Intensive care medicine
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Intensive care medicine · Jan 1986
Case ReportsHypophosphatemia and acute respiratory failure in a diabetic patient.
A previously healthy 48-year-old male developed diabetic ketoacidosis and severe hypophosphatemia. Within a few hours, acute respiratory insufficiency developed with a marked discrepancy between the pulmonary pathology and the very poor oxygenation seen. We argue that this was due to the effect of hypophosphatemia on respiratory muscle- and heart function and P50, leading to impaired oxygen delivery.
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Mortality occurs from a burn injury because of infections which result from the metabolic and bacterial consequences of a large open wound, depression of the host's resistance, and both protein and total caloric malnutrition. Systemic antibiotics, topical wound therapy, and gentle wound debridement constitute traditional burn therapy. The systemic antibiotics and topical wound therapy do not solve problems presented by large open wounds and the related protein and caloric deprivation. ⋯ As long as devitalized, burned tissue remains present in the setting of depressed host resistance, cross infection tends to colonize those remaining devitalized burn wounds with more virulent organisms than those that were already present. Bacterial controlled nursing units (BCNU) provide strict protection against that cross infection. Though inevitably a catabolic response occurs with massive injury, intensive nutritional support provides the calories necessary for the response to injury to avoid a prolongation of that negative nitrogen balance.
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Intensive care medicine · Jan 1986
Case ReportsRhabdomyolysis and acute renal failure in a patient with thermal injury.
We report a case of rhabdomyolysis with acute renal failure during recovery from thermal burn injury. The late occurrence of this unusual complication is emphasized and possible etiological factors are discussed.
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There are widespread disturbances in hepatic and peripheral metabolism in sepsis. Prominent effects include elevated plasma concentrations of aromatic and sulfur-containing amino acids during sepsis, while BCAA are normal or reduced. These alterations probably in part reflect accelerated muscle protein breakdown and hepatic dysfunction. ⋯ Although the main objective in the treatment of septic patients, of course, is to remove or drain the septic focus, recent studies have shown that administration of BCAA-enriched solutions may be beneficial in the improvement of metabolic derangements and septic encephalopathy. It should be emphasized that not a great deal of work has been done in this area, and the above results are preliminary and fragmentary. However, they do at least provide a working hypothesis for testing of another form of metabolic encephalopathy.
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Intensive care medicine · Jan 1986
An index to predict outcome in adult respiratory distress syndrome.
Thirty patients with adult respiratory distress syndrome required intermittent positive pressure ventilation; 15 survived. In 25 the syndrome followed bacterial infection or multiple injuries. From the peak upper airway pressure, the oxygen gradient and the age of the patient, an index was obtained which discriminated between the survivors and those who died from the pulmonary lesion of the syndrome.