Israel journal of medical sciences
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The objective of our study was to evaluate the applicability of the Acute Physiology and Chronic Health Evaluation (Apache II) scoring system in an Israeli general intensive care unit (GICU), and to monitor the outcome of care using the Apache II severity score. We compared over a 3-year period the distribution of Apache II score, and of hospital mortality in our GICU (790 consecutive admissions) to that of the original American study, using a prediction formula based on 5,815 admissions in the United States. Our admissions were classified as post-elective surgery, post-emergency surgery or nonsurgical. ⋯ The majority of excess mortality occurred in the nonsurgical group (odds ratio 1.27, 95% CI 1.09, 1.48). We found the Apache II score useful for determining the severity of illness in our GICU. The Apache equation accurately predicts the mortality of elective and emergency surgery admissions, but underestimates the mortality of nonsurgical admissions.
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Review Case Reports
Wernicke's encephalopathy in hyperemesis gravidarum: association with abnormal liver function.
A 27-year-old woman developed Wernicke's encephalopathy in the 18th week of her pregnancy after 11 weeks of vomiting accompanied by weight loss of 21 kg and moderately abnormal liver function tests. The patient recovered after thiamine therapy but the fetus was lost. ⋯ Six of the 15 patients (40%) had aspartate aminotransferase values > 100 U/l, much higher than the rate reported in previous series of patients with hyperemesis gravidarum (7%). This suggests the need for parenteral thiamine supplementation in patients with severe hyperemesis gravidarum lasting more than 3 weeks, especially those with abnormal liver function, and supports the hypothesis that the hepatic abnormality plays a pathogenetic role in the development of Wernicke's encephalopathy in hyperemesis gravidarum.