Journal of critical care
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Journal of critical care · Jun 2000
Comparative StudyDifferences in metabolic and hormonal milieu in diabetic- and alcohol-induced ketoacidosis.
Diabetic ketoacidosis (DKA) and alcoholic ketoacidosis (AKA) are two medical emergencies characterized by elevated total ketone body concentration. We aimed to determine differences in pathogenesis of ketoacidosis and its metabolic consequences by comparing both at presentation and during treatment, the different metabolic products and hormones involved in the ketoacidotic state. ⋯ Our results indicate that, in addition to a history of diabetes or alcoholism, patients with DKA and AKA differ in their metabolic parameters more than in their hormonal profile. The metabolic profile of DKA is characterized by a higher plasma glucose concentration, and lower beta-hydroxybutyrate to acetoacetate and lactate to pyruvate ratios compared with patients with AKA. The initial hormonal profile in both ketoacidotic states is characterized by similarly decreased insulin levels and elevated levels of counterregulatory hormones.
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Journal of critical care · Mar 2000
Randomized Controlled Trial Clinical TrialThe anticatabolic and wound healing effects of the testosterone analog oxandrolone after severe burn injury.
Severe burn injury leads to marked catabolism and decreased lean mass, which can impair healing. Anabolic agents can attenuate net catabolism. Our purpose was to determine whether the testosterone analog, oxandrolone, given during the acute post burn period decreased the degree of nitrogen loss and loss of body weight while also increasing the healing rate of a skin donor site. ⋯ We found the anabolic agent, oxandrolone, significantly decreased weight loss and net nitrogen loss and increased donor site wound healing compared with placebo controls. We noted no complications with the use of oxandrolone.
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Journal of critical care · Mar 2000
Vancomycin dosage requirements among pediatric intensive care unit patients with normal renal function.
The purpose of this study was to determine a vancomycin dosage regimen among pediatric intensive care unit (PICU) patients with normal renal function resulting in desired peak and trough serum concentration and to determine the predictability of vancomycin peak concentrations based on reported trough concentrations. ⋯ PICU patients required higher doses of vancomycin than are typically prescribed to achieve conventionally accepted peak and trough vancomycin serum concentrations. In the absence of renal impairment, we recommend an initial dosage regimen of 60 mg/kg/day divided every 8 hours. Vancomycin trough concentrations are highly predictive of corresponding peak concentrations and therefore may negate the need to obtain routine peak concentrations.
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Journal of critical care · Dec 1999
Randomized Controlled Trial Clinical TrialEffectiveness of albumin versus normal saline as a test of volume responsiveness in post-cardiac surgery patients.
A volume challenge is useful for determining whether cardiac output will respond to further volume loading by the Frank-Starling mechanism. To properly test this mechanism, there must be an increase in right atrial pressure (Pra) but this requires variable amounts of normal saline. The purpose of this study was to determine if 100 mL of 25% albumin would reliably provide a predictable increase in Pra and to compare this with a volume challenge with normal saline. As in a previous study, we also examined the potential for the pattern of respiratory variation of Pra to predict the response to a fluid challenge. ⋯ A hyperoncotic albumin solution appears to have an inotropic effect in patients following cardiopulmonary bypass procedures. We also again show that the pattern of respiratory variation in right atrial pressure is a useful guide to predict response to volume loading.