ABSTRACT
How to cite this article: Shastri PS, Taneja S. Dengue and Other Viral Hemorrhagic Fevers. Indian J Crit Care Med 2021;25(Suppl 2):S130-S133.
ABSTRACT
A 65-year-old gentleman was referred to our hospital with encephalopathy and renal failure. His medications included lithium for the treatment of bipolar disorder. The clinical examination and the laboratory investigations that followed revealed findings classical of lithium overdose. The patient was successfully managed and discharged from the hospital on Day 9 of admission. Clinicians should be aware of this rather unusual and relatively rare differential cause of acute on chronic renal failure with encephalopathy.
Subject(s)
Antimanic Agents/poisoning , Drug Overdose/therapy , Lithium Compounds/poisoning , Renal Dialysis , Acute Kidney Injury/chemically induced , Acute Kidney Injury/therapy , Aged , Bipolar Disorder/drug therapy , Consciousness Disorders/chemically induced , Consciousness Disorders/therapy , Humans , Male , Renal Insufficiency, Chronic/chemically induced , Renal Insufficiency, Chronic/therapyABSTRACT
PURPOSE: Differentiation between culture-negative sepsis and noninfectious systemic inflammatory response syndrome (SIRS) remains a diagnostic challenge for clinicians, both conditions having similar clinical presentations. Therefore, a swift accurate diagnostic tool, which helps differentiate these 2 conditions would immensely aid appropriate therapeutic continuum. This prospective study was conducted to evaluate the potential diagnostic role of biomarkers, procalcitonin (PCT) and interleukin 6 (IL-6), in culture-negative sepsis patients. METHODS: Enrolled patients (208) included 46 noninfectious SIRS, 90 culture-negative sepsis, and 72 culture-positive sepsis. Culture, PCT, and IL-6 estimations were performed on day 1 of intensive care unit admission. RESULTS: Procalcitonin and IL-6 levels were significantly higher (P < .001) in both culture-negative and culture-positive groups as compared with SIRS group. Procalcitonin was a better predictor of sepsis in both culture-negative (area under curves 0.892 vs 0.636) and culture-positive (area under curves 0.959 vs 0.784) groups as compared with IL-6. In culture-negative group, the best cutoff point for PCT was at 1.43 ng/mL (92% sensitivity; 83% negative predictive value), best cutoff point for IL-6 was at 219.85 pg/mL (47% sensitivity and 42% negative predictive value). CONCLUSIONS: Procalcitonin can accurately differentiate culture-negative sepsis from noninfectious SIRS and thereby contribute to early diagnosis and effective management of these conditions.
Subject(s)
Calcitonin/blood , Interleukin-6/blood , Protein Precursors/blood , Sepsis/diagnosis , Systemic Inflammatory Response Syndrome/diagnosis , Adolescent , Adult , Aged , Aged, 80 and over , Area Under Curve , Bacteremia , Biomarkers/blood , Calcitonin Gene-Related Peptide , Diagnosis, Differential , Early Diagnosis , Female , Humans , Intensive Care Units , Male , Middle Aged , Prospective Studies , Sensitivity and Specificity , Sepsis/blood , Sepsis/microbiology , Systemic Inflammatory Response Syndrome/blood , Young AdultABSTRACT
OBJECTIVE: To assess the influence of proseal laryngeal mask airway (PLMA) insertion on intraocular pressure (IOP). AIM: We compared the effects of PLMA insertion and laryngoscopic intubation on IOP and hemodynamic response in pediatric patients. BACKGROUND: Previous studies have shown that there is no hemodynamic response to PLMA insertion similar to classic LMA insertion, but there is no published report about the influence of PLMA insertion on IOP. Conventional laryngoscopic tracheal intubation evokes a rise in IOP and cardiovascular response and has been traditionally used to secure the airway in pediatric patients undergoing ophthalmic surgery. MATERIALS AND METHODS: 59 patients, less than 14 years of age, scheduled for elective ophthalmic surgery were randomly divided into two groups, group P, in which the patient's airway was secured with PLMA (using introducer tool technique), and group T, in which the airway was secured with laryngoscopy-guided endotracheal intubation. Heart rate, blood pressure, and IOP were measured just before insertion of the airway device and subsequently three times at intervals of 1 min after insertion of the airway device. RESULTS: In group T, there was a significant rise in IOP as well as hemodynamic parameters recorded. In group P, there was no significant rise in hemodynamic parameters, but a significant rise in IOP was found though the rise was less than in group T. CONCLUSION: We conclude that the PLMA use is associated with lesser cardiovascular response and rise in IOP as compared to tracheal intubation.
