Ugeskrift for laeger
-
Ugeskrift for laeger · Apr 2013
Review[Central venous oxygen saturation as a resuscitation goal for patients with severe sepsis should be examined closely].
Fluids, vasopressors and inotropics are mainstays in the initial treatment of sepsis. Consensus guidelines recommend a central venous oxygen saturation (ScvO(2)) larger than 69% as a resuscitation goal for sepsis treatment. Several studies demonstrate that many patients with sepsis have normal or higher ScvO(2) and this may lead to inappropriate use of vasopressors or inotropics when the patient is still in need of fluid. We discuss the (patho)physiology of ScvO(2) in sepsis and propose individualized fluid therapy based on optimization of cardiac preload, e.g. by establishing a maximal ScvO(2).
-
Ugeskrift for laeger · Apr 2013
Case Reports[Twiddler's syndrome as the cause of pacemaker electrode displacement].
Twiddler's syndrome is a rare cause of pacemaker electrode displacement. The displacement is caused by the patient's manipulation with the pacemaker, so the electrode is retracted. ⋯ Age and overweight are known risk factors for twiddler's syndrome; and in this case the patient's psychiatric habitus was probably an additional risk factor. Before performing a pacemaker implantation it is important to take the patient's risk factors into account, and thus consider submuscular implantation.
-
Ugeskrift for laeger · Apr 2013
Review[Diagnostics and treatment of Wernicke-Korsakoff syndrome patients with an alcohol abuse].
Wernicke-Korsakoff syndrome is a condition with high morbidity and mortality and occurs as a consequence of thiamine deficiency. Clinical symptoms are often ambiguous and post-mortem examinations show that the syndrome is underdiagnosed and probably undertreated. There is sparse clinical evidence concerning optimal dosage and duration of treatment. This article reviews the current literature and concludes that all patients with a history of alcohol abuse should be treated with high dosage IV thiamine for an extended period of time, albeit further research is needed.