Pathogenetic aspects of circulation and hidration and acid-base statuses in the clinical course of toxic epidermal necrolysis

Abstract

Aim: the aim of our research was the study of changes of circulation and hydration and acid-based statuses at the different stages of TEN clinical course and it gives a possibility for further optimization of therapy of this kind of patients and to diminish lethality.Methods. There were observed 13 patients with toxic epidermal necrolysis, 8 men and 5 women. For assessment of the state of patients and the clinical course were determined the next parameters of homeostasis: hematocrit, central venous pressure (CVP), arterial pressure (systolic, diastolic, sphygmic ones), blood plasma osmolarity, extracellular liquid and circulating blood volume deficiency, diurnal diuresis, Algover shock index, the determination of the main acid-based status parameters. Results. The examined patients with the different variants of TEN clinical course in the period of detailed clinical picture were at the state of essential circulation and hydration disorders that were verified by the low arterial systolic and sphygmic pressure and extremely low CVP. The patients with TEN were in shock of the 2-3 degree according to the rate of the shock index. In patients with TEN were fixed metabolic acidosis, subcompensated by the respiratory alkalosis with the deviation of buffer bases. Conclusions: So in patients with TEN were noticed the essential disorders of hemostasis, caused by dehydration characterized with circulation instability as an effect of extracellular isotonic dehydration. Depending on the period of disease hemodynamic and oxygenated disorders are attended with metabolisms disturbance. The fixed deviation of buffer bases essentially oxidizes the internal medium of organism and allow suggest the circulating genesis of these disorders. So only the learning pathogenetic links of so heavy dermatosis as toxic epidermal necrolysis allows carry out the pathogeneticaly grounded therapy and diminish lethality