Journal of critical care
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Journal of critical care · Jun 2020
Case ReportsA potential diagnostic problem on the ICU: Euglycaemic diabetic Ketoacidosis associated with SGLT2 inhibition.
Sodium glucose cotransporter 2 (SGLT2) inhibitors are the latest class of oral hypoglycaemic agents approved to treat type II diabetes. Their use is increasing and as such more patients will present to critical care whilst on this treatment. ⋯ Under such circumstances the blood glucose is often normal or only moderately elevated and hence the diagnosis may be delayed resulting in inappropriate therapy. In this review we describe a case of SGLT2 mediated ketoacidosis who presented to our intensive care unit, discuss the proposed pathophysiology behind this development of ketoacidosis as well as its potential prevention, management and treatment.
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Septic shock is the most severe form of sepsis, characterized by (a) persistent hypotension despite fluid resuscitation and (b) the presence of tissue hypoperfusion. Delays in the diagnosis and initiation of treatment of septic shock is associated with increasing risk for mortality. Early and effective fluid resuscitation and vasopressor administration play a crucial role in maintaining tissue perfusion in septic shock patients. ⋯ Controversy currently exists as to the balance of fluids and vasopressors to maintain target mean arterial pressure. The aim of this article is to review the rationale for fluid resuscitation and vasopressor therapy and the importance of both mean and diastolic blood pressure during the initial resuscitation of the septic shock. We relate our personal prescription of balancing fluids and vasopressors in the resuscitation of septic shock.
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Journal of critical care · Jun 2020
Observational StudyPharmacogenomic response of low dose haloperidol in critically ill adults with delirium.
To characterize the pharmacogenomic response of low-dose haloperidol for delirium treatment in critically ill adults. ⋯ This pilot study, the first to evaluate the pharmacogenomic response of low-dose haloperidol when used to treat delirium in the ICU, suggests CYP2D6/CYP3A4 metabolizer status does not affect the serum haloperidol concentrations.
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Journal of critical care · Jun 2020
Patients alter power of breathing as the primary response to changes in pressure support ventilation.
The patient-ventilator relationship is dynamic as the patient's health fluctuates and the ventilator settings are modified. Spontaneously breathing patients respond to mechanical ventilation by changing their patterns of breathing. This study measured the physiologic response when pressure support (PS) settings were modified during mechanical ventilation. ⋯ The data indicates that patients maintain a set minute ventilation by adjusting their breathing rate, volume, and power. The data indicates that the subjects regulate their Ve and PetCO2 by adjusting power of breathing and breathing pattern.
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Journal of critical care · Jun 2020
Observational StudyThe effects of severe hemoconcentration on acid-base equilibrium in critically ill patients: the forgotten role of buffers in whole blood.
Idiopathic Systemic Capillary Leak Syndrome (ISCLS) is a paroxysmal permeability disorder characterized by abrupt onset of shock and hemoconcentration due to massive shift of fluids and proteins from the intravascular to the interstitial compartment. We hypothesize that increased hemoglobin concentration has a pivotal role in the acid-base imbalance during life-threatening crises. ⋯ Hemoglobin has a remarkable role in buffering metabolic acidosis during the shock phase of ISCLS. In these circumstances, the assessment of acid-base equilibrium in plasma alone may overestimate unmeasured anions. On the contrary, the physical-chemical model corrected for whole blood better explains the metabolic component of acid-base imbalance when marked shift of hemoglobin concentration occurs.