Medizinische Klinik, Intensivmedizin und Notfallmedizin
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Endocrine emergencies during pregnancy can become life-threatening for both mother and fetus. In addition to some pregnancy-linked endocrine disorders, several pre-existing forms of endocrinopathy, such as Grave's disease, type 1 diabetes and adrenal insufficiency might deteriorate acutely during pregnancy. ⋯ Laboratory tests are subject to altered physiological ranges and pharmacological options are limited while therapeutic goals are stricter than in the non-pregnant patient. This article focuses on endocrine emergencies complicating pregnancy.
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Med Klin Intensivmed Notfmed · Mar 2012
Review[Cardiopulmonary emergencies during pregnancy and the postpartum period].
The number of patients who develop cardiac problems during pregnancy are increasing and represent to date the major cause of maternal death in western countries. Pregnancy induces several changes which together increase the hemodynamic burden on the cardiovascular system and can also cause a prothrombotic state. ⋯ Due to potential fetal harm conventional diagnostic and therapeutic approaches are limited by the restricted use of radiogenic cardiac imaging and applicable medications. Therefore, knowledge about available therapeutic options is of greatest importance, since guideline recommendations have clearly been demonstrated to reduce morbidity and mortality in acute cardiac emergencies during pregnancy.
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Medical emergencies in pregnant patients pose a great challenge. Due to a lack of experience many emergency care providers are uncertain about which drugs can be used and the dosage. The following article reviews the physiological changes during pregnancy, general considerations about pharmacotherapy in pregnant patients and highlights typical emergency scenarios with the corresponding recommendations for which drugs to use in pregnant patients.
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Med Klin Intensivmed Notfmed · Mar 2012
Review[Preeclampsia and HELLP syndrome as an obstetric emergency].
Preeclampsia and HELLP syndrome are multisystemic hypertensive disorders in pregnancy. A causative treatment is not yet available. ⋯ In this scenario a good interdisciplinary cooperation between obstetricians and intensive care physicians ensures an optimal outcome for the pregnant woman. This article gives an insight into both diseases and the clinical management.
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Acute kidney injury plays a pivotal role in intensive care medicine and exerts crucial adverse effects on the course of the disease and overall prognosis of the critically ill patient. Intensive renal support, including initiation of earlier dialysis or maximal uremic toxin removal by higher dosage and frequency of renal replacement therapy, and individualized selection of modality were not able to decrease excessive mortality in this population. Systemic acute inflammation, mediated, at least in part, by cytokines, and not secondary uremic side effects, seems to have a major impact on nonrenal organ damage. ⋯ The overall survival at 5 years in patients discharged alive after severe acute kidney injury necessitating renal replacement therapy is only 20-30%, comparable to cancer patients. In addition, acute renal damage was identified as an independent risk factor for progression of chronic renal insufficiency. Current research focuses on strategies for the prevention of acute kidney injury and on the establishment of effective biomarkers for the early recognition and accurate diagnosis of subclinical renal damage.