Articles: sepsis.
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Patients treated for pneumococcal bacteremia were prospectively evaluated over a 21-month period. Of 2,610 blood cultures obtained, 79 (3%) were positive for Streptococcus pneumoniae. Of these, 37 patients (47%) initially had a focus of infection, and 73 (92%) were reevaluated after the results of the blood culture were known. ⋯ Six demonstrated persistence of the original disease, nine showed no focus of infection, seven developed a focus of infection, and one developed a second focus of infection. No patients with temperatures less than 37.4 C developed significant disease. A regimen for management of patients with pneumococcemia is given.
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Fifteen anesthetized rats, 273 +/- 9 gm (SEM), were monitored hemodynamically for six hours following an IV injection of a sublethal (4--5) X 10(8) organisms/100 gm body wt, n = 5) or lethal 12--15 X 10(8) organisms/100 gm body wt, n = 5) dose of live Escherichia coli or saline (control, n = 5). A transpulmonary thermodilution method was used for measurement of cardiac output. Changes in the arterial blood temperature and pressure were recorded on a polygraph. ⋯ The mean arterial blood pressure was decreased in both groups in the early stage but maintained above 100 mm Hg. Essentially, no hemodynamic changes were noted in the control group. These results confirm our hypothesis that an injection of live E coli can produce a hyperdynamic state in the early stage as well as hypodynamic state in the late stage, and that serial hemodynamic studies on bacteremia in rats can be done successfully using the thermodilution method.
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Sepsis and septic shock were induced in fifteen awake rabbits by the infusion of live Escherichia coli. Sodium K+, and adenosine triphosphate (ATP) concentrations in red blood cells (RBC) and plasma were measured during the control, septic, and septic shock periods. The significant elevations of Na+ content in RBC during sepsis appeared to be primarily a function of increased cell membrane permeability. ⋯ Hyponatremia and hyperkalemia were apparent in the late stages of sepsis, these alterations reached statistically significant levels in the shock period. The electrolyte derangements associated with sepsis and septic shock could not be related to energy depletion. The continuous significant accumulations of ATP, observed in RBC and plasma, were interpreted as a result of decreased energy utilization and attributed to the diminished active ion transport by the impaired Na+-K+ pump.