Absent Peripheral Pulses Research Articles

Combination blood pressure lowering therapy in patients with type 2 diabetes: messages from the ADVANCE trial.

The Action in Diabetes and Vascular disease: preterAx and diamicroN Controlled Evaluation (ADVANCE) trial investigated the effects of intensive blood pressure (BP) lowering using a fixed combination of perindopril-indapamide versus placebo in type 2 diabetes (T2D). The study showed that combination perindopril-indapamide had significant benefits in reducing cardiovascular, renal, and mortality events, with consistent relative risk reductions across different patient subgroups. Secondary analyses of ADVANCE have identified novel risk markers in T2D including cessation of BP lowering therapy, absent peripheral pulses and cardiac biomarkers to name a few. ADVANCE also shed light on practical aspects of hypertension management, including the limitations of office BP, tolerability of combination BP lowering therapy across the range of BP levels and the interpretation of changes in serum creatinine after treatment initiation. This review article summarizes the findings of ADVANCE and its subsequent substudies, which have been foundational in our understanding of BP management and the use of combination BP lowering therapy in T2D.

IMPORTANCE OF TIMELY INTERVENTION IN PATIENTS WITH PERIPHERAL ARTERIAL THROMBOEMBOLIC DISEASE

A 38-year old male welder by profession ,smoker presented with complaints of pain in right lower limb of four days duration and absent peripheral pulses from femoral artery downwards .Arterial doppler revealed diffuse thrombus causing total occlusion of right common iliac ,right common femoral and right supercial femoral artery with no ow. Emergency right femoro-popliteal thromboembolectomy was done after which femoral pulsations returned and patient reported pain relief and the limb was warm.

Pulselessness in an HIV Infected adult Female: A Rare Case of Ergotism

Ergotism can present with vascular, neurologic and gastrointestinal symptoms including gangrene in severe cases. In HIV, toxicity from interaction with protease inhibitors has been documented. We report case of a female who took cafergot for migraine resulting in absent peripheral pulses. She made a good recovery with steroids and pentoxyfilline

Surgical management of Coarctation of the Aorta in the Pediatric Population: A fifteen-year experience

Coarctation of the aorta is one of the most commonly encountered congenital heart defects (CHD), in the pediatric population. It is defined as a hemodynamically significant stenosis of the descending aorta, typically at the site of insertion of ductus arteriosus. It has an estimated incidence of 4-6 cases per 100,000 births, accounting for 5-8% of all congenital heart defects [1-4]. According to The New England Regional Infant Cardiac Program (NERICP), coarctation of the aorta is the fourth most common defect requiring surgery during the first year of life [5]. It can present as an isolated lesion or coexist with other cardiac or extra-cardiac congenital defects. The most common one include bicuspid aortic valve, patent ductus arteriosus, ventricular septal defect, mitral stenosis, berry aneurysms in the circle of Willis [6-8]. Clinical presentation is heterogenous, varying from asymptomatic to congestive heart failure, acute pulmonary edema and cardiogenic shock, depending on the degree of coarctation, the development of collateral circulation and age at presentation [9]. During the neonatal period patients may present with circulatory collapse and pulmonary edema, reduced or absent peripheral pulses, tachypnea, lethargy and progressive metabolic acidosis [9-13]. In early childhood, they present primarily with symptoms of congestive heart failure (CHF) including tachypnea, irritability, sweating, feeding difficulties and failure to thrive [9-13]. In adolescence and adulthood patients may be asymptomatic, presenting with non-specific symptoms including exercise intolerance, fatigue and cramps in the lower limbs, recurrent headaches, epistaxis, vertigo, tinnitus, high blood pressure and difference in blood pressure between arms and legs and reduced or absent peripheral pulses [9-13]. Treatment options for coarctation of the aorta include both surgery and catheter-based procedures. Several surgical techniques have been developed including extended resection with end-to-end anastomosis, prosthetic patch aortoplasty, subclavian patch aortoplasty, interposition grafting and extraanatomic bypass grafting [9-11,13-18]. Catheter-based approaches include balloon angioplasty and stenting. The choice is based on the age at presentation, the type of coarctation, and the presence of associated anomalies, as well as other patient-specific characteristics.

Visual Vignette

Case Presentation: A 45-year-old woman, with type 2 diabetes for over 15 years presented to the endocrinology department with claudication pain and deformed toes of the right foot for a duration of 2 years (Fig. 1 A). The claudication distance decreased gradually from 5 to 1 km over the 2-year interval. She denied the presence of pain at rest, due to exposure to severe cold, or due to consumption of ergot products. Her foot examination revealed absent peripheral pulses and shrivelled skin with band like constriction of the soft tissue (open arrows) at the base of the 3rd and 5th toes (Fig. 1 A). Her glycated hemoglobin was 11.6% (103 mmol/mol) and a Doppler study revealed absent flow in the digital arteries. A foot radiograph (Fig. 1 B) revealed resorption of the phalanges and metatarsal heads involving the 3rd and 5th toes (arrow heads) along with calcified dorsalis pedis artery (closed arrow). What is the diagnosis?

The Rare Case of Thromboangiitis Obliterans in a Patient Previously Diagnosed with a Stroke

Thromboangiitis obliterans (Buerger’s disease) is a disease of small and medium-sized vasculature, mainly involving the distal upper and lower extremities in male patients under the age of 45. Smoking tobacco is considered to be a predisposing and triggering agent. This presentation discusses the case of JS, a 35-year old male patient who initially presented with a stroke, followed by pain and swelling in the upper extremity, and finally with pain, absent peripheral pulses, and necrosis of the left lower extremity requiring below knee amputation. This case is of interest due to the rarity of this disease in the developed world, the presentation of a stroke in a young patient later diagnosed with thromboangiitis obliterans, and the use of a prostaglandin analog in treatment. This case highlights the difficulty of making the diagnosis of vasculitis and the time consuming, multispecialty approach that is required. The availability of subspecialists, medical record integration, communication between community hospitals, and the drug Iloprost could have positively affected the patient’s outcomes and prognosis.

Acute Hepatopathy and Coagulopathy in the Canine: A Nursing Care Report

This nursing care report discusses the treatment and management of acute hepatopathy and secondary coagulopathy in the canine as well as the impact this case had on the development of the author's nursing ability. The patient, a nine-year-old Labrador Retriever, was referred for treatment after an episode of vomiting followed by collapse during a walk with their owner. On presentation the patient was tachycardic, tachypnoeic with absent peripheral pulses. After haematological and biochemical analysis of the patient's blood, the clinical team implemented a medical care plan based on two differential diagnoses; xylitol poisoning or leptospirosis. The nursing team delivered an intensive care regimen including extensive patient monitoring, environmental modification, assisted feeding and blood transfusion with strict adherence to barrier nursing protocols. Fortunately, due to the dedicated efforts of the clinical team, the patient successfully recovered and was returned to their family in good health.

A rare case of Takayasu’s arteritis presenting with stroke

Takayasu’s arteritis is a chronic inflammatory large vessel vasculitis of unknown aetiology that commonly affects women of child bearing age. It appears to have an acute early phase, with non- specific symptoms such as hypertension, headache, fever, muscle pain, arthralgia, night sweats and weight loss. Stroke, as presenting feature of Takayasu’s arteritis is rare. Our patient presented with brocas aphasia, right hemiplegia and right-sided facial palsy. Physical examination revealed left-sided carotid bruit and absent peripheral pulses. CT angiography showed to have right subclavian, left internal carotid and middle cerebral arteritis. She was treated with immunosuppressive treatment and showed significant improvement. Though subclavian artery involvement is not rare, presentation with stroke is rare.1 Takayasu’s arteritis must be considered as a cause of stroke in young women.

Absence of Peripheral Pulses and Risk of Major Vascular Outcomes in Patients With Type 2 Diabetes.

The burden of vascular diseases remains substantial in patients with type 2 diabetes, requiring identification of further risk markers. We tested the absence of dorsalis pedis and posterior tibial pulses as predictors of major macrovascular and microvascular events, death, and cognitive decline in this population. Data were derived from 11,120 patients with type 2 diabetes in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation (ADVANCE) study. Absent peripheral pulses at baseline were defined as absence of at least one dorsalis pedis or posterior tibial pulse. Absent compared with present peripheral pulses (n = 2,218) were associated with increased 5-year risks for major macrovascular events (hazard ratio 1.47 [95% CI 1.28-1.69], P < 0.0001), myocardial infarction (1.45 [1.13-1.87], P = 0.003), stroke (1.57 [1.23-2.00], P = 0.0003), cardiovascular death (1.61 [1.33-1.95], P < 0.0001), heart failure (1.49 [1.21-1.84], P = 0.0002), all-cause mortality (1.48 [1.29-1.71], P < 0.0001), major microvascular events (1.17 [1.00-1.36], P = 0.04), nephropathy (1.24 [1.00-1.54], P = 0.04), end-stage renal disease or renal death (2.04 [1.12-3.70], P = 0.02), and peripheral neuropathy (1.13 [1.05-1.21], P = 0.0008) after multiple adjustment. Participants with absent dorsalis pedis or posterior tibial pulses had comparable hazard ratios. Risks increased proportionally with the number of absent peripheral pulses, with the highest risks observed in patients with three or four absent pulses. Every additional absent pulse increases the risk of all outcomes. Absent dorsalis pedis and/or posterior tibial pulses are independent predictors of major vascular outcomes in patients with type 2 diabetes. These simple clinical indicators should be used to improve risk stratification and treatment of these patients.

Endovascular repair of blunt axillo-subclavian arterial injuries as the first line treatment

AimTo report and analyse our results regarding the endovascular management of blunt axillo-subclavian arterial injuries as the first line treatment. MethodsDuring an eight-year period, seven patients (mean age 56.4±14.1 years, all males) with blunt traumatic axillo-subclavian arterial injuries were presented to the emergency department. All patients suffered also from concomitant other injuries and had a supraclavicular haematoma along with diminished or absent upper limb peripheral pulses, while computed tomography angiography set the diagnosis. ResultsThe endovascular procedure was technically successful in all patients. No procedure-related complication was encountered during the in-hospital stay, while none of the patients died. The median hospital stay was 22 days (range 12–46). During a follow-up period spanning an average of 27 months (range 6–44 months) there was one stent-graft thrombosis at 12 months in an otherwise asymptomatic patient that required no further intervention. ConclusionEndovascular technique seems to constitute a reliable approach for treating blunt axillo-subclavian arterial injuries in the emergent setting. Despite uncertainties in patient selection and optimal management algorithms, it seems that endovascular approach could be the first line treatment for such injuries. Accumulation of data on larger number of patients with longer follow-up is warranted to further define the value of this therapeutic modality in the trauma setting.

Hypernatremia in Children With Diarrhea: Presenting Features, Management, Outcome, and Risk Factors for Death.

We sought to investigate the magnitude, clinical features, treatment, and outcome of children suffering from hypernatremic diarrhea and to identify risk factors for fatal outcome among them. We reviewed 2 data sets of children <15 years admitted to the in-patient ward of the Dhaka Hospital of International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b) with diarrhea and hypernatremia (serum sodium ≥150 mmol/L): (a) March 2001 to March 2002 (n = 371) and (b) March 2009 to August 2011 (n = 360). We reviewed their records and collected relevant information for analyses. The prevalence of hypernatremia was 5.1% (371/7212) and 2.4% (360/15 219), case fatality rate was 15% and 19%, respectively. In logistic regression analysis, the risk for death significantly increased in association with serum sodium ≥170 mmol/L, nutritional edema, hypoglycemia, respiratory distress, and absent peripheral pulses and reduced with the sole use of oral rehydration salts (ORS) or ORS following intravenous fluid, if indicated (for all, P < .05). Thus, managing children with hypernatremia using only ORS or ORS following intravenous fluid may help reduce the number of deaths.

Intramyometrial vasopressin as a haemostatic agent: Is it really safe?

Vasopressin when given intramyometrially during myomectomy results in good surgical haemostasis.[1,2] At the same time, there are published reports of adverse cardiac events following vasopressin injection.[3,4] Resuscitation measures following such adverse cardiac events require understanding of pharmacodynamics of vasopressin administration.[5] We present a case of successful resuscitation of complete heart block following intramyometrial vasopressin injection during myomectomy and the associated implications.

Progression of severe sepsis to septic shock in under-five diarrheal children in an urban critical care ward in Bangladesh: Identifiable risks, blood isolates and outcome

Background: Both severe sepsis and septic shock are the terminal events of all infectious diseases including diarrhea and often associated with fatal outcome. However, death is highest in septic shock even in high resource centre in developed countries. Thus, identification of factors associated with septic shock from severe sepsis is critically important. Nevertheless, data are scarce on the clinical predictors of septic shock in under-five children presenting with severe sepsis especially in resource poor settings. We evaluated the factors associated with septic shock and their outcome in such population. Methods: This study involved the analysis of retrospective data in diarrheal children which had been extracted from the hospital management system (SHEBA), an online data base of the Dhaka Hospital of icddr,b. All under-five diarrheal children, admitted to the Dhaka Hospital of the International Canter for Diarrhoeal Diseases Research, Bangladesh (icddr,b) having severe sepsis between October`2010 and September`2011 were studied. Severe sepsis defined as tachycardia plus hypo (?35.0° C) or hyperthermia (?38.5° C), or abnormal WBC count plus presence of infection with poor peripheral perfusion (age specific hypotension and/or absent peripheral pulses or delayed capillary refilling time (CRT) in absence of dehydration. Patient unresponsive to fluid (normal saline/cholera saline) boluses (20 ml/kg; maximum 60 ml/kg and 40 ml/kg in well nourished and malnourished children respectively) and required inotrop(s) categorized as septic shock. Children with (cases=88) and without septic shock (controls=116) wee compared. Results: Median (inter-quartile range) age (months) was comparable among the cases and the controls [5.3 (3.2, 12.0) vs. 5.6 (2.7, 10.0); p = 0.515). Case-fatality-rate was significantly higher among the cases than the controls (67% vs. 14%; p&lt;0.001). In logistic regression analysis after adjusting for potential confounders such as severe under-weight, nutritional edema, respiratory difficulty and pneumonia, cases more frequently had drowsiness on admission (OR = 4.2, 95% CI = 1.3-14.2, p = 0.017), received blood transfusion (OR = 5.8, 95% CI = 2.7-12.2, p &lt;0.001), and required mechanical ventilation (OR = 13.7, 95% CI = 4.8-39.5, p &lt;0.001). Bacterial isolates were equally distributed among the groups but more than three-fourths were gram negatives. Conclusion: The results of our data suggest that darrheal children under five years of age with severe sepsis presenting with drowsiness on admission are vulnerable to develop septic shock and may often require blood transfusion and mechanical ventilation. Thus, clinicians may consider inotrop(s) in such children presenting with the co-morbidity of severe sepsis and drowsiness which may help to prevent mechanical ventilation and death. DOI: http://dx.doi.org/10.3329/bccj.v2i1.19950 Bangladesh Crit Care J March 2014; 2 (1): 10-15

The impact of arterial vessel injuries associated with pediatric supracondylar humeral fractures.

Pediatric supracondylar humeral fractures are regularly complicated by vascular compromise. However, the treatment regimen for pulseless hands with good capillary refill time is discussed controversially. The aim of the present study was to present our treatment strategy in a series of children sustaining supracondylar humeral fractures associated with impaired peripheral blood flow. Medical charts of all children sustaining supracondylar humeral fractures treated between 1995 and 2009 were reviewed. Treatment and the course of patients with impaired peripheral blood flow were evaluated. Patients were invited for a follow-up examination. Forty of 499 patients sustaining a supracondylar humeral fracture presented with peripheral pulselessness. Two children underwent immediate vascular surgery. In the remaining 38 patients, the fracture was reduced, followed by a re-evaluation of the peripheral circulation. Twenty-four of those patients had normal peripheral pulse and capillary refill time, and no further therapy was necessary. Fourteen patients had a persisting absent peripheral pulse after fracture reduction. While in 4 of those patients-including 3 patients with prolonged peripheral capillary refill time-vascular surgery was performed, 10 patients were successfully treated with "watchful waiting." At follow-up of 3.5 years (range, 2-6 years), the performed diagnostic workup including capillary refill time and blood pressure was without pathologic findings in all patients. Our data suggest that blood flow often recovers following reduction of supracondylar fractures with impaired peripheral vascularization. In cases of a "pink pulseless hand" (absent peripheral pulse and good peripheral capillary refill time), "watchful waiting" instead of immediate surgical exploration might be a treatment option. However, further studies with more patients have to be conducted to formulate a recommendation for the treatment of these severe injuries. Therapeutic study, level V.

Time trends in the characteristics of patients undergoing primary total knee arthroplasty.

To study the time trends in sociodemographic and clinical characteristics of patients undergoing primary total knee arthroplasty (TKA). We used the Mayo Clinic Total Joint Registry to examine the time trends in patient demographics (body mass index [BMI] and age), underlying diagnosis, medical (Deyo-Charlson Index) and psychological comorbidity (anxiety and depression), and examination findings of primary TKA patients from 1993-2005. We used the chi-square test and analysis of variance. In total, 7,229 patients constituted the primary TKA cohort; 55% were women. The mean age decreased by 1.3 years (69.3 to 68.0 years), mean BMI increased by 1.7 kg/m(2) (30.1 to 31.8 kg/m(2) ), and mean Deyo-Charlson Index increased by 36% (1.1 to 1.5) over the 13-year study period (P ≤ 0.001 for all). Compared with 1993-1995, significantly more patients (by 2-3 times) in 2002-2005 had a BMI ≥40 kg/m(2) (4.8% versus 10.6%), age <50 years (2.9% versus 5.2%), Deyo-Charlson Index of ≥3 (12% versus 22.3%), depression (4.1% versus 14.8%), and anxiety (4.1% versus 8.9%), and significantly fewer patients had an underlying diagnosis of rheumatoid/inflammatory arthritis (6.4% versus 1.5%; P < 0.001 for all). Compared with 1993-1995, significant reductions were noted in 2002-2005 for the physical examination findings of anteroposterior knee instability, mediolateral knee instability, moderate to severe knee synovitis, severe limp, fair or poor muscle strength, and absent peripheral pulses (P ≤ 0.001 for all). In this large US total joint registry study, we found significant time trends in patient characteristics, diagnosis, comorbidity, and knee/extremity examination findings in primary TKA patients over 13 years. These secular trends should be taken into account when comparing outcomes over time and in policy-making decisions.

Prevalence, clinical features, and outcome of pseudomonas bacteremia in under-five diarrheal children in bangladesh.

We sought to evaluate the prevalence, associated factors, and outcome of under-five diarrheal children with either sex having Pseudomonas bacteremia. A retrospective chart review of under-five diarrheal children admitted to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), from January 2011 to December 2011 was performed using an online hospital management system. Children with Pseudomonas bacteremia constituted the cases (n = 31), and the controls (n = 124), without Pseudomonas bacteremia, were randomly selected. The prevalence of Pseudomonas bacteremia was 1% (31/5,179). The Pseudomonas was multidrug resistant but was 84% sensitive to ceftazidime and 100% to imipenem. The case-fatality rate was significantly higher among the cases than the controls (26% versus 5%; P = 0.003). In logistic regression analysis, after adjusting for potential confounders such as severe wasting, severe underweight, severe pneumonia, and young age (11.71 (4.0, 18.0) months), the cases more often presented with absent peripheral pulses in absence of dehydration (95% CI = 2.31–24.45) on admission. This finding underscores the importance of early identification of this simple clinical sign to ensure prompt management including fluid resuscitation and broad spectrum antibiotics to help reduce morbidity and mortality in such children, especially in resource-poor settings.

Diagnostic and classification criteria of Takayasu arteritis

Takayasu arteritis (TA) is a chronic large vessel vasculitis that affects aorta, its main branches and pulmonary arteries. The inflammatory process results in stenosis, occlusion, dilation or aneurysm formation in the arterial wall. TA has been described in different parts of the world and affects predominantly young individuals (<50 years of age). Patients with TA may present constitutional symptoms, vascular pain (e.g. carotidynia) and typical features such as limb claudication, decreased or absent peripheral pulses, vascular bruits, hypertension, and reduction or discrepancies in blood pressure between arms. A proper diagnosis of TA is an important issue since delays may result in significant morbidity. The definition of TA was included in the 1994 and 2012 Chapel Hill Consensus Conference and TA was categorized as a large vessel vasculitis. The first diagnostic criteria for TA were developed by Ishikawa in 1988 and modified by Sharma et al., in 1995. Two sets of classification criteria were developed for TA to include patients in epidemiologic studies and clinical trials: the 1990 ACR Classification Criteria for TA and the Classification Criteria for childhood TA proposed by the European League Against Rheumatism (EULAR), the Pediatric Rheumatology European Society (PRES) and by the Pediatric Rheumatology International Trials Organization (PRINTO) to be used for patients younger than 18 years. The Diagnostic and Classification Criteria in Vasculitis Study (DCVAS) is an international effort that is under way to develop a single classification system and a validated set of diagnostic criteria for systemic vasculitides using data-driven methods.

Predictors of Meningitis in Under-Fifteen Children Attending an Intensive Care Unit of an Urban Large Diarrheal Disease Hospital in Bangladesh

Background: Data are lack on predicting features of meningitis in diarrheal children although the great clinical importance. Objective: To evaluate clinical and laboratory features in predicting meningitis in under-fifteen children having diarrheal illnesses. Methods: Children aged 1 month to 15 years, admitted in the ICU of the Dhaka Hospital of icddr, b between March 2011 and February 2012 with fever and seizure or altered consciousness and having LP done were enrolled into this analysis. Those children who had abnormal CSF findings [pleocytosis (normal range of leukocyte, 0 - 10/mm3) and/or elevated protein (normal range, 0.10 - 0.45 mg/dl) and low glucose (normal value, 60% of corresponding blood glucose)] were defined as meningitis. Comparison was made between children with (cases = 17) and without meningitis (controls = 66) from our study children. Data were retrospectively collected from SHEBA, an online database system of the Dhaka Hospital of icddr, b. Results: Death was significantly higher among the cases compared to the controls (29% vs. 3%, p = 0.003). In logistic regression analysis, after adjusting for potential confounders, cases frequently had hypoxemia (95% CI 1.55 - 21.93), absent peripheral pulse (95% CI 1.95 - 27.13) and neutrophilia (95% CI 1.13 - 17.00). Conclusion: Our data suggest that children with meningitis had higher case fatality rate. Simple independent predictors of meningitis such as hypoxemia, absent peripheral pulse, and neutrophilia may help clinicians to initiate early and prompt management in order to curve lifelong sequel due to meningitis and death in such patient population especially those in resource poor settings.

Serum Homocysteine Level in Type 2 Diabetes Mellitus with Peripheral Arterial Disease

Peripheral arterial disease is a macrovascular complication of type 2 diabetes mellitus. Hyper-homocysteinemia is found to be associated with peripheral arterial disease. Homocysteine induced endothelial-cell injury is mediated by hydrogen peroxide. Hydrogen peroxide exposes the underlying matrix and smooth muscle cells of the arteries which, in turn, proliferate and promote the activation of platelets and leukocytes. The present study was carried out in the Department of Biochemistry, Dhaka Medical College, Dhaka from July 2010 to June 2011 to observe the association of hyperhomocysteinemia with peripheral arterial disease in type 2 diabetes mellitus. A total of 100 subjects (50 cases and 50 controls) were selected by purposive sampling from Bangladesh Institute of Health sciences (BIHS) and BIRDEM Hospital, Dhaka. Subjects having ankle brachial index &lt;0.9 were considered as cases and those having ankle brachial index 0.9 were considered as controls. Subjects with absent peripheral pulses or nonrecordable ankle brachial index were considered as ankle brachial index &lt;0.9. All study subjects were normotensive, normolipidemic and non- smoker. The study showed a higher level of homocysteine (?mol/L) in cases when compared with that of controls (15.95±1.80 vs. 9.31±2.11; p&lt;0.001). In cases, males had higher proportion of arterial disease (56%) than females. Other variables (age and body mass index) showed no significant difference between two groups. DOI: http://dx.doi.org/10.3329/bjmb.v6i1.13282 Bangladesh J Med Biochem 2013; 6(1): 14-18

Predictors of death in under‐five children with diarrhoea admitted to a critical care ward in an urban hospital in Bangladesh

To evaluate the clinical and laboratory predictors of death in hospitalized under-five children with diarrhoea. This is a prospective cohort study carried out in the Special Care Ward (SCW) of the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh. All admitted diarrhoeal children of both sexes, aged 0-59 months, from September 2007 through December 2007 were enrolled. We compared and analysed factors among diarrhoeal children who died (n = 29) with those who survived (n = 229). In logistic regression analysis, after adjusting for potential confounders (infusion of intravenous fluid and immature PMN), absent peripheral pulse even after complete rehydration (OR 10.9, 95% CI 2.1-56.8; p < 0.01), severe malnutrition (OR 7.9, 95% CI 1.8-34.8; p < 0.01), hypoxaemia (OR 8.5, 95% CI 1.0-75.0; p = 0.05), radiological lobar pneumonia (OR 17.8, 95% CI 3.7-84.5; p < 0.01) and hypernatraemia (OR 15.8, 95% CI 3.0-81.8; p < 0.01) were independently associated with deaths among diarrhoeal children admitted to SCW. Thus, the absence of peripheral pulses even after full rehydration, severe malnutrition, hypoxaemia, lobar pneumonia and hypernatraemia are independent predictors of death among the under-five children with diarrhoea admitted to critical care ward of a resource-limited setting in Bangladesh.