ABSTRACT
Little research has been carried out into the infusion of intravenous sterile water for the treatment of hypernatraemia, and it remains a contentious issue. We conducted a review of the literature and extract results following an extensive search of Medline 1946, Embase 1974, ProQuest, evidence-based practice resources, national and international guideline sites and the publications of various professional bodies. The review is presented on the infusion of sterile water (hypotonic fluid) to lower serum sodium level in those circumstances when enteral supplementation of water is not possible, such as in postoperative patients or when other isotonic fluids (such as 5% dextrose in water infusion) are less than ideal-for example, hyperglycaemic patients on an insulin infusion. Absence of guidelines has limited the use of sterile water, even as an off-label drug when it can be administered relatively safely via a central line.
Subject(s)
Hyperglycemia/therapy , Water/administration & dosage , Humans , Infusions, Intravenous , Off-Label Use , Sodium/blood , SterilizationABSTRACT
We present a case study of a severe episode of iodine toxicity following povidone-iodine wash with clinical manifestations of cardiovascular collapse, metabolic acidosis, renal failure and seizures. Povidone-iodine has been used as a medical antiseptic and disinfectant since 1952 Iodine toxicity secondary to povidone-iodine use is rare. Iodine toxicity is difficult to diagnose and the diagnosis is made by a high index of suspicion. Toxicity due to iodine correlates with serum and urine iodine levels. Treatment of iodine toxicity is supportive. A review of literature relating to the components of povidone-iodine, iodine metabolism, its manifestations and management of iodine toxicity secondary to povidone-iodine is also presented. An Ovid-Medline search from 1950 to 2009 revealed 1236 articles on the clinical manifestations of povidone-iodine usage but no article on iodine toxicity relating to povidone-iodine based on the following search criteria: povidone-iodine and/or iodine toxicity secondary to povidone-iodine (limited to English language, review articles, full text and human patients).
Subject(s)
Acidosis/chemically induced , Anti-Infective Agents, Local/adverse effects , Heart Arrest/chemically induced , Povidone-Iodine/adverse effects , Renal Insufficiency/chemically induced , Seizures/chemically induced , Acidosis/therapy , Aged , Anti-Infective Agents, Local/therapeutic use , Anticonvulsants/therapeutic use , Diuretics/administration & dosage , Fluid Therapy , Follow-Up Studies , Furosemide/administration & dosage , Heart Arrest/therapy , Hemodiafiltration , Humans , Iodine/adverse effects , Iodine/therapeutic use , Male , Povidone-Iodine/therapeutic use , Renal Insufficiency/therapy , Seizures/drug therapy , Therapeutic Irrigation/adverse effects , Therapeutic Irrigation/methodsABSTRACT
We report an unusual complication of pulmonary artery catheterisation related to the removal of the pulmonary artery catheter introducing sheath. The sheath had been accidentally tethered to the suture line of the superior vena cava following cardiopulmonary bypass surgery. Physicians and nurses should abandon attempts to remove the pulmonary artery catheter or the introducing sheath after cardiac surgery if any resistance is noted. Minimal force might result in serious morbidity or death.
Subject(s)
Catheterization, Swan-Ganz/adverse effects , Postoperative Complications , Sutures , Aged , Cardiac Surgical Procedures , Device Removal , Female , Humans , Vena Cava, SuperiorABSTRACT
Levosimendan is a myocardial calcium sensitiser and potassium-ATP channel opener Levosimendan has been used in critically ill patients in various conditions to support myocardial function as an inotrope, lusitrope and vasodilator. We report the use of levosimendan in a patient with invasive streptococcal septic shock.
