Delirium in Acute Poisoning with 1,4-Butanediol and Its Correction

Delirium complicating regular use of psychoactive substances remains one of the major issues of critical care, toxicology, and psychiatry. However, the pathogenetic mechanisms of delirium development in patients with 1,4-butanediol poisoning have been poorly studied until now.The aim of the study was to reveal specific patterns of delirium in patients with 1,4-butanediol poisoning as well as to study the changes in systemic hemodynamic parameters, respiratory function, and body fluid compartments during the treatment.Material and methods. The study was prospective and treatment-randomized. Forty-eight male patients aged 20 to 45 years with delirium and acute 1,4-butanediol poisoning were enrolled. Of them, 24 patients were administered with succinate-containing drug 40 ml daily, 24 patients received standard treatment without antihypoxic agents. We studied the evolution of delirium, changes in anaerobic metabolism parameters, systemic hemodynamics, respiratory function, and the volume of fluid compartments. Impedance measurement method adjusted for interference was used in the study.Results. At the «peak» of delirium (days 1–3), the hyperdynamic circulation, increased systemic arterial tone, stroke output, respiratory function parameters, and metabolic lactate acidosis were recorded. A decrease in total fluid volume and extracellular fluid volume was clearly observed during day 1 of intoxication delirium along with increased permeability of cell membranes. On day 3 of delirium, a decrease in intracellular fluid volume and increase in extracellular fluid volume were noted. After the cytoflavin administration, shorter delirium duration (7.5 [6; 8] days), more rapid correction of lactate acidosis, stabilization of respiratory parameters and stabilization of cell membrane permeability by day 5 were found. In the control group, delirium persisted for up to 14 [11; 15] days (z=-5.9; P=0.00011) with more frequent development of complications such as nosocomial pneumonia (χ2=8.4, P<0.001).Conclusion. The severity of delirium in acute poisoning with 1,4-butanediol was associated with metabolic lactate acidosis, changes in systemic hemodynamics and pulmonary function. A positive effect of adjunctive antihypoxic therapy with succinate-containing agent on cardio-respiratory parameters, cell membrane permeability, water balance due to elimination of tissue hypoxia and prompt switching to tissue aerobic metabolism has been found.

Hyperlactatemia and lactate acidosis in the practice of pediatricians

Assessment of blood lactate / lactic acid levels by a General pediatrician is sometimes difficult. Lactate is a product of cellular metabolism of glucose, fatty acids, and some interchangeable amino acids. The norm of lactate in the blood is not defined by international standards, so it depends on the methodology and reagents used in the laboratory. The level of lactate in the blood is the result of an equilibrium between the processes of its formation and utilization. The leading causes of increased blood lactate are anaerobic muscle activity (heavy exercise, seizures), impaired liver and kidney function, lung and heart diseases (respiratory failure, circulatory failure), diabetes, sepsis, regional tissue circulatory disorders (burns and injuries), shocks, some severe abnormalities in the condition of newborns, mitochondrial diseases, and medications. Lactatacidosis is a rare dangerous complication caused by certain pathological conditions (diseases or syndromes), which can end in death. Identification of the cause of lactic acidosis and differential diagnosis of its type is a crucial factor for choosing a treatment strategy. Lactatacidotic coma in diabetes mellitus is a rare, but possible complication, that requires intensive complex treatment in intensive care units. The pediatrician should be able to assess the level of lactate in the blood, analyze the possible causes of hyperlactatemia, and know the algorithm of actions in the development of lactate acidosis.

Metabolic Ketoacidosis in a Gravida Diagnosed with COVID-19: A Case Report

We present a case of term pregnancy which presented with chief complaint of Breathlessness, chest pain as well as a one day history of vomiting. She tested positive for COVID19 through reverse transcriptase polymerase chain reaction of nasopharyngeal swab and the symptoms were attributed to Pneumonia caused due to COVID19.However,the arterial blood gas showed metabolic acidosis with high anion gap. This was a non lactate acidosis with no hypoxemia. Most reasonably the state of pregnancy with increased energy demands along with increased metabolic maternal demand due to infection coupled with maternal starvation had resulted in this Ketoacidosis . In view of non progression of labor caesarian section was carried out and a healthy neonate was delivered. There was an initial improvement in maternal ketoacidosis post partum however optimal management of COVID19 pneumonia required oxygen support and use of corticosteroids. Thus we highlight how an unusual metabolic demands of pregnancy might mimic COVID 19.

Perioperative Outcome in Dogs Undergoing Emergency Abdominal Surgery: A Retrospective Study on 82 Cases (2018–2020)

Emergency abdominal surgery carries high morbidity and mortality rates in human medicine; however, there is less evidence characterising the outcome of these surgeries as a single group in dogs. The aim of the study was to characterise the clinical course, associated complications and outcome of dogs undergoing emergency abdominal surgery. A retrospective study was conducted. Dogs undergoing emergency laparotomy were included in the study. Logistic regression analysis was performed to identify variables correlated with death and complications. Eighty-two dogs were included in the study. The most common reason for surgery was a gastrointestinal foreign body. Overall, the 15-day mortality rate was 20.7% (17/82). The median (range) length of hospitalisation was 3 (0.5–15) days. Of the 82 patients, 24 (29.3%) developed major complications and 66 (80.5%) developed minor complications. Perioperative factors significantly associated with death included tachycardia (p < 0.001), hypothermia (p < 0.001), lactate acidosis (p < 0.001), shock index > 1 (p < 0.001), leukopenia (p < 0.001) and thrombocytopenia (p < 0.001) at admission, as well as intraoperative hypotension (p < 0.001) and perioperative use of blood products (p < 0.001). The results of this study suggest that mortality and morbidity rates after emergency abdominal surgery in dogs are high.

The Clinical Case of Lactate-acidosis with Fatal Outcome in a Patient with 2 Type Diabetes

At the moment, lactate-acidosis coma in patients with diabetes mellitus is considered a rare and extremely urgent condition that occurs in patients with concomitant diseases as well as when taking the most widely used sugar reducing drug – metformin. This article describes a case of lactate-acidosis coma with a fatal outcome, which occurred against the background of taking metformin and alcohol abuse, in a woman with type 2 dia-betes mellitus aged 48 years.

Parenteral glucose supply and pharmacological glycolysis inhibition determine the clinical fate of infected preterm newborns

Preterm infants are susceptible to bloodstream infection that can lead to sepsis. High parenteral glucose supplement is commonly used to support their growth and energy expenditure, but may exceed endogenous regulation during infection, causing dysregulated immune response and clinical deterioration. Using a preterm piglet model of neonatal sepsis induced by Staphylococcus epidermidis infection, we demonstrate the delicate interplay between immunity and energy metabolism to regulate the host infection response. Circulating glucose levels, glycolysis and inflammatory response to infection are closely connected across the states of tolerance, resistance and immunoparalysis. Further, high parenteral glucose provision during infection induces hyperglycemia, elevated glycolysis and inflammation, leading to lactate acidosis and sepsis, whereas glucose restricted individuals are clinically unaffected with increased gluconeogenesis to maintain moderate hypoglycemia. Finally, pharmacological glycolysis inhibition during normoglycemia enhances bacterial clearance and dampens inflammation but fails to prevent sepsis. Our results uncover how blood glucose controls immune cell metabolism and function, in turn determining the clinical fate of infected preterm neonates. This also questions the current practice of parenteral glucose supply for infected preterm infants.

Perioperative Outcome in Dogs Undergoing Emergency Abdominal Surgery: A Retrospective Study on 82 Cases (2018-2020)

Emergency abdominal surgery carries high morbidity and mortality rates in human medicine; however, there is less evidence characterizing the outcome of these surgeries as a single group in dogs. The aim of the study was to characterize the clinical course, associated complications and outcome of dogs undergoing emergency abdominal surgery. A retrospective study was conducted. Dogs undergoing emergency laparotomy were included in the study. Logistic regression analysis was performed to identify variables correlated with death and complications. Eighty-two dogs were included in the study. The most common reason for surgery was gastrointestinal foreign body. Overall 15-day mortality rate was 20.7% (17/82). Median (range) length of hospitalization was 3 (0.5 - 15) days. Of the 82 patients, 24 (29.3%) developed major complications and 66 (80.5%) minor complications. Perioperative factors significantly associated with death included tachycardia (P &amp;lt; 0.001), hypothermia (P &amp;lt; 0.001), lactate acidosis (P &amp;lt; 0.001), shock index &amp;gt; 1 (P &amp;lt; 0.001), leukopenia (P &amp;lt; 0.001), thrombocytopenia (P &amp;lt; 0.001) at admission; intraoperative hypotension (P &amp;lt; 0.001) and perioperative use of blood products (P &amp;lt; 0.001). The results of this study suggest that mortality and morbidity rates after emergency abdominal surgery in dogs are high.

The Effect of Thiamine Supplementation for Critically Septic Patient: An Evidence-Based Case Report

Sepsis has been accounted for various burdens worldwide, especially in critically ill patients. This could eventually lead to inflammatory response, provocation ischemia and lactic acidosis. On the other hand, thiamine was suggested as a coenzyme which could improve the outcome of those patients. Thus, we conducted an evidence-based case study with research on PubMed, ProQuest, and Scopus using a search strategy focusing on RCT or cohort study on thiamine supplementation/level towards the outcome of critically ill patients with sepsis. We found three articles eligible for review after full-text assessment. Articles were appraised using the University of Oxford’s tools for critical appraisal. It was known that all studies were good in terms of validity and applicability. This study showed that thiamine supplementation could improve lactate clearance and reduce mortality risk, moreover, thiamine deficiency could increase the risk of lactate acidosis. However, a high level of thiamine was associated with a high level of lactate in patients with liver failure. Therefore, thiamine supplementation could be recommended for critically ill patients with sepsis and normal liver function. Further research, such as RCT or systematic review on thiamine supplementation for age groups to make this study more applicable.