Intravenous Fluid Replacement Research Articles

Hyperglycemic Crisis: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State

The two most severe metabolic consequences of diabetes mellitus (DM) are diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemia state (HHS). Type 1 and type 2 diabetics are both susceptible to these illnesses. Hyperglycemia, ketone body production, and metabolic acidosis are symptoms of DKA. Hyperosmolality, high blood glucose increase, and little to no ketosis are signs of HHS. Despite significant advancements, it has been difficult to come to a consensus on the diagnostic criteria and course of therapy for both disorders. Another difficulty is that there is a large overlap between these two extremities of the hyperglycemia crisis continuum. A thorough biochemical and clinical patient evaluation, along with prompt diagnosis and therapy, has long been recognized as being essential for symptom relief. Intravenous insulin, fluid replacement, and concurrent management of the triggering causes all form the cornerstones of therapy. Large-scale research that contributes to the definition of how hyperglycemic crises should be handled is lacking globally. A thorough analysis of the pathogenesis, diagnosis, and treatment of DKA and HHS will be provided in this article.

The 2023 Türkiye-Syria earthquakes: analysis of pediatric victims with crush syndrome and acute kidney Injury

BackgroundOn February 6th, 2023, two consecutive earthquakes struck southeastern Türkiye with magnitudes of 7.7 and 7.6, respectively. This study aimed to analyze the clinical and laboratory findings, as well as management of pediatric victims with Crush Syndrome (CS) and Acute Kidney Injury (AKI).MethodsThe study included pediatric earthquake victims who were presented to Mersin University Hospital. Clinical and laboratory characteristics of the patients were collected retrospectively.ResultsAmong 649 patients, Crush injury (CI), CS and AKI was observed in 157, 59, and 17 patients, respectively. White blood cell count (12,870 [IQR: 9910–18700] vs. 10,545 [IQR: 8355–14057] /µL, P < 0.001), C-reactive protein (51.27 [IQR: 14.80–88.78] vs. 4.59 [1.04–18.25] mg/L, P < 0.001) and myoglobin levels (443.00 [IQR: 198.5–1759.35] vs. 17 [11.8–30.43] ng/ml) were higher in patients with CS, while their sodium (IQR: 134 [131–137] vs. 136 [134–138] mEq/L, P < 0.001) levels were lower compared to non-CS patients. An increase in myoglobin levels was identified as an independent risk factor for developing CS (OR = 1.017 [1.006–1.027]). Intravenous fluid replacement was administered to the patients with CS at a dose of 4000 cc/m2/day. Hypokalemia was observed in 51.9% of the CS patients on the third day. All patients with AKI showed improvement and no deaths were reported.ConclusionsHyponatremia and increase in inflammation markers associated with CS may be observed. An increase in myoglobin levels was identified as a risk factor for CS. Hypokalemia may be seen as a complication of vigorous fluid therapy during hospitalization.Graphical abstractA higher resolution version of the Graphical abstract is available as Supplementary information

1376. A Retrospective Analysis of Intravenous Fluid Therapy Practice at Hospital Admission for Adults with Dengue

Abstract Background Dengue epidemics in Asia was almost exclusively a childhood disease but recently dengue in adults have become increasingly prevalent. Yet intravenous fluid replacement (IVFR), the main supportive therapy for dengue, was developed for pediatric dengue. Evidence-based guidance for fluid replacement, especially for older adults with concomitant chronic diseases that both increases risk of severe dengue and complicate fluid replacement, is lacking. We retrospectively analyzed the use of IVFR in adult dengue patients at admission to a tertiary hospital. Methods Medical records of patients diagnosed with dengue (confirmed by rapid NS1 kit or laboratory confirmation of RT-PCR, NS1 or IgM) from January 2020 to December 2022 were analyzed. Recovery phase was defined as fever defervescence for &amp;gt;12 hours with rising platelet count. Appropriateness of IVFR was based on disease severity according to the 2009 WHO dengue classification scheme. Results Preliminary analysis of the first 30 patients found an almost equal number of males (47%) and females. The median age was 52.5 years (range 15.0-83.0). 20 patients had at least one comorbidity with hyperlipidemia (33%), hypertension (23%) and ischemic heart disease (10%) being the most common. Average time from onset to presentation was 4.3 days (95% CI: 3.8-4.9). 16 (53%) met the WHO classification scheme as requiring IVFR at admission; 4 hypotension, 5 acute kidney injury (AKI), 2 hypotension with AKI, 4 hemoconcentration, 1 AKI with hemoconcentration. Of these 16, one also had altered mental status and another had hemophagocytic lymphohistiocytosis-like presentation. Despite 47% having uncomplicated dengue, all patients had IVFR at admission. Total fluid volume administered during hospitalization varied across the population and fluctuated daily for each patient, with 8 patients receiving IVFR beyond the recovery phase. One developed fluid overload while another had IV cannula-related thrombophlebitis. There was no mortality. Conclusion Preliminary findings of our on-going study suggest excessive use of IVFR and the lack of standardization possibly contributed to two iatrogenic complications. We call for development of evidence-based protocol on fluid management in older dengue patients. Disclosures All Authors: No reported disclosures

Evaluation of myocardial infarction by a 12-lead routine electrocardiogram: a case report of an ST-segment elevation.

The spiked helmet sign (SHS) is a type of ST-segment elevation associated with critical cardiac disease and a high risk of death. We report a case of SHS caused by an ECG artifact. A 60-year-old male patient presented to the clinic after suffering an electric shock. The initial 12-lead routine elec-trocardiogram showed an SHS. The patient received appropriate intravenous fluid replacement therapy, and after 30 minutes, the ST-T changes of the 12-lead electrocardiogram were all restored to normal. The patient was discharged after a 24-hour observation period in the emergency room.Recent studies have pointed out that there may be two different types of SHS. One is the mechanical factor, and the other is the significant prolongation of the QT interval. The two types have different clinical significance. In our report, the radial artery of the patient’s right wrist pulsed strongly, and after the occurrence of SHS, the SHS disappeared after adjusting the contact position of the electrode in his right arm. This SHS caused by mechanical traction was an ECG artifact.Although the SHS may be an essential indicator of critical illness, there are mechanical factors that lead to the appearance of ECG artifacts. Therefore, in clinical work, obtaining a complete medical history and primary conditions of the patient at the time of ECG sampling is necessary to help the diagnosis and thus avoid er-roneous treatment.

New-onset severe Diabetic Ketoacidosis in a 13-months old Nepali Toddler: a case report

Diabetes mellitus (DM) is a glucose metabolism disorder with diabetic ketoacidosis (DKA) being the most common complication associated with significant morbidity and mortality. Unlike other patients with typical symptoms of abdominal discomfort, pain, nausea and emesis of DKA, our patient presented with atypical symptoms such as cough, runny nose and fast breathing. This symptoms would have initially misled with diagnosis of respiratory tract infection, which would have caused delay in the treatment of DKA. In our patient DKA was treated with intravenous fluid replacement followed by intravenous insulin infusion, along with monitoring of blood glucose and electrolyte levels. We would like to emphasize that DKA can be precipitated by simple upper respiratory tract infection in toddlers with undiagnosed type 1 DM. Hence, random blood sugar measurement and urine for ketone bodies test should be performed if feasible in sick patients presenting with respiratory tract illness-like symptoms.

Hyperosmolar Hyperglycaemic State: A Life-Threatening Complication of Type 2 Diabetes Patients

Hyperosmolar hyperglycaemic state (HHS) is a life-threatening complication of type 2 diabetes (T2D), but it is preventable. There is no precise definition of HHS. It is characterized by severe hyperglycaemia with blood glucose levels greater than 600 mg/dl (33.3 mmol/l), a marked increase in serum osmolality greater than 320 mOsm/kg, and severe dehydration without significant ketoacidosis (&lt;3 mmol/l). Early clinical diagnosis and prompt treatment, such as insulin therapy, restoration of electrolyte disturbances and management of concurrent illnesses may improve the outcome. Intravenous insulin and fluid replacement with careful monitoring are the main treatment policy of HHS. In this study an attempt has been taken to discuss various effects of HHS with prevention and treatment of this complication of diabetes.

Carica papaya extract: a new leaf in treating dengue?

Carica papaya extract: a new leaf in treating dengue?

Choosing fluids to reduce the risk of delayed graft function after deceased donor kidney transplantation

Delayed graft function (DGF) after deceased donor kidney transplantation, defined clinically as the need for at least one dialysis session within the first week after transplantation, is a common occurrence. 1 Swanson KJ Bhattarai M Parajuli S Delayed graft function: current status and future directions. Curr Opin Organ Transplant. 2023; 28: 1-7 Crossref PubMed Scopus (0) Google Scholar Use of organs that are predisposed to DGF is increasing, 2 NHS Blood and TransplantOrgan and tissue donation and transplantation. Activity Report 2021/22. nhsbtdbe.blob.core.windows.net/umbraco-assets-corp/27108/activity-report-2021-2022.pdfDate accessed: March 23, 2023 Google Scholar meaning it is important to consider the clinical sequelae of DGF. In a systematic review and meta-analysis of 38 studies, 3 Li MT Ramakrishnan A Yu M et al. Effects of delayed graft function on transplant outcomes: a meta-analysis. Transplant Direct. 2023; 9: e1433 Crossref PubMed Scopus (1) Google Scholar DGF was associated with adverse short-term and long-term outcomes, including risk for rejection, graft failure, and (in single-centre studies only) all-cause mortality. Some studies suggest the duration of DGF is more important than its occurrence. 4 Schrezenmeier E Müller M Friedersdorff F et al. Evaluation of severity of delayed graft function in kidney transplant recipients. Nephrol Dial Transplant. 2022; 37: 973-981 Crossref PubMed Scopus (2) Google Scholar However, any DGF has a real-world impact on patients and can influence decision making for clinicians. For example, a third of North American transplant professionals indicated in a survey that the risk of DGF had a role in their willingness to accept organs, 5 Jadlowiec CC Hippen B Gill J et al. Current opinions on DGF management practices: a survey of the United States and Canada. Clin Transplant. 2023; 37: e14949 Crossref PubMed Scopus (0) Google Scholar and strategies to reduce DGF are a clinical priority. A simple intervention to reduce DGF might relate to optimising intravenous fluid replacement. Isotonic sodium chloride (0·9% saline) is the standard of care in many transplantation units. However, 0·9% saline might be harmful due to its high chloride content, which causes metabolic acidosis and can promote acute kidney injury, thus DGF. 6 Yunos NM Bellomo R Hegarty C Story D Ho L Bailey M Association between a chloride-liberal vs chloride-restrictive intravenous fluid administration strategy and kidney injury in critically ill adults. JAMA. 2012; 308: 1566-1572 Crossref PubMed Scopus (844) Google Scholar Balanced crystalloid solution versus saline in deceased donor kidney transplantation (BEST-Fluids): a pragmatic, double-blind, randomised, controlled trialAmong patients receiving a deceased donor kidney transplant, intravenous fluid therapy with balanced crystalloid solution reduced the incidence of DGF compared with saline. Balanced crystalloid solution should be the standard-of-care intravenous fluid used in deceased donor kidney transplantation. Full-Text PDF

Intravenous Fluid Replacement Therapy and Hospital Outcomes for Vaso-Occlusive Episodes in Patients with Sickle Cell Disease

Background: Vaso-occlusive event (VOE) is the most common reason for hospitalization in pediatric patients with sickle cell disease (SCD) and can cause significant morbidity and mortality. Fluid replacement in patients with VOE can reduce the sickling process and volume replete, however clinical practices regarding fluid therapy in SCD vary across different institutions. A large contributor to this variation is the lack of evidence surrounding the amount, rate, or type of fluid that should be used during a pain crisis episode. The goal of this retrospective analysis is to examine the relationship of average amount of fluid replacement with length of hospitalization and risk for adverse events, such as acute chest syndrome (ACS), transfer to the pediatric intensive care unit (ICU) and readmission (within 4 weeks from previous admission), at a large academic institution. Our hypothesis is that excessive fluid therapy prolongs hospital length of stay (HLOS) and increases risk for the aforementioned adverse events. Methods: This was a retrospective analysis from a single center between January 2015 and April 2020. Patients with SCD (HbSS, HbSC, HbS-β0 thalassemia, or HbS-β⁺ thalassemia), aged 0- 30 years, with consecutive admissions hospitalized for VOE were included after local IRB approval. Records were reviewed for demographic variables such as age and gender, as well as clinical parameters, such as intravenous fluid therapy, tonicity, total fluid amount, medical history, intravenous pain medication, oral pain medication, and treatment during hospitalization. Results: A total of 617 hospitalizations in 162 patients were included in this study. One hundred forty-one (22.9%) of the 617 hospitalizations experienced ACS; and in 55 (9%) of these hospitalizations, ACS developed during the hospital stay. Fifteen (2.4%) of the 617 hospitalizations required transfer to the pediatric ICU; 7 of the 15 hospitalizations required transfer for exchange transfusion, 7 required transfer for acute hypoxemic respiratory failure, and 1 for hypertension. One hundred twenty-one (19.7%) of the 617 hospitalizations required readmission within four weeks of their previous admission. A Pearson correlation coefficient assessing the relationship between HLOS (days) and average IV fluid over admission (ml/kg/day) showed that more IV fluid therapy was associated with shorter HLOS (r = -0.140 and p = < 0.01). In a univariate analysis, oxygen requirement, acute chest syndrome, ICU transfer, readmission within four weeks, history of chronic pain, treatment with hydroxyurea, not receiving a normal saline bolus, and requiring a transfusion were associated with a prolonged hospital stay (p = < 0.05). A multivariable linear regression showed that ICU transfer, readmission within four weeks, history of chronic pain, treatment with hydroxyurea and requiring a transfusion were significantly associated with a prolonged hospital stay. Moreover, oxygen requirement and requiring a transfusion were significantly associated with developing ACS during their hospitalization (OR=11.094, 95% CI=5.32, 23.15) and (OR=4.69, 95% CI= 2.18, 10.09), respectively. Chronic pain was significantly associated with readmission within four weeks (OR=6.40, 95% CI=3.84, 10.65). Conclusions: This retrospective study suggests that IV fluid therapy was associated with shorter HLOS and lower incidence of complications such as ACS. However, clinical parameters such as chronic pain and treatment with hydroxyurea were associated with prolonged LOS. These results differ from previous studies and highlight the need for prospective multicenter studies to clarify the relationship between IV fluid therapy, HLOS and adverse events in patients with sickle cell disease. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

PSAT302 Hypothyroidism Induced Nontraumatic Rhabdomyolysis: a Rare Cause of a Potentially Fatal Condition

Abstract Introduction Severe hypothyroidism can present with a vast array of clinical presentations, including musculoskeletal symptoms in up to 80% of patients. These symptoms can vary from simple muscle weakness and myalgias to rare complications such as rhabdomyolysis. Rhabdomyolysis, a syndrome characterized by degradation of muscle tissue, can occasionally lead to life-threatening complications including hyperkalemia, cardiac arrhythmias, and acute renal failure. We describe an interesting case of an otherwise healthy 19-year-old female with a past medical history of asthma who presented with nontraumatic rhabdomyolysis secondary to untreated hypothyroidism. Case description A 19-year-old female and college athlete of Asian descent with a past medical history of asthma presented to her primary care provider for acute and progressive swelling in her face, hands, and lower extremities bilaterally. In addition, she reported the onset of oligomenorrhea, decreased concentration, and myalgias for the past year. After relevant labwork was sent, the patient was found to have an extremely elevated TSH of 491.6 mIU/L with an undetectable level of free T4. She was referred for emergent hospital evaluation where notable lab findings included: creatinine 1.35 mg/dL, AST 300 IU/L, ALT 155 IU/L, LDH 888 IU/L, prolactin 41 ng/dL, and creatine kinase 8,380 IU/L. She was also found to be bradycardic (heart rate of 48 beats per minute) with low voltage QRS complexes on electrocardiography. She was admitted for treatment of newly diagnosed, severe hypothyroidism complicated by significant rhabdomyolysis. During her hospitalization, TPO antibodies were found to be negative however she was found to have a positive TSI level of 263% from baseline and positive antithyroglobulin of 6.7 units. Following treatment with weight-based intravenous levothyroxine (70 mcg daily), oral liothyronine (5 mcg twice daily), and intravenous fluid replacement with normal saline, the patient's condition and lab abnormalities improved significantly. She was eventually discharged and transitioned to oral levothyroxine (88 mcg). Seen in subsequent outpatient endocrinology follow-up, the patient has had normalization of all labs, including TSH, free T4, prolactin, creatinine kinase, and creatinine levels. She has experienced a complete resolution of myxedema symptoms and has had resumption of normal menses. Discussion Untreated or suboptimally treated hypothyroidism can be causative of various musculoskeletal manifestations including rhabdomyolysis. Hypothyroidism can induce muscle damage via various mechanisms including impaired glucose and triglyceride metabolism, glycosaminoglycan deposition in type I and II muscle fibers, decreased contractility of the actin-myosin unit and slowed ATP turnover. It is important to recognize hypothyroidism as a potential cause of non-traumatic rhabdomyolysis as prompt treatment with thyroid hormone can help prevent worsening muscle injury. As typically seen alongside myxedema with or without coma, treatment should be done in the inpatient setting with close hemodynamic and clinical monitoring and should include intravenous thyroid hormone, intravenous fluids and supportive care. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

DENGUE and its Prevalence

About 2.5 billion individuals worldwide are infected with the dengue virus (DENV), an important arthropod-borne viral disease, of which 975 million reside in both large and small cities in tropical and subtropical regions of Southeast Asia, the Pacific, and the America. Dengue is presently endemic in more than 100 countries as a result of a sharp increase in incidence over the past few decades [1]. Aedes genus mosquitoes, particularly Aedes aegypti or Aedes albopictus, which are infected females and transmit the dengue virus, which is a member of the Flaviviridae family, infect people. Primary infection and secondary infection are the two types of diseases brought on by the dengue virus. A complicated immune response clears dengue fever (DF), an acute febrile sickness brought on by a primary infection, in about seven days. Haemorrhagic fever (DHF) or dengue shock syndrome (DSS) are the effects of a secondary infection that is more severe. Pakistan is at a significant risk for dengue endemics because of its congested cities, contaminated water, poor sanitation, huge refugee population, and low immunisation rates [2]. Dengue fever (DF), as well as more severe DHF/DSS, can be brought on by the dengue virus. Within three to five days of an infection, DF might result in a fever, which is accompanied by thrombocytopenia, relative leucopenia, headache, joint discomfort, and skin rashes. Other etiologies, including non-dengue flavivirus infections, should be ruled out based on the patient's place of origin [3]. Dengue virus infection can be diagnosed in a lab by examining a specific virus, viral antigen, genomic sequence, and/or antibodies. Due to the four viral serotypes, there is currently no vaccination for the prevention of Dengue virus infection. In the most severe cases, dengue infection can result in patient death. To combat dengue virus infection, numerous antiviral compounds are being explored, but an effective, affordable, and secure vaccine that can neutralise all four dengue virus serotypes is still required. However, a patient with dengue fever can be saved with supportive care and therapy. Antipyretics like paracetamol can be used to treat fever. Drugs that reduce pain, such as analgesics, can be used to alleviate joint pain. Patients with DHF/DSS must be hospitalised. Oral rehydration therapy can reduce dehydration, and intravenous fluid replacement can reduce shock in infected individuals if oral intake is impossible. A platelet transfusion is advised if the patient's platelet count falls below 20,000 or if there is substantial bleeding. Aspirin, Brevrin, and non-steroidal anti-inflammatory drugs should be avoided as they may exacerbate the tendency to bleed [4].

Central diabetes insipidus from a patient's perspective: management, psychological co-morbidities, and renaming of the condition: results from an international web-based survey

Central diabetes insipidus is a rare neuroendocrine condition. Data on treatment-associated side-effects, psychological comorbidities, and incorrect management are scarce. The aim of this study was to investigate patients' perspectives on their disease. This study used a cross-sectional, web-based, anonymous survey, developed by endocrinologists and patient representatives, to collect the opinions of patients with central diabetes insipidus on management and complications of their disease, psychological comorbidities, degree of knowledge and awareness of the condition among health-care professionals, and renaming the disease to avoid confusion with diabetes mellitus (diabetes). Between Aug 23, 2021, and Feb 7, 2022, 1034 patients with central diabetes insipidus participated in the survey. 91 (9%) participants were children and adolescents (37 [41%] girls and 54 [59%] boys; median age 10 years [IQR 6-15]) and 943 (91%) were adults (757 [80%] women and 186 [20%] men]; median age 44 years [34-54]). 488 (47%) participants had isolated posterior pituitary dysfunction and 546 (53%) had combined anterior and posterior pituitary dysfunction. Main aetiologies were idiopathic (315 [30%] of 1034 participants) and tumours and cysts (pre-surgical 217 [21%]; post-surgical 254 [25%]). 260 (26%; 95% CI [0·23-0·29]) of 994 patients on desmopressin therapy had hyponatraemia leading to hospitalisation. Patients who routinely omitted or delayed desmopressin to allow intermittent aquaresis had a significantly lower prevalence of hyponatraemia compared with those not aware of this approach (odds ratio 0·55 [95% CI 0·39-0·77]; p=0·0006). Of patients who had to be hospitalised for any medical reason, 71 (13%; 95% CI 0·10-0·16) of 535 patients did not receive desmopressin while in a fasting state (nil by mouth) without intravenous fluid replacement and reported symptoms of dehydration. 660 (64%; 0·61-0·67) participants reported lower quality of life, and 369 (36%; 0·33-0·39) had psychological changes subjectively associated with their central diabetes insipidus. 823 (80%; 0·77-0·82) participants encountered a situation where central diabetes insipidus was confused with diabetes mellitus (diabetes) by health-care professionals. 884 (85%; 0·83-0·88) participants supported renaming the disease; the most favoured alternative names were vasopressin deficiency and arginine vasopressin deficiency. This is the largest survey of patients with central diabetes insipidus, reporting a high prevalence of treatment-associated side-effects, mismanagement during hospitalisation, psychological comorbidities, and a clear support for renaming the disease. Our data are the first to indicate the value of routinely omitting or delaying desmopressin. Swiss National Science Foundation, Swiss Academy of Medical Sciences, and G&J Bangerter-Rhyner-Foundation.

Acute Kidney Injury in a Patient with Darifenacine Overdose

Introduction:Darifenacin is a medication that has anticholinergic and antimuscarinic effects and is used in the treatment of overactive bladder.Adverse and overdose effects of the medication such as dry mouth and eyes,headache,nausea, constipation, urinary retention, and dyspepsia have been reported .An overdose effect on AKI has not been reported in the literature, and no dose adjustment is recommended in patients with renal impairment&#x0D; Case:A 24-year-old male patient applied to the emergency department with a declaration of taking 25 drugs containing darifenacin active ingredient for suicidal purposes.The patient had complaints of nausea and difficulty urinating.The patient's physical examination was normal.In laboratory, creatinine was 2.09mg/dL, and hemoglobi (+++) and protein(++) were found in urine test.Renal USG revealed a grade 1-2 increase in echogenicity of both kidneys.The patient was followed up with intravenous fluid replacement therapy, and the patient whose creatinine levels regressed was discharged with the recommendation of nephrology outpatient control.&#x0D; Conclusion:Any molecule taken in overdose can cause AKI via ATN should not be ignored by emergency physicians.The fact that such a side effect or undesirable situation has not been reported with Darifenacin so far doesn’t mean that the molecule is safe for this situation.An overdose of Darifenacin may cause AKI in patients.

Comparison of End-Tidal Carbon Dioxide (ETCO2) Gradient and Vena Cava Collapsibility Index (VCCI) in Response to Intravenous Fluid Therapy in Patients with Moderate and Severe Dehydration and Acute Gastroenteritis

Acute gastroenteritis (AGE) is one of the most common clinical diagnoses globally, and dehydration in severe AGE cases can cause severe morbidity and mortality. Depending on the metabolic acidosis that occurs in dehydration, the respiratory rate per minute is increased, and the carbon dioxide pressure in the arterial blood is decreased. This condition correlates with end-tidal carbon dioxide (ETCO2). Therefore, this study primarily aims to evaluate whether ETCO2 measurement has a role in detecting metabolic fluid deficit, dehydration level, and regression in dehydration level after fluid replacement and its correlation with Vena Cava Collapsibility Index (VCCI). This study included spontaneously breathing patients admitted to the emergency department of a tertiary training and research hospital with symptoms of AGE and were thought to be moderately (6.0%-9.0%) and severely (>10.0%) dehydrated according to the Primary Options of Acute Care (POAC) Clinical Dehydration Scale. After the first evaluation, the patients' vital signs, ETCO2 values, diameters of the inferior vena cava (IVC) in inspiration and expiration, and VCCI were measured and recorded. These measurements were repeated after intravenous (IV) fluid replacement, and finally, a comparison was made between the measurements. A total of 49 patients, as 16 male (32.7%) and 33 female (67.3%), were included in the study. The mean fluid replacement value was calculated as 664.29 (SD = 259.41) ml. The mean increase in ETCO2 was 3.653 (SD = 2.554) mmHg (P <.001). The mean increase in inferior vena cava expirium (IVCexp) was calculated as 0.402 (SD = 0.280) cm (P <.001) and the mean increase in inferior vena cava inspirium (IVCinsp) as 0.476 (SD = 0.306) cm (P <.001). The VCCI (%) decreased by 12.556 (SD = 13.683) (P <.001). Post-replacement vital signs, ETCO2, and VCCI correlations of the patients were examined and no significant correlation was found between ETCO2 and VCCI (%). As a result of this study, a receiver operating characteristic (ROC) curve was established for the ETCO2 values predicting the level of dehydration and fluid response, and the area under the curve was calculated as 0.748. However, to classify the patient as moderately dehydrated, the ETCO2 cutoff value was determined as 28.5mmHg. The sensitivity and specificity of ETCO2 levels were 71.43% and 74.29% in evaluating the level of dehydration, and no correlation was found with VCCI, which is known to have high sensitivity and specificity in previous studies in determining the level of dehydration and fluid response. Hence, VCCI measurement made through ultrasonography (USG) is a method that should be preferred more in determining the level of dehydration. Nevertheless, as per the results of this study, swift ETCO2 measurements may be helpful in monitoring the change in the degree of dehydration with treatment in patients who were admitted to the emergency department with dehydration findings and were administered IV fluid replacement therapy.

The role of simulation-based training to improve team performance in implementing one-hour sepsis bundle: a randomized trial

Background: Excellent team performance is one of the keys in managing patients with sepsis successfully. Simulation-based training with high fidelity manikin (HFM) is one of the many ways to enhance team performance. This study aims to compare the role of simulation-based training with HFM with conventional method to improve team performance in conducting one-hour sepsis bundle.&#x0D; Methodology: This randomized single-blind study was conducted on 16 doctors and 24 nurses in intensive care unit. Subjects were divided randomly into two groups, the simulation group and the discussion group. Simulation group received simulation training with HFM in conducting one-hour sepsis bundle in sepsis patients, while conventional group received case-based oral discussion with their tutor. The training was rounded off by a case simulation exam using HFM for both groups. The team performance consisted of clinical skills and communication skills evaluated through a validated assessment tool. Skills being assessed included initial assessment, diagnosing sepsis with SOFA and conducting one-hour sepsis bundle.&#x0D; Results: The simulation group with high fidelity manikin completed the one-hour sepsis bundle better than the conventional group (p = 0.022). Particularly in collecting venous blood samples (p = 0.027) and blood culture samples (p = 0.011), along with giving the correct intravenous fluid replacement, tailored for each scenario (p = 0.027). Communication aspect was not significantly different in both groups.&#x0D; Conclusion. Team performance in implementing one-hour sepsis bundle is better in the simulation group trained with high fidelity manikin as compared to conventional training group, who received case-based oral discussion.&#x0D; Abbreviations: HFM - high fidelity manikin; ICU - Intensive Care Unit; SOFA - Sequential Organ Failure Assessment&#x0D; Key words: Simulation-based training; One-hour sepsis bundle; Intensive care unit; Medical education; Interprofessional training&#x0D; Citation: Sugiarto A, Tantri AR, Manggala SK, Peddyandhari FS, Auerkari AN, Fabiola T, Swannjo JP, Anakotta V, Theresia S. The role of simulation-based training to improve team performance in implementing one-hour sepsis bundle: a randomized trial. Anaesth. pain intensive care 2022;26(3):463-468; DOI: 10.35975/apic.v26i4.1954&#x0D; Received: November 08, 2021; Reviewed: May 03, 2022; Accepted: 31 May 2022

Survival Trends in Adults with Out-of-Hospital Cardiac Arrests after Traffic Collisions in Japan: A Population-Based Study.

The 1-month survival rate from out-of-hospital cardiac arrest (OHCA) of cardiac origin has reportedly improved recently, at ≥5%. However, the characteristics of patients with OHCA after a traffic collision have not been adequately evaluated in Japan. We analyzed the All-Japan Utstein Registry data of 12,577 adult patients aged ≥ 20 years with OHCA due to traffic collisions who were resuscitated by emergency medical service personnel or bystanders and were then transported to medical institutions between 2013 and 2019. Multiple logistic regression analysis was used to assess factors potentially associated with the 1-month survival rate after OHCA. The 1-month survival rate was 1.4% (174/12,577). The proportion of 1-month survival of all OHCAs after a traffic collision origin did not increase significantly (from 1.6% [30/1919] in 2013 to 1.8% [25/1702] in 2019), and the adjusted odds ratio for 1-year increments was 1.04 (95% confidence interval, 0.96–1.12). In multivariate analysis, men who received ventricular fibrillation, pulseless electrical activity, intravenous fluid replacement, or early emergency medical service response and had a traffic collision during daytime had significantly favorable 1-month outcomes. In Japan, the 1-month survival after OHCA of a traffic collision origin was lower than that of a cardiac origin and remains stable.

Neonatal acute ethanol intoxication during the epidemic of COVID-19: a case report

BackgroundAfter the outbreak of COVID-19, many families equip with 75% ethanol to inactivate the SARS-CoV-2, which increases the risk of exposure to ethanol.Case presentationWe reported a 25-day-old newborn who was diagnosed with neonatal acute ethanol intoxication with a presenting complaint of accidental consumption about 15 ml formula milk containing 75% ethanol. His main clinical manifestations were irritability, flushed skin, tachycardia, tachypnea, and toxicology analysis detected ethanol. After timely gastric lavage and intravenous fluid replacement, he was cured and discharged.ConclusionsDuring the COVID-19 epidemic, high concentration ethanol used for inactivating SARS-COV-2 should be placed reasonably and neonatal feeding safety should be emphasized. Timely diagnosis and symptomatic treatment are essential for the prevention and management of acute ethanol intoxication in newborns.

High-Risk Factors causing Mortality in Pediatric Burn Patients, admitted in Burns Centre of Karachi

ABSTRACT&#x0D; Background: Different risk variables that lead to mortality of a burn victim. The most important categories for assessment of severity in burns among pediatric age group is, total body surface area (TBSA) involved, age and type of burn which can lead to increased deaths. The current study was performed to analyze the various factors of causing risk of burns and leading to mortality.&#x0D; Methods: It is a cross-sectional non-probability descriptive study, performed of Pediatric Burns unit Ruth Pfau Civil hospital, Karachi. Clinical recordof 227 Patients of both sexes135 males and 92 females was analyzed after receiving approval from Burn Center, Ruth Pfau Civil Hospital Karachi. Statistical analyzes was carried out using version 20.00 of SPSS.&#x0D; Results: Largest percentage of mortality was in age between 1 and 5 years. In 139 patients, Scalding due to hot water was the most common form of burn. Major cause of mortality was due to multiple burns with &gt; 50% involvement of TBSA was the most common category constituting 68.7% among the patients in the current study. Significant association was analyzed between the nutritional status of patients as assessed by albumin levels and mortality (p=0.004). However, total mortality among the reported cases in between 2016 until 2018 was 28.2% being in 1-5years of age with above-mentioned associations.&#x0D; Conclusion: Current research indicates that an increasing mortality in pediatric burn patients is linked with the proportion of total body surface area (TBSA) exposed to burns, duration of the exposure, decrease total protein content due to damage of tissues and muscles. This leads to prolonged protein and intravenous fluid replacement. One of the most common complication is progression to respiratory failure.&#x0D; Keywords: Burns, burns etiology, burns mortality rate.

Hospital in the Home Delivery of Supportive Care for Autologous Stem Cell Transplantation: A Novel Single Centre Patient Focused Approach

Hospital in the Home Delivery of Supportive Care for Autologous Stem Cell Transplantation: A Novel Single Centre Patient Focused Approach

Acute Occlusion of the Lower Limb Artery Associated with Hyperosmolar Hyperglycemic Nonketotic Coma in a Patient with Amyotrophic Lateral Sclerosis: A Case Report

A 61-year-old man with amyotrophic lateral sclerosis (ALS) on tracheostomy positive pressure ventilation was brought to the emergency room due to decreased consciousness. He was diagnosed with hyperosmolar hyperglycemic nonketotic coma (HHNC) with severe systemic hypotension. He exhibited an adequate response to treatment of continuous intravenous insulin infusion and fluid replacement. On the third day, he developed acute limb ischemia due to extensive occlusion from the left common iliac artery to the femoral artery.