Renal failure
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The study objective was to determine the applicability of the acute physiology and chronic health evaluation (APACHE) II score in surgical patients with acute renal failure (ARF) requiring dialytic support, and to assess its utility in evaluating data from this specific disease group. This was a retrospective, partly prospective follow-up study of patients who developed ARF during their course of stay on the surgical intensive care unit (ICU) of a Dutch university hospital from January 1, 1986, to January 31, 1994. A total of 111 patients were identified, of whom 104 patients were considered eligible for this study. ⋯ APACHE II, when used at the time of initiation of dialytic support, proved to be a valid way in our surgical ICU to stratify ARF patients by the severity of their illness. Moreover, use of the AP2/AP1 ratio further improved the usefulness of this severity index and may help to identify patients who have little chance of survival. Predicting death with the APACHE II equation did not improve predictive power.
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Case Reports
Rhabdomyolysis and acute renal failure following cardioversion and cardiopulmonary resuscitation.
A 39-year-old male suffered a myocardial infarction at work and cardiopulmonary resuscitation was initiated immediately. After 15 cardioversions, ventricular fibrillation converted to sinus rhythm. ⋯ The patient died and autopsy revealed acute posterior myocardial infarction. Prolonged cardiopulmonary resuscitation involving repeated cardioversion may predispose to myoglobinuric renal failure.