertaken to determine the usefulness of admission serum magnesium levels with regards to patient outcome considering mortality, need and duration of ventilator support, and acute physiologic assessment and chronic health evaluation 2 (APACHE 2) score.Methods: Demographic data such as age and sex were recorded. Patients were assessed for presenting complaints, history of other diseases and habits through an interview with the patients or care giver. These findings were recorded on a predesigned proforma patients was followed up for the outcomes such as mortality, need of ventilator support, duration of ICU stay and APACHE 2 score.Results: Regarding comparison between outcome of patients between two groups, 44% patients with magnesium level <1.7 mg/dl have improved and 72% patient didn’t improve. 44% patients with magnesium level >1.7 mg/dl have improved and 28% patient didn’t improve.Conclusions: From present observational study we can conclude that hypomagnesaemia is more common in patients more than 50 years of age and with male predominance. Pneumonia with septicaemia and cerebrovascular accident (CVA) was commonly associated with hypomagnesaemia. In present study we have observed that hypomagnesaemia is associated with high APACHE 2 score, poor outcome and more requirement of ventilatory support.

scholarly journals Use of Gentamicin for Sepsis and Septic Shock in Anaesthesia-Intensive Care Unit: A Clinical Practice Evaluation

2020 ◽  
Vol 48 (5) ◽  
pp. 399-405
Author(s):  
Cyril Pernod ◽  
◽  
Antoine Lamblin ◽  
Andrei Cividjian ◽  
Patrick Gerome ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Clinical Practice ◽  
Sepsis And Septic Shock
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