La Nouvelle presse médicale
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Severe ketoacidosis sometimes develops in chronic alcoholics after increased alcohol intake associated with dietary restriction. This particular case was unusual from two standpoints: a considerable, prolonged and unexplained increase in serum free fatty acid, and discordance between the degree of ketonaemia and an abundant liver glycogen load.
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The hemodynamic and respiratory effects of spontaneous ventilation with continuous positive airway pressure (CPAP) and mechanical ventilation with positive and expiratory pressure (CPPV) were compared in six patients with acute respiratory failure. Arterial and mixed venous gases, cardiac output, oxygen delivery and consumption, airway and oesophageal pressures were measured, with each patient on intermittent positive pressure ventilation (IPPV), CPAP and CPPV with the same level of positive and expiratory pressure (PEEP = 20 cmH2O). ⋯ However total oxygene consumption and PaCO2 were slightly increased with CPAP due to a higher breathing's work. So, CPAP is as efficient as CPPV at the same level of PEEP in improving intra-pulmonary shunt and PaO2, without adversely affecting cardiac output.
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Fifteen patients were treated with low-dose (5 u/hour) insulin infusion, including 10 cases of ketoacidosis, 3 cases of hyperglycemia without acidosis in severely affected diabetics, and 2 cases with hyperosmolality. The treatment was successful in all cases. Insulin was infused at a constant rate, during 12 hours as a mean value. ⋯ The two elderly patients with hyperosmolality recovered quickly and completely. The method of low-dose insulin infusion seems thus effective and easily applicable, at least in an intensive care unit. Our experience prompted us to increase (10 u/h) rather than to decrease the insulin infusion rate, with the aim to obtain a faster correction of ketoacidosis.