Intensive care medicine
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Measuring or calculating plasma osmolality is of interest in critical care medicine. Moreover, the osmolal gap (i.e. the difference between the measured and calculated osmolality) helps in the differentiation of metabolic acidosis. A variety of formulas for calculating osmolality have been published, most of them relying on sodium, urea and glucose. A novel formula developed by Zander has recently been published, which also takes into account the effects of potassium, chloride, lactate and bicarbonate on osmolality. We evaluate the previously published formulas including the novel formula by comparing calculated and measured osmolality. ⋯ Only 4 out of the 36 evaluated formulas gave mean differences between measured and calculated osmolality of less than 1 mosmol/kg H(2)O. Zander's novel formula showed excellent concordance with measured osmolality and facilitates a more precise diagnosis based on blood gas analysers. The new equation has the potential to replace separate measurements of osmolality in many cases.
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Intensive care medicine · Feb 2013
Practice GuidelineSurviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012.
To provide an update to the "Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock," last published in 2008. ⋯ Strong agreement existed among a large cohort of international experts regarding many level 1 recommendations for the best care of patients with severe sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for this important group of critically ill patients.
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Intensive care medicine · Feb 2013
Comparative StudyMesenteric blood flow, glucose absorption and blood pressure responses to small intestinal glucose in critically ill patients older than 65 years.
To compare nutrient-stimulated changes in superior mesenteric artery (SMA) blood flow, glucose absorption and glycaemia in individuals older than 65 years with, and without, critical illness. ⋯ In critically ill patients aged >65 years, stimulation of SMA flow by small intestinal glucose infusion may be attenuated, which could account for the reduction in glucose absorption.