Crit Care Resusc
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To review and compare the 'metabolic' component of an acid-base abnormality by assessing the arterial blood bicarbonate and the 'strong ion difference'. ⋯ In man the renal and respiratory systems regulate acid-base homeostasis by modifying the bicarbonate buffer pair (i.e. PCO(2) and HCO(3)(-)), with all other body buffer systems adjusting to alterations in this pair. To maintain electrical neutrality there is a change in cation concentration commensurate with the change in bicarbonate concentration.
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Clostridium perfiringens may cause myonecrosis (i.e. gas gangrene), acute food poisoning or necrotic enteritis (e.g. enteritis necroticans or Pig Bel). We describe a case of enteritis necroticans in a 33 year old man with acute myeloid leukaemia. ⋯ Treatment of enteritis necroticans requires urgent surgery to remove dead bowel and in adults intravenous penicillin (1g 2-hourly) and metronidazole (500 mg 8-hourly) or clindamycin (600 mg 6-hourly). While antibiotics may also reduce toxin formation, beta toxoid has not been found to be of benefit in established disease.
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To review the function and use of intravenous magnesium in magnesium depleted and non-magnesium depleted patients. ⋯ Magnesium is required in patients who are magnesium depleted and is also of benefit in non-magnesium depleted patients with pre-eclampsia. It may also be of benefit in non-magnesium depleted patients with acute coronary syndromes, arrhythmias, acute asthma, stroke, seizures and spinal cord injury.