Critical care clinics
-
Intoxications frequently perturb acid-base and electrolyte status, intravascular volume, and renal function. In selected cases, extracorporeal techniques effectively restore homeostasis and augment intoxicant removal. The use of 4-methylpyrazole, an inhibitor of alcohol dehydrogenase, is a new and effective treatment for patients exposed to toxic alcohols. In this section, practical approaches to commonly encountered intoxicants and the use of extracorporeal techniques are critically reviewed.
-
Critical care clinics · Apr 2002
ReviewDisorders of potassium homeostasis. Hypokalemia and hyperkalemia.
This article reviews the diagnosis and management of clinical disorders of potassium balance, with particular attention to the critically ill patient. The normal regulation of potassium balance is reviewed as a background for understanding these disorders, followed by a discussion of the causes and management of hypo- and hyperkalemia. Practical guidelines are presented for acute and chronic management.
-
In summary, use of plasmapheresis has changed in recent years given advances in medical technology that have allowed a wider clinical application in the critical care setting. Membrane filtration technology has provided an alternative to centrifugation that can be easily applied in intensive care units. Use of plasmapheresis has also changed in recent years reflecting the availability of evidence largely obtained from controlled prospective studies. ⋯ Reported data also suggest a possible benefit of plasmapheresis in patients with myeloma cast nephropathy, sepsis, and poisoning/overdose, but the case for plasmapheresis in these disorders is largely unproven and the reported evidence insufficient to recommend its use outside research settings. In contrast, data from controlled trials do not support a role for plasmapheresis in immune complex-mediated RPGN, such as lupus nephritis, and acute allograft rejection. The more widespread application of prospective, randomized, controlled clinical trials should help to better define the value of plasmapheresis for treatment of acute renal diseases.
-
This article focuses on the epidemiology, pathogenesis, and prevention of the most common forms of acute renal failure encountered in the critically ill. These include pre-renal azotemia and acute tubular necrosis that occurs postoperatively, in patients with rhabdomyolysis, or as a complication of sepsis. In addition, some unusual causes of acute renal failure that occur predominantly in the intensive care unit are briefly discussed.
-
Critical care clinics · Apr 2002
ReviewHepatorenal syndrome. Definition, pathophysiology, and intervention.
Hepatorenal syndrome is a well characterized entity in which vasodilation of splanchnic vessels and intense constriction of the renal cortical vasculature occur in concert. The condition is often fatal unless orthotopic liver transplantation (OLT) is performed. ⋯ Unfortunately, mortality and hepatic regeneration do not appear to be affected by such interventions. The development of a hybrid bioartifical liver support system and pharmacologic manipulation of the hemodynamic perturbations that occur in HRS provide particularly appealing prospects as a means of providing a bridge to liver transplantation in the future.