Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2020
Case Reports[Severe Metformin-Associated Lactic Acidosis in a 67-Year-Old Patient].
Metformin-associated lactic acidosis (MALA) is a difficult to diagnose and potentially life-threatening disease. We report a rare case of severe MALA treated at our hospital's intensive care unit. Suspected diagnosis of MALA and quick initiation of an adequate therapy containing renal replacement therapy led to successful management of this complicated MALA-case.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2020
[The New DGEM Guideline - All the Clinician Needs to Know].
The German Society for Nutritional Medicine has recently updated its guideline on clinical nutrition in critically ill patients thereby cooperating with seven other national medical societies. This article provides readers with a concise overview on selected key aspects of this guideline relevant for clinical practice. We will discuss some issues in detail such as the determination of energy expenditure and of calorie and protein intake, the choice of the route of administration (enteral or parenteral), and the handling of micronutrients.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2020
[Penicillin Allergy - Deadly "Fake News" in the Medical Record?]
The note "penicillin allergy" in the medical record is given in the literature with a prevalence of 8 - 12% and represents the most frequently reported "allergy". However, there are a number of hypersensitivity reactions of which true anaphylaxis is only a small part. Therefore, a specific allergy history should be included in the file for patients with suspected penicillin allergy. ⋯ Any unclear history of antibiotic allergy should be followed by a stepwise allergological diagnosis. This is because suspected allergies are associated with an increased rate of postoperative wound infections when alternatives to preoperative prophylaxis are used and a general increase in mortality, presumably due to poorly effective therapies and increased side effects. The article explains the risk stratification for the evaluation of a penicillin allergy, shows reasons for insufficient clarification and incorrect documentation of allergy anamnesis and describes diagnosis and therapy of true anaphylaxis.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2020
[Anaesthesia in Children and Adolescents with Disabilities].
Children and adolescents with disabilities have the right of full and effective participation and inclusion in society. Disability includes a wide range of long-term physical, mental, intellectual and sensory impairments for various reasons. In addition to the basic illness many children with disabilities have concomitant diseases. ⋯ Induction of anaesthesia can be challenging and sometimes requires unconventional methods. Pain behaviour may be unusual. There are suitable scales that incorporate such behaviours.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2020
[Nutrition in Critically Ill Patients - Challenges in Special Patient Groups].
Medical nutrition therapy in daily intensive care often is challenging for the clinician. The severity of disease with possible compromises of conscience, hemodynamics, respiration, renal and gastrointestinal systems requires an individual adaptation of the nutrient-supply adjusted to the disease phase and secondary metabolic tolerance. ⋯ Close monitoring is necessary for a rapid response in case the medical condition changes or new medical or nutritional problems arise. This pragmatic educational article describes recommended nutrition therapies for different patient cohorts in intensive care medicine based on currently valid (inter)national guidelines.