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1.
BMC Pregnancy Childbirth ; 21(1): 427, 2021 Jun 16.
Article in English | MEDLINE | ID: covidwho-1277922

ABSTRACT

BACKGROUND: Euglycaemic ketoacidosis (EKA) is an infrequent but serious condition which usually follows a period of starvation, severe vomiting or illness in individuals with or without diabetes. Ketoacidosis is associated with materno-fetal morbidity and mortality necessitating prompt diagnosis and management. Physiological increases in insulin resistance render pregnancy a diabetogenic state with increased susceptibility to ketosis. COVID-19 is associated with worse clinical outcomes in patients with diabetes and is an independent risk factor for ketoacidosis in normoglycaemic individuals. CASE PRESENTATIONS: We describe two cases of SARS-CoV-2 positive pregnant women presenting with normoglycaemic metabolic ketoacidosis. Both cases were associated with maternal and fetal compromise, requiring aggressive fluid and insulin resuscitation and early delivery. CONCLUSION: We discuss possible physiology and propose a management strategy for euglycaemic ketoacidosis in pregnancy.


Subject(s)
COVID-19/diagnosis , Ketosis/diagnosis , Pregnancy Complications/diagnosis , Starvation/complications , COVID-19/complications , Female , Fluid Therapy/methods , Humans , Insulin Resistance , Ketosis/complications , Ketosis/therapy , Maternal-Fetal Exchange , Pregnancy , Pregnancy Complications/therapy , SARS-CoV-2 , Starvation/therapy
2.
Medicina (Kaunas) ; 57(1)2021 Jan 09.
Article in English | MEDLINE | ID: covidwho-1016197

ABSTRACT

Nowadays, humanity faces one of the most serious health crises, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. The severity of coronavirus disease 2019 (COVID-19) pandemic is related to the high rate of interhuman transmission of the virus, variability of clinical presentation, and the absence of specific therapeutic methods. COVID-19 can manifest with non-specific symptoms and signs, especially among the elderly. In some cases, the clinical manifestations of hyponatremia may be the first to appear. The pathophysiological mechanisms of hyponatremia among patients with COVID-19 are diverse, including syndrome of inappropriate antidiuretic hormone secretion (SIADH), digestive loss of sodium ions, reduced sodium ion intake or use of diuretic therapy. Hyponatremia may also be considered a negative prognostic factor in patients diagnosed with COVID-19. We need further studies to evaluate the etiology and therapeutic management of hyponatremia in patients with COVID-19.


Subject(s)
COVID-19/metabolism , Hyponatremia/metabolism , Inappropriate ADH Syndrome/metabolism , COVID-19/complications , Diuretics/adverse effects , Fluid Therapy/methods , Humans , Hyponatremia/epidemiology , Hyponatremia/etiology , Hyponatremia/therapy , Inappropriate ADH Syndrome/etiology , Incidence , Interleukin-6/metabolism , Intestinal Mucosa/metabolism , Prognosis , SARS-CoV-2 , Saline Solution, Hypertonic/therapeutic use , Sodium, Dietary
3.
Intensive Care Med ; 46(12): 2157-2167, 2020 12.
Article in English | MEDLINE | ID: covidwho-911887

ABSTRACT

Care for patients with acute respiratory distress syndrome (ARDS) has changed considerably over the 50 years since its original description. Indeed, standards of care continue to evolve as does how this clinical entity is defined and how patients are grouped and treated in clinical practice. In this narrative review we discuss current standards - treatments that have a solid evidence base and are well established as targets for usual care - and also evolving standards - treatments that have promise and may become widely adopted in the future. We focus on three broad domains of ventilatory management, ventilation adjuncts, and pharmacotherapy. Current standards for ventilatory management include limitation of tidal volume and airway pressure and standard approaches to setting PEEP, while evolving standards might focus on limitation of driving pressure or mechanical power, individual titration of PEEP, and monitoring efforts during spontaneous breathing. Current standards in ventilation adjuncts include prone positioning in moderate-severe ARDS and veno-venous extracorporeal life support after prone positioning in patients with severe hypoxemia or who are difficult to ventilate. Pharmacotherapy current standards include corticosteroids for patients with ARDS due to COVID-19 and employing a conservative fluid strategy for patients not in shock; evolving standards may include steroids for ARDS not related to COVID-19, or specific biological agents being tested in appropriate sub-phenotypes of ARDS. While much progress has been made, certainly significant work remains to be done and we look forward to these future developments.


Subject(s)
Respiratory Distress Syndrome/therapy , Standard of Care/trends , COVID-19/complications , COVID-19/physiopathology , Fluid Therapy/methods , Fluid Therapy/trends , Humans , Prone Position/physiology , Respiratory Distress Syndrome/physiopathology
4.
A A Pract ; 14(9): e01295, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-684161

ABSTRACT

We report for the first time therapy-resistant hypernatremia (plasma sodium concentration ≥150 mmol per liter) developing in 6 of 12 critically ill coronavirus disease 2019 (COVID-19) patients age 57-84 years requiring mechanical ventilation. There was no correlation between plasma sodium concentrations and sodium input. Plasma concentrations of chloride were elevated, those of potassium decreased. These findings are consistent with abnormally increased renal sodium reabsorption, possibly caused by increased angiotensin II activity secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced downregulation of angiotensin-converting enzyme 2 (ACE2) receptors. As hypernatremia was associated with increased length of intensive care unit stay, special attention should be paid to the electrolyte status of COVID-19 patients.


Subject(s)
Coronavirus Infections/complications , Fluid Therapy/methods , Hypernatremia/complications , Natriuretic Agents/therapeutic use , Pneumonia, Viral/complications , Aged , Aged, 80 and over , Betacoronavirus , COVID-19 , Case-Control Studies , Chlorides/blood , Cohort Studies , Coronavirus Infections/blood , Female , Fluid Therapy/statistics & numerical data , Hospital Mortality , Humans , Hypernatremia/blood , Hypernatremia/epidemiology , Hypernatremia/therapy , Length of Stay/statistics & numerical data , Male , Middle Aged , Pandemics , Pneumonia, Viral/blood , Renal Dialysis , Respiration, Artificial , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy , Retrospective Studies , SARS-CoV-2
5.
Eur J Endocrinol ; 183(1): G9-G15, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-647341

ABSTRACT

COVID-19 has changed the nature of medical consultations, emphasizing virtual patient counseling, with relevance for patients with diabetes insipidus (DI) or hyponatraemia. The main complication of desmopressin treatment in DI is dilutional hyponatraemia. Since plasma sodium monitoring is not always possible in times of COVID-19, we recommend to delay the desmopressin dose once a week until aquaresis occurs allowing excess retained water to be excreted. Patients should measure their body weight daily. Patients with DI admitted to the hospital with COVID-19 have a high risk for mortality due to volume depletion. Specialists must supervise fluid replacement and dosing of desmopressin. Patients after pituitary surgery should drink to thirst and measure their body weight daily to early recognize the development of the postoperative syndrome of inappropriate antidiuresis (SIAD). They should know hyponatraemia symptoms. The prevalence of hyponatraemia in patients with pneumonia due to COVID-19 is not yet known, but seems to be low. In contrast, hypernatraemia may develop in COVID-19 patients in ICU, from different multifactorial reasons, for example, due to insensible water losses from pyrexia, increased respiration rate and use of diuretics. Hypernatraemic dehydration may contribute to the high risk of acute kidney injury in COVID-19. IV fluid replacement should be administered with caution in severe cases of COVID-19 because of the risk of pulmonary oedema.


Subject(s)
Antidiuretic Agents/administration & dosage , Coronavirus Infections/therapy , Deamino Arginine Vasopressin/administration & dosage , Diabetes Insipidus, Neurogenic/therapy , Fluid Therapy/methods , Hypernatremia/therapy , Hyponatremia/therapy , Inappropriate ADH Syndrome/therapy , Pneumonia, Viral/therapy , Brain Injuries/complications , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Dehydration/therapy , Diabetes Insipidus/complications , Diabetes Insipidus/therapy , Diabetes Insipidus, Neurogenic/complications , Disease Management , Humans , Hyponatremia/etiology , Hyponatremia/prevention & control , Hypotonic Solutions/therapeutic use , Neurosurgical Procedures , Pandemics/prevention & control , Pneumonia, Viral/complications , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Postoperative Complications/therapy , Practice Guidelines as Topic , Saline Solution/therapeutic use , Shock/etiology , Shock/therapy
6.
Rev Assoc Med Bras (1992) ; 66(4): 521-527, 2020. tab
Article in English | WHO COVID, LILACS (Americas) | ID: covidwho-613692

ABSTRACT

SUMMARY Severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2 infection) is a new challenge for all countries, and children are predisposed to acquire this disease. Some studies have demonstrated more severe diseases in adults, but critically ill pediatric patients have been described in all ages. Pulmonary involvement is the major feature, and ventilatory support is common in critical cases. Nevertheless, other very important therapeutic approaches must be considered. In this article, we reviewed extensively all recent medical literature to point out the main clinical attitudes to support these pediatric patients during their period in respiratory support. Radiologic findings, fluid therapy, hemodynamic support, use of inotropic/vasopressors, nutritional therapy, antiviral therapy, corticosteroids, antithrombotic therapy, and immunoglobulins are analyzed to guide all professionals during hospitalization. We emphasize the importance of a multi-professional approach for adequate recovery.


RESUMO A síndrome respiratória aguda grave (SRAG) pelo novo coronavirus (SARS-CoV-2) é um novo desafio para todos os países e crianças estão predispostas a adquirir a doença. Alguns estudos demonstraram quadros mais graves em adultos, mas crianças criticamente doentes foram descritas em todas as idades. O envolvimento pulmonar é a principal característica e a necessidade de suporte ventilatório é comum nos casos mais graves. Entretanto, outras abordagens terapêuticas importantes devem ser consideradas. Nesse artigo revisamos extensamente a literature médica até o momento a fim de citar os principais recursos terapêuticos para o manejo dos pacientes pediátricos durante o período de suporte ventilatório. Achados radiológicos, terapia fluídica, terapia antiviral, o uso de corticosteroides, terapia antitrombótica e o uso de imunoglobulinas foram analisados a fim de guiar os profissionais durante o período de hospitalização desses pacientes. Nós reforçamos a importância de uma abordagem multiprofissional para recuperação adequada.


Subject(s)
Humans , Child , Adolescent , Pneumonia, Viral/therapy , Respiration, Artificial/methods , Coronavirus Infections/therapy , General Practice/methods , Physical Therapy Modalities , Critical Illness , Coronavirus Infections , Nutrition Therapy/methods , Pandemics , Fluid Therapy/methods , Betacoronavirus , Hemodynamic Monitoring/methods
8.
J Anesth ; 34(5): 758-764, 2020 10.
Article in English | MEDLINE | ID: covidwho-385537

ABSTRACT

Non-protocolized fluid administration in critically ill patients, especially those with acute respiratory distress syndrome (ARDS), is associated with poor outcomes. Therefore, fluid administration in patients with Coronavirus disease (COVID-19) should be properly guided. Choice of an index to guide fluid management during a pandemic with mass patient admissions carries an additional challenge due to the relatively limited resources. An ideal test for assessment of fluid responsiveness during this pandemic should be accurate in ARDS patients, economic, easy to interpret by junior staff, valid in patients in the prone position and performed with minimal contact with the patient to avoid spread of infection. Patients with COVID-19 ARDS are divided into two phenotypes (L phenotype and H phenotype) according to their lung compliance. Selection of the proper index for fluid responsiveness varies according to the patient phenotype. Heart-lung interaction methods can be used only in patients with L phenotype ARDS. Real-time measures, such a pulse pressure variation, are more appropriate for use during this pandemic compared to ultrasound-derived measures, because contamination of the ultrasound machine can spread infection. Preload challenge tests are suitable for use in all COVID-19 patients. Passive leg raising test is relatively better than mini-fluid challenge test, because it can be repeated without overloading the patient with fluids. Trendelenburg maneuver is a suitable alternative to the passive leg raising test in patients with prone position. If a cardiac output monitor was not available, the response to the passive leg raising test could be traced by measurement of the pulse pressure or the perfusion index. Preload modifying maneuvers, such as tidal volume challenge, can also be used in COVID-19 patients, especially if the patient was in the gray zone of other dynamic tests. However, the preload modifying maneuvers were not extensively evaluated outside the operating room. Selection of the proper test would vary according to the level of healthcare in the country and the load of admissions which might be overwhelming. Evaluation of the volume status should be comprehensive; therefore, the presence of signs of volume overload such as lower limb edema, lung edema, and severe hypoxemia should be considered beside the usual indices for fluid responsiveness.


Subject(s)
Coronavirus Infections/therapy , Critical Care/methods , Fluid Therapy/methods , Pandemics , Pneumonia, Viral/therapy , COVID-19 , Coronavirus Infections/complications , Humans , Pneumonia, Viral/complications , Respiratory Distress Syndrome/complications , Respiratory Distress Syndrome/therapy , Shock, Septic/therapy
9.
J Med Virol ; 92(6): 564-567, 2020 06.
Article in English | MEDLINE | ID: covidwho-142841

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cause china epidemics with high morbidity and mortality, the infection has been transmitted to other countries. About three neonates and more than 230 children cases are reported. The disease condition of the main children was mild. There is currently no evidence that SARS-CoV-2 can be transmitted transplacentally from mother to the newborn. The treatment strategy for children with Coronavirus disease (COVID-19) is based on adult experience. Thus far, no deaths have been reported in the pediatric age group. This review describes the current understanding of COVID-19 infection in newborns and children.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/epidemiology , Pandemics , Pneumonia, Viral/epidemiology , Adolescent , Angiotensin-Converting Enzyme 2 , Betacoronavirus/drug effects , COVID-19 , Cell Line , Child , Child, Preschool , China/epidemiology , Coronavirus Infections/diagnosis , Coronavirus Infections/drug therapy , Coronavirus Infections/transmission , Disease Management , Fluid Therapy/methods , Humans , Infant , Nitric Oxide/therapeutic use , Peptidyl-Dipeptidase A/metabolism , Pneumonia, Viral/diagnosis , Pneumonia, Viral/drug therapy , Pneumonia, Viral/transmission , Protein Binding , Pulmonary Surfactants/therapeutic use , SARS-CoV-2 , Spike Glycoprotein, Coronavirus/metabolism
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