Clinical Complications of Continuous Renal Replacement Therapy.

The various complications of continuous renal replacement therapy (CRRT) are mostly preventable. Hemodynamic disturbances are dominated by hypotension due to the modification of volume status, myocardial dysfunction, cardiac arrhythmia, or modification of systemic vascular resistances, which are correlated with body temperature changes. Metabolic complications remain at the forefront and have profoundly changed with the use of regional citrate anticoagulation (RCA). RCA may lead to two distinct situations: citrate overload and citrate accumulation, respectively, responsible for metabolic alkalosis and metabolic acidosis. Electrolyte imbalance is also a classic occurrence with RCA. The chelation of cations by citrate results in hypocalcemia and hypomagnesemia in case of inappropriate substitution. Hemorrhagic complications have been drastically reduced mostly for two reasons: the use of systematic ultrasound guidance for the insertion of dialysis catheters and the use of RCA instead of systemic heparin anticoagulation. Hypothermia induced by CRRT and complications associated with prolonged bed rest are also better controlled today. Finally, the removal of undesired substances remains a major issue, especially when it comes to antibiotics, vitamins and micronutrients, molecules for which the intake should be adapted in case of CRRT.

DRESS Syndrome in the ICU: When a Patient Is Treated with Multiple Drugs.

The Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome is life-threatening. It associates a skin condition with hematological and visceral disorders. The DRESS syndrome diagnosis in the intensive care unit (ICU) is difficult as clinical features are nonspecific. Furthermore, the need to treat patients with multiple drugs usually prevents the identification of the causative drug. We report the case of a patient who developed two bouts of DRESS caused by piperacillin-tazobactam, the first being complicated with a distributive shock. Cases of DRESS occurring inside ICU are seldom reported. However, any intensivist may encounter this situation during his career and should be aware of its diagnostic and management specific aspects.