Critical care clinics
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The management of the morbidly obese critically ill patient is a challenging and formidable task. A better understanding of the pathophysiologic changes that occur with obesity and the complications unique to this group of patients may improve their outcome.
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In sum, there is no convincing evidence yet published supporting the utility of T4 or T3 administration in patients with nonthyroidal illness. The authors recognize that evidence accrued in one disease state may not be applicable to others and that, although these studies are difficult to perform, further large scale prospective studies need to be performed. ⋯ Until that time, there may be rare circumstances when a clinician may think it best to treat an individual patient with T4 or T3. For the majority of patients, however, there will be little indication for the administration of thyroid hormones until the potential benefits can be shown to outweigh the risks.
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Intracellular magnesium is an important modulator of calcium and potassium channels in cardiac myocytes. Hypomagnesemia is common in hospitalized patients and may contribute significantly to cardiac morbidity and mortality, particularly in states associated with myocardial ischemia. Therefore, it is important to maintain the plasma magnesium concentration within the normal range in asymptomatic patients and in patients with cardiac disease as prophylaxis against the occurrence of significant arrhythmias.
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Hyponatremia, particularly that due to the syndrome of inappropriate antidiuretic hormone secretion (SIADH), is common in patients seen in the critical care setting. Because of aging-associated changes in the hormonal and renal systems involved in regulation of water and sodium balance, older persons are at higher risk than the young. ⋯ Careful monitoring of serum sodium during treatment is essential to produce prompt resolution of symptoms while avoiding the development of central pontine myelinolysis. Several therapeutic modalities are available for the longterm management of chronic hyponatremia.
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Critical care clinics · Jan 2001
ReviewManagement of hypothyroidism and hyperthyroidism in the intensive care unit.
Thyroid storm and myxedema coma are uncommon problems in the ICU, but both usually present with typical findings, and when recognized early, are treatable. Thus, rapid recognition with early institution of therapy may be life saving. It is always important to search diligently to determine the underlying cause of the decompensation and to treat that aggressively.