Critical care clinics
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Critical care clinics · Apr 2022
ReviewGenetic Defects that Predispose to Serious Viral Infections.
Viral immunity is a complex, multistep process involving both the innate and adaptive immune systems. Genetic defects in the immune system known as primary immune deficiency disorders (PIDDs) can result in viral infections that are severe, recurrent, or recalcitrant to therapy. These infections can lead to respiratory tract disease and pneumonitis, skin disease, and disseminated viral syndromes that affect multiple organs and even the brain. This review will provide a brief overview of immunity to viruses, an overview of PIDDs that result in significant viral susceptibility, as well as a diagnostic approach to these infections with a focus on defects that are severe and may require intensivist care.
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Hypertensive crisis, especially in children, is a rare condition and is defined as a sudden and abrupt elevation in blood pressure that poses a threat of rapid onset of end-organ damage. Symptomatic hypertension requires urgent and thorough evaluation and management. ⋯ This article discusses common and rare causes of severe hypertension in infancy, childhood, and adulthood. Clinical features that indicate possible serious underlying disease associated with severe and symptomatic hypertension are outlined.
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Pediatric acute liver failure is a rare process that results from many different diseases including toxin ingestion and drug overdose, infections, metabolic and genetic disorders, immune-mediated diseases, and ischemia. Up to 50% of children with acute liver failure will never have an underlying cause found. ⋯ Nonetheless, overall survival is approximately 50% without liver transplantation. Opportunities for improvement in the care of children with acute liver failure still exist.
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Critical care clinics · Apr 2022
ReviewAutoimmune Encephalitis: Distinguishing Features and Specific Therapies.
Autoimmune encephalitis is characterized by subacute onset of the altered mental status that can rapidly progress to autonomic instability and refractory seizures requiring intensive care. It is mediated by autoantibodies that bind to synaptic surface proteins and alter their function. ⋯ Diagnosis, treatment, and monitoring for this devastating condition continue to evolve. Pathogenesis, diagnosis and both current and emerging therapies are reviewed.
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Critical care clinics · Apr 2022
ReviewRecognition and Management Considerations of Cardiac Channelopathies in the Intensive Care Unit.
The understanding and prevalence of cardiac channelopathies has grown over time. Many patients are asymptomatic but are at risk for malignant arrhythmias during high-acuity medical admissions. Long QT syndrome, Brugada syndrome, and catecholaminergic polymorphic ventricular tachycardia are discussed with specific consideration given for the role these medical conditions play during an intensive care unit admission-for either cardiac or noncardiac reasons.