Reporte de caso: síndrome de absorción intravascular en histeroscopia, intoxicación por glicina / Case report: Intravascular absorption syndrome in hysteroscopy, glycine intoxication

El síndrome de absorción intravascular en histeroscopia se origina por la rápida absorción vascular de soluciones isotónicas e hipotónicas utilizadas en irrigación intrauterina, ocasionando hipervolemia y dilución de electrolitos, especialmente hiponatremia. Cuando este síndrome es debido a intoxicación por glicina al 1,5% causa acidosis severa y neurotoxicidad. La incidencia de este síndrome es baja pero puede aumentar por factores como: falta de control de altura de bolsas de irrigación, ausencia de equilibrio de fluidos de soluciones de irrigación, tejidos altamente vascularizados como miomas uterinos y uso de sistema de electrocirugía monopolar. Se reporta el caso de una paciente con miomas uterinos, programada para resección mediante histeroscopia que cursa con síndrome de absorción intravascular por glicina, el temprano diagnóstico y rápido tratamiento intraoperatorio y postoperatorio permitió una evolución favorable. El manejo se basó en el uso de diuréticos, restricción de fluidos y soluciones hipertónicas de sodio.

Intravascular absorption syndrome in hysteroscopy is caused by rapid vascular absorption of isotonic and hypotonic solutions used in intrauterine irrigation, causing hypervolemia and electrolyte dilution, especially hyponatremia. When this syndrome is due to 1.5% glycine toxicity, it causes severe acidosis and neurotoxicity. The incidence of this syndrome is low but may increase due to factors such as: lack of control of the height of irrigation bags, lack of fluid balance in irrigation solutions, highly vascularized tissues such as uterine myomas and use of a monopolar electrosurgery system. The case of a patient with uterine myomas, scheduled for resection by hysteroscopy, who presents with intravascular glycine absorption syndrome, is reported. Early diagnosis and rapid intraoperative and postoperative treatment allowed a favorable evolution. Management was based on the use of diuretics, fluid restriction, and hypertonic sodium solutions.

Acidose metabólica e sua associação com o estado nutricional em hemodiálise / Metabolic acidosis and its association with nutritional status in hemodialysis

Resumo Introdução: A acidose metabólica é frequente em pacientes dialíticos e participa na patogênese da desnutrição energético-proteica destes pacientes. Objetivos: Avaliar a prevalência de acidose metabólica em hemodiálise e pesquisar sua associação com o estado nutricional. Métodos: Foi realizado um estudo transversal em pacientes em hemodiálise em um único centro. O estado nutricional foi avaliado por meio de indicadores antropométricos, bioquímicos e da bioimpedância elétrica multifrequencial. Acidose metabólica foi definida como bicarbonato sérico (BIC) < 22 mEq/L, e os pacientes foram divididos em 3 grupos, segundo o BIC (< 15,15-21,9 e ≥ 22). A associação entre o BIC e as variáveis contínuas foi pesquisada com o teste de Kruskal Wallis. A correlação linear entre o BIC e as variáveis do estudo também foi testada. Resultados: Foram avaliados 95 pacientes, 59% masculinos, idade média 52,3 anos. A prevalência de acidose metabólica foi 94,7%. O IMC, o ganho de peso interdialítico e o PTH foram significativamente diferentes entre os 3 grupos de BIC. O BIC apresentou correlação negativa significativa com ureia, fósforo e ganho de peso interdialítico. Não houve correlação significativa com albumina, ângulo de fase e índice de massa magra. Conclusão: A prevalência de acidose metabólica foi elevada na população em estudo, e um BIC mais baixo correlacionou-se com valores maiores de ureia, PTH, fósforo, ganho de peso interdialítico e menores de IMC. A avaliação do estado metabólico em hemodiálise deve ser implementada rotineiramente, considerando-se os efeitos negativos da acidose no estado nutricional, inflamatório e na doença óssea.

Abstract Introduction: Metabolic acidosis is a common problem in dialysis patients and plays an important role in the pathogenesis of protein-energy malnutrition in these patients. Objectives: To assess the prevalence of metabolic acidosis in hemodialysis and search their association with nutritional status. Methods: A cross-sectional study was performed in hemodialysis patients at a single center. Nutritional status was assessed by anthropometric, biochemical and multifrequency bioelectrical impedance analysis. Metabolic acidosis was defined as serum bicarbonate (BIC) < 22 mEq/L and patients were divided into 3 groups according to BIC (< 15.15 to 21.9 and ≥ 22). The association between BIC and continuous variables was investigated using the Kruskal Wallis test. The linear correlation between BIC and the variables of the study was also tested. Results: We studied 95 patients, 59% male, mean age 52.3 years. The prevalence of metabolic acidosis was 94.7%. BMI, interdialytic weight gain and PTH were significantly different among the 3 groups of BIC. The BIC was negatively correlated with urea, phosphorus and interdialytic weight gain. There was no significant correlation with albumin, phase angle and lean body mass index. Conclusion: The prevalence of metabolic acidosis was high in this population, and a lower BIC correlated with higher levels of urea, PTH, phosphorus, interdialytic weight gain and lower BMI. The evaluation of acid-basic status should be routinely implemented in dialysis patients by considering the negative effects of acidosis on the nutritional status, inflammation and bone disease.

Unintended Cannulation of the Subclavian Artery in a 65-Year-Old-Female for Temporary Hemodialysis Vascular Access: Management and Prevention

Ultrasound-guided cannulation of a large-bore catheter into the internal jugular vein was performed to provide temporary hemodialysis vascular access for uremia in a 65-yr-old woman with acute renal failure and sepsis superimposed on chronic renal failure. Despite the absence of any clinical evidence such as bleeding or hematoma during the procedure, a chest x-ray and computed tomographic angiogram of the neck showed that the catheter had inadvertently been inserted into the subclavian artery. Without immediately removing the catheter and applying manual external compression, the arterial misplacement of the hemodialysis catheter was successfully managed by open surgical repair. The present case suggests that attention needs to be paid to preventing iatrogenic arterial cannulation during central vein catheterization with a large-bore catheter and to the management of its potentially devastating complications, since central vein catheterization is frequently performed by nephrologists as a common clinical procedure to provide temporary hemodialysis vascular access.

Biopsy-Proven Type 1 Renal Tubular Acidosis in a Patient with Metabolic Acidosis

No abstract available.

Risk Factors for Periventricular-Intraventricular Hemorrhage in Premature Infants

Periventricular-intraventricular hemorrhage (PV-IVH) is a major cause of neurological disabilities in preterm newborns. This study aimed to determine the perinatal factors associated with PV-IVH. We conducted a retrospective case-control study from preterm infants born at < or =34 weeks of gestation and admitted to Neonatal Intensive Care Units of Seoul National University Children's Hospital and Seoul National University Bundang Hospital between June 2003 and December 2007. Neonates with no cranial sonographic data or infants transferred from other centers after three days of age were excluded. Of 1,044 eligible subjects, 59 infants with PV-IVH grade 2, 3, and 4 were allocated to the case group. The control group consisted of 118 infants without PV-IVH who were matched for gestational age and birth weight to each case of PV-IVH. At the multivariate logistic regression model, metabolic acidosis (odds ratio [OR]: 6.94; 95% confidence interval [CI]: 1.12-43.23) and use of inotropes (OR: 3.70; 95% CI: 1.16-11.84) were associated with an increased risk of PV-IVH. Maternal use of antenatal corticosteroids decreases the risk of PV-IVH (OR: 0.36; 95% CI: 0.14-0.92).

Monitorização não-invasiva dos parâmetros oxi-hemodinâmicos nas disfunções cardíacas agudas / Non-invasive oxy-hemodynamic monitoring in acute cardiac dysfunction

Disfunção cardíaca aguda é uma das causas mais frequentes condições clínicas encontradas em pacientes graves e está associada a altas taxas de morbidade e mortalidade. Esses pacientes desenvolvem quadros de hipoperfusão tecidual, cuja principal manifestação clínica é a síndrome da disfunção de múltiplos órgãos e sistemas. Monitorização hemodinâmica efetiva deve englobar parâmetros macros (pressão arterial, débito cardíaco) e micro (avaliação da oxigenação tecidual). Atualmente, há tecnologias disponíveis que permitem realizar essa monitorização de maneira não-invasiva ou minimamente invasiva. Nesta revisão descreveremos as tecnologias disponíveis para uso clínico, geralmente em ambiente de terapia intensiva.

Evaluación hermodinámica y respuesta al óxido nítrico inhalado / Hemodynamic assessment and response to inhaled nitric oxide to hypoxia and acidosis un newborn pigs

La hipertensión pulmonar (HTP) es un trastorno de la adaptación a la vida extrauterina de muchos recién nacidos. La hipoxia y la acidosis son factores desencadenantes y perpetuadores de la misma. Objetivos: evaluar el efecto del óxido nítrico inhalado (ONi) a la respuesta vascular pulmonar a la hipoxia y acidosis en cerdos recién nacidos. Material y método: se diseñó una serie de intervenciones experimentales en cerdos recién nacidos, sedados, anestesiados y en asistencia ventilatoria mecánica. El protocolo experimental consistió en inducir hipoxia en forma controlada y progresiva (FiO2 desde 0,21 (basal) hasta 0,14; 0,10 o 0,08, mezclando nitrógeno con aire), entre 6 y 10 minutos, valorando la respuesta hemodinámica. Estabilizada la respuesta a la hipoxia con elevación en meseta de la presión arterial pulmonar (PAP) y sistémica, se administró ONi a 20 ppm. Mediante infusión de HCl 0,1 N i/v se estabilizó el pH en diferentes valores en los cuales se reiteraron esta serie de experimentos. Resultados: se encontró que el descenso de la FiO2 (debajo de 0,21) produce una caída de la saturación y un aumento inmediato de la PAP a diferentes pH y una efectividad del ONi para descender la PAP próximo a 70%. Sin embargo a pH más bajo la existencia de acidosis genera un nivel basal de PAP elevado con respecto a pH 7,4, que el ONi no desciende. En cuanto a la HTP desarrollada ante diferentes FiO2 se confirmó que la elevación de la PAP es gradualmente más elevada. Conclusión: en la investigación experimental en cerdos recién nacidos se observa que los eventos hipóxicos de breve duración generan HTP e inestabilidad sobre la hemodinamia sistémica. De igual modo la acidosis induce un incremento en la PAP basal en este modelo experimental. En estas condiciones la aplicación de ONi desciende la PAP eficazmente sin alterar la hemodinamia sistémica. Es más efectiva su acción a pH normal que en acidosis.

Pulmonary hypertension (HTP) is a frequently pathological situation of maladaptation to the extratuerine life in newborns. Hypoxia and acidosis are key factors capable of evoking the referred situation and can also act as a perpetuator factor of it. Objectives: To evaluate the effect of inhaled nitric oxide (iNO) on pulmonary vascular response to hypoxia and acidosis in newborn pigs. Material and methods: we performed a series of experimental interventions in newborn pigs, sedated, anesthetized and mechanical ventilation. The experimental protocol was to induce hypoxia in a controlled and progressive (FiO2 from 0.21 (baseline) to 0.14, 0.10 or 0.08, mixing nitrogen with air), between 6 and 10 minutes, evaluating the hemodynamic response. Stabilized response to hypoxia plateau elevation in pulmonary artery pressure (PAP) and systemic administered iNO at 20 ppm. By infusion of HCl 0.1 N i/v was stable at different pH values which were reiterated in this series of experiments. Results: we found that the decrease in FiO2 (below 0,21) produces a fall in saturation and an immediate increase in PAP at different pH and an ERA of iNO for the PAP down near 70%. However, at lower pH, the presence of acidosis produces a basal level of PAP high relative to pH 7.4, which does not descend iNO. As PH developed at different FiO2 was confirmed that the elevation of the PAP is gradually higher.Conclusion: experimental research in newborn pigs shows that the short-term hypoxic events generate HTP and instability on systemic hemodynamics. Similarly acidosis induces an increase in baseline PAP in this experimental model. Under these conditions the application of iNO decreases the PAP effectively without altering systemic hemodynamics...

Routine laboratory investigations in infants and children presenting with fever and seizures at the University Hospital of the West Indies / Investigaciones de rutina en el laboratorio en relación con infantes y niños que se presentan con fiebre y convulsiones en el Hospital Universitario de West Indies

A retrospective chart review of the case notes of all children aged 6 months to 8 years presenting with fever and seizures to the University Hospital of the West Indies (UHWI) between January 2000 and December 2004 was conducted. Descriptive analyses were performed. Fifty-nine children (median age 1.58 years, range 0.58 to 6.83 years) were entered into the study. The main laboratory abnormalities were metabolic acidosis (23%), anaemia (10%), leukocytosis (35%) and hypomagnesaemia (3%). These were not significantly associated with meningitis or an underlying bacterial infection. There were no significant episodes of hyponatraemia, hypocalcaemia or hypoglycaemia. Meningitis was uncommon and occurred in only two (3.4%) children both younger than 16 months of age and who had other abnormal clinical signs. This study demonstrated that routine performance of haematological and biochemical investigations in children presenting with seizures and fever were of limited value. Lumbar punctures in children older than age 18 months with no other abnormal clinical signs were also found to be of low yield. Current American Academy of Paediatrics (AAP) recommendations that serum electrolytes, calcium, phosphate, magnesium, complete blood count and blood glucose should not be performed routinely in a child with a first simple febrile seizure can be safely applied to this study population.

Se llevó a cabo un estudio retrospectivo de las historias clínicas en busca de notas sobre los casos de todos los niños de 6 meses a 8 años de edad que se presentaron con fiebre y convulsiones en el Hospital Universitario de West Indies (HUWI) entre enero de 2000 y diciembre de 2004. Se realizaron análisis descriptivos. Cincuenta y nueve niños (edad mediana (1.58 años, rango 0.58 a 6.83 años) formaron parte de este estudio. Las principales anormalidades halladas mediante el laboratorio fueron: acidosis metabólica (23%), anemia (10%), leucocitosis (35%), e hipomagnesemia (3%). Éstas no estuvieron significativamente asociadas con meningitis o alguna infección bacteriana subyacente. No hubo episodios significativos de hiponatremia, hipocalcemia o hipoglicemia. La meningitis fue poco común, ocurriendo sólo en dos niños (3.4%), ambos con menos de 16 meses de edad y con otros signos clínicos anormales. Este estudio demostró que el trabajo de rutina realizado en las investigaciones hematológicas y bioquímicas en los niños que se presentaron con fiebre y convulsiones, tuvo un valor limitado. También se halló que las punciones lumbares realizadas a niños de más de 18 meses sin ningún otro signo clínico anormal, tuvieron poco valor. Las recomendaciones actuales de la Academia Americana de Pediatría (AAP) en cuanto a que las pruebas de electrolitos en suero, las mediciones de calcio, fosfato, magnesio, el conteo sanguíneo completo, y la prueba de glucosa en sangre, no deben ser realizadas rutinariamente en un niño con una primera simple convulsión febril, pueden ser aplicadas con seguridad a esta población bajo estudio.

Acid-base disarrangement and gastric intramucosal acidosis predict outcome from major trauma / Desarranjo ácido-base e acidose gástrica intramucosal predizem desfecho de trauma grave

INTRODUCTION: This prospective non-interventional study intended to assess the prognostic value of gastric intramucosal acidosis in patients with severe trauma admitted to a medical/surgical ICU. METHODS: Gastric tonometer catheters were introduced to measure air PCO2 level (Tonocap device) in forty consecutive critically ill trauma patients. Gastric intramucosal pH, air PCO2 gradient, lactate and acid-base parameters were measured at admission and at 6, 12 and 24 h thereafter. RESULTS: The median age, mean APACHE II and SOFA scores were higher in nonsurvivors than in survivors (p<0.05). There were significant differences in the PCO2 gradient between survivors and nonsurvivors at 12 and 24 hours (10±7 vs. 24±19 mmHg, 13±16 vs. 29±25 mmHg; p<0.05). Gastric intramucosal pH values were lower in nonsurvivors than in survivors, on admission and after 12 or 24 hours (p<0.05). Arterial pH and bicarbonate were lower, lactate concentration higher, and base excess more negative in nonsurvivors. Prediction of outcome (mortality and MODS) at 24 hours of ICU assessed by their ROC curves was similar (p=NS). At 24 hours, air PCO2 gradient > 18 mmHg carried a relative risk of 4.6 for death, slightly higher than a HCO3 <20 mEq/L (RR=4.29) or base excess of <-2 mmol/L (RR=3.65). CONCLUSION: Bicarbonate, base deficit, lactate, gastric intramucosal pH and PCO2 gradient discriminate survivors from nonsurvivors of major trauma. A critical air PCO2 gradient carried the greatest relative risk for death at 24 hours of ICU. Inadequate regional blood flow as detected by a critical PCO2 gradient seems to contribute to morbidity and mortality of severe trauma patients.

INTRODUÇÃO: O objetivo deste estudo prospectivo, não-intervencionista, foi avaliar o valor prognóstico da acidose gástrica intramucosal em pacientes com trauma grave admitidos numa UTI. MÉTODOS: Cateteres tonométricos gástricos foram introduzidos para medir o nível de PCO2 aéreo em 40 pacientes traumatizados. O pH gástrico intramucosal, o gradiente de PCO2 aéreo, o lactato e os parâmetros ácido-base foram medidos na admissão e 6, 12 e 24 h após a admissão. RESULTADOS: A idade mediana, o APACHE II e os escores SOFA médios foram maiores nos não-sobreviventes que nos sobreviventes (p<0.05). Não houve diferenças significativas para o gradiente de PCO2 entre sobreviventes e não-sobreviventes após 12 e 24 horas (10±7 vs. 24±19 mmHg, 13±16 vs. 29±25 mmHg; P<0.05). Os valores de pH gástrico intramucosal foram menores nos não-sobreviventes que nos sobreviventes na admissão e após 12 ou 24 horas (P<0.05). O pH arterial e o bicarbonato foram menores, a concentração de lactato maior, o excesso de base mais negativo nos não-sobreviventes. Predição do desfecho (mortalidade e FMOS) nas 24 horas de UTI acessada pelas curvas ROC foi similar (p=NS). Nas 24 horas, um gradiente de PCO2 aéreo >18 mmHg acarretou um risco relativo de 4.6 para óbito, um pouco maior que um HCO3 <20 mEq/L (RR=4.29) ou um excesso de base <-2 mmol/L (RR=3.65). CONCLUSÃO: Bicarbonato, déficit de base, lactato, pH gástrico intramucosal e o gradiente de PCO2 discriminaram os sobreviventes dos não-sobreviventes de trauma. Um gradiente crítico de PCO2 aéreo acarretou o maior risco relativo para óbito após 24 horas de UTI. Fluxo sangüíneo regional inadequado detectado por um gradiente crítico de PCO2 parece contribuir para a morbidade e mortalidade de pacientes traumatizados graves.

Efeitos da acidose metabólica sobre o tecido ósseo: evidências clínicas e experimentais / Effects of metabolic acidosis on the bone: clinical evidence and experimentai

A acidose metabólica é considerada um componente comum a diversas doenças. Inúmeros estudos descreveram a participaçâo do tecido ósseo na manutençâo da homeostase ácido básica. Entretanto, os efeitos do tamponamento ósseo sobre o osso propriamente dito nâo estâo bem estabelecidos. A acidose metabólica altera a composiçâo do osso através de açâo fisico química direta, além de estimular a reabsorçâo óssea mediada por células. Este artigo revisa algumas evidências experimentais e clínicas sobre a participaçâo do osso como sistema de tamponamento dos distúrbios do equilibrio ácido básico. Os efeitos que o osso, agindo como tampâo, exerce sobre sua própria composiçâo celular e estrutura também sâo discutidos.

Outcome of newborns with birth asphyxia.

Birth asphyxia is one of the common causes of mortality and morbidity in neonates and the incidence is 2-9 per 1,000 live borns. The present work is a retrospective hospital based observational study. Babies born at B.P. Koirala Institute of Health Sciences, Dharan, Nepal during the period from April 2002 to April 2003 with gestational age >or=37 weeks with Apgar score <or=6 at 5 minutes were included in the study. The aim was to study the clinical profile, the acid base parameters and the outcome of asphyxiated newborns. Babies with congenital defects, evidence of infection and maternal drug addiction were excluded from the study. All babies were resuscitated according to the guidelines of American Heart Association. Data on 50 birth asphyxia cases were tabulated and analysed. There were 10 (20%) cases of severe birth asphyxia (Apgar score: 1-3 ) and 40 (80%) cases of moderate birth asphyxia (Apgar score: 4-6). Staging of hypoxic ischaemic encephalopathy (HIE) was performed according to Sarnat's staging. Thirty percent of these cases presented with various stages of HIE and the incidence was higher in low Apgar score group. The common presentations of HIE cases had depressed neonatal reflexes, seizures, lethargy, and pupillary abnormalities. The common acid base disturbance was metabolic acidosis which was observed only in babies with HIE-3. Two neonates (4%) died during the hospital stay due to multiorgan failure and severe metabolic acidosis.

Corticosteroid-responsive enteropathy of infancy.

Nineteen American infants aged less than three months developed persistent diarrhoea, acidosis, hypoalbuminaemia, and malnutrition, without evidence of enteric pathogens. Symptoms began 11-59 days before admission to the University of North Carolina Children's Hospital, and infants were fed semielemental formula. Despite further treatment with amino acid-based formula by continuous nasogastric infusion, diarrhoea persisted. Endoscopic biopsies showed inflammation in the stomach, duodenum, and/or colon. A trial of intravenous corticosteroids was initiated in 14 infants. Corticosteroids were associated with rapid resolution of diarrhoea (duration after corticosteroids = 3.8 +/- 1.7 days [mean +/- SD]). In contrast, five infants with identical history were not treated with corticosteroids. In three infants, diarrhoea lasted for 92-147 days versus 31 +/- 3 total days in the treated group. In the other two infants, diarrhoea worsened after discharge, but were treated later with corticosteroids, with rapid resolution. Corticosteroids were uneventfully weaned over a four-month period. The results suggest that a trial of corticosteroids in infants with unresponsive persistent diarrhoea of unknown origin is beneficial and deserves prospective evaluation.

Pseudo-hypo aldosteronism Type II.

A 50-day-old infant diagnosed as meningitis had persistently elevated serum potassium, low serum bicarbonate and normal serum sodium. She had metabolic acidosis with low TTKG, low serum renin and low normal serum aldosterone with no renal failure or extra renal causes of hyperkalemia. Hence a diagnosis of Type II pseudo-hypoaldosteronism was made. She was started on oral thiazide following which her serum electrolytes normalized.

Severe neutropenia in an infant with methylmalonic acidemia

Neutropenia exists when the neutrophil counts is less than 1000/mm3 in infants between 2 weeks and 1 year of age and less than 1500/mm3 beyond 1 year of age (1). Severe infections occur when the absolute neutrophil count is below 500/mm3 with perirectal abscesses, pneumonia, and sepsis being common. Granulocyte Colony-Stimulating Factor (G-CSF) produces a sustained neutrophil recovery in patients with severe neutropenia, reduces the incidence and severity of infection, and improves the quality of life. Various cytopenias, including neutropenia, thrombocytopenia and pancytopenia, have been reported in association with inborn errors of branched aminoacid metabolism such as methylmalonic, propionic and isovaleric acidemia. We report an infant with methylmalonic acidemia who presented severe neutropenia

Predicao da acidose no nascimento em gestacao com diastole zero ou reversa a dopplervelocimetria das arterias umbilicais / Predicting acidosis at birth in pregnancies with absent or reverse end-diastolic flow velocity diagnosed through dopplervelocimetry of the umbilical arteries

A diastole zero e a diastole reversa demonstram grave insuficiencia placentaria, merecendo intensiva vigilancia do bem estar fetal. O conhecimento de um teste de avaliacao da vitalidade fetal de predicao da acidose no nascimento em casos de diastole zero ou diastole reversa a dopplervelocimetria das arterias umbilicais pode facilitar a escolha do melhor momento para interrupcao da gestacao diminuindo assim a mortalidade e a morbidade perinatal nestes casos

Acidemia propionica no periodo neonatal / Propionic acidemia in the neonatal period

A acidemia propionica e uma desordem do metabolismo de acidos organicos caracterizada por um amplo espectro de variacao clinica e laboratorial. Muitas vezes ja se manifesta no periodo neonatal, quando a mortalidade e elevada e as sequelas neurologicas sao graves nos sobreviventes. O caso apresentado refere-se a um recem-nascido do sexo masculino, saudavel ate 49 horas de vida, quando iniciou quadro de recusa alimentar, gemencia e hipotermia. Evoluiu com piora clinica progressiva atingindo estado de neurotoxicidade importante. Desenvolveu acidose metabolica grave e a deteccao de elevados niveis de acido 3-hidroxi-propionico, 2-metil-3-hidroxibutirico e metil-citrico na urina, confirmou o diagnostico de acidemia propionica

Tratamiento médico de la sepsis intraabdominal grave / Intraabdominal sepsis medical treatment

La sepsis intraabdominal grave es un problema médico-quirúrgico complejo que se asocia a una elevada mortalidad y en donde se interrelacionan una serie de factores que determinan el pronóstico del enfermo. La terapéutica médica de apoyo a las diferentes funciones orgánicas en el perioperatorio es de capital importancia, ya que ésta se complementará con el manejo operatorio por parte del cirujano para trata de controlar y/o erradicar el proceso infeccioso intraabdominal