Critical care : the official journal of the Critical Care Forum
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Case Reports
Licorice consumption as a cause of posterior reversible encephalopathy syndrome: a case report.
A 49-year-old woman was admitted to our hospital because of thunderclap headache and blurred vision. At the time of presentation, her blood pressure was 219/100 mmHg, her arterial pH was 7.64 and her potassium level was 2.7 mM/l. ⋯ To the best of our knowledge, this is the first case report describing licorice consumption as a cause of PRES. Glycyrrhizic acid, a component of licorice, inhibits 11β-hydroxysteroid dehydrogenase and subsequently causes mineralocorticoid excess. Mineralocorticoid excess in turn causes high blood pressure and ultimately gives rise to malignant hypertension. Physicians should remember that licorice use is a very easy-to-treat cause of hypertension, hypertensive encephalopathy and PRES.
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Probiotics are live micro-organisms with a health promoting effect. Because of their immunomodulating capacity as well as improvement of gut barrier function, probiotics have the capacity to prevent infectious complications in a variety of clinical settings. Now selected probiotics show potential for improving the clinical outcome of severe trauma patients.
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Postoperative delirium is an important problem in patients undergoing major surgery. Cerebral oximetry is a non-invasive method to detect imbalances in the cerebral oxygen supply/demand-ratio. Low preoperative cerebral oxygen saturation (ScO₂) levels have been associated with postoperative delirium in non-cardiac surgery patients. The present prospective observational study determines the relationship between pre- and intra-operative ScO₂ levels and postoperative delirium in patients undergoing on-pump cardiac surgery. ⋯ The presented study shows that a low preoperative ScO₂ is associated with postoperative delirium after on-pump cardiac surgery.
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The sepsis resuscitation bundle is the result of an effort on behalf of the Surviving Sepsis Campaign and the Institute for Healthcare Improvement to translate individual guideline recommendations into standardized, achievable goals for physicians caring for the critically ill patient. Implementation of this bundle is associated with decreased mortality. ⋯ Elevations in serum lactate are associated with increased mortality, and may result from either increased lactate production or impaired lactate clearance. Lactate clearance may be an important addition to the monitoring and management bundles of patients with severe sepsis and septic shock, However, specific mechanisms of lactate clearance, the relation of lactate clearance to traditional hemodynamic parameters, and the importance of lactate clearance as a therapeutic target or monitoring tool remain unclear.
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Heavy sedation in the ICU is associated with coma, delirium, and prolonged stays, but links between sedatives and non-brain organ failure have rarely been described. In a post hoc analysis, Strøm and colleagues explored associations between sedation and acute kidney injury among ICU patients randomly assigned to one of two sedation strategies. The 'no sedation' protocol was associated with less kidney injury, but methodologic limitations preclude firm conclusions regarding mechanisms underlying this association. This hypothesis-generating study warns that sedation may harm organs other than the brain during critical illness, a possibility that warrants careful study in the future.