RESUMO
To illustrate our experience with two cases of neonatal life-threatening hyperkalemia during therapeutic hypothermia (TH) despite a normal acid-base status, urine output, and preserved renal function. Clinical cases are presented from Pediatric Intensive Care Unit (PICU) admission to the onset of the hyperkalemia, with related complications and after resolution. Similar cases were not retrieved from a critical review of pertinent literature. Severe hyperkalemia pathophysiology and risk factors have been debated. Two full-term adequate for weight female neonates were admitted to PICU because of perinatal asphyxia who underwent TH. Prenatal history was completely uneventful, nor hereditary genetic conditions were reported; moreover, long-term follow-up ruled out any metabolic or renal disease. Despite an accurate evaluation of previous clinical series and literature on TH and perinatal asphyxia, these hyperkalemic episodes remain unexplained. The hypoxic-ischemic insult may affect multiple organs, mainly central nervous system, heart, lung, and kidneys; acute muscle breakdown and consequent rising of myoglobin may also have a precipitating role in acute kidney failure (AKF) and hyperkalemia. Electrolyte imbalance is a possible finding as a consequence of combined cell injury and AKF. In contrast, an isolated severe hyperkalemia is exceedingly rare in nonoliguric neonates.
Assuntos
Injúria Renal Aguda , Asfixia Neonatal , Hiperpotassemia , Hipotermia Induzida , Asfixia Neonatal/terapia , Feminino , Humanos , Hiperpotassemia/etiologia , Hiperpotassemia/terapia , Hipotermia Induzida/efeitos adversos , Recém-Nascido , Gravidez , Fatores de RiscoAssuntos
Candidíase Invasiva/diagnóstico , Neoplasias do Colo/cirurgia , Perfuração Intestinal/microbiologia , Intestino Delgado/microbiologia , Complicações Pós-Operatórias/diagnóstico , Idoso , Colectomia , Evolução Fatal , Feminino , Humanos , Perfuração Intestinal/cirurgia , Intestino Delgado/cirurgia , Recidiva , ReoperaçãoRESUMO
BACKGROUND: In critical care, dopamine is administered by infusion at low doses (
Assuntos
Estado Terminal , Dopamina/farmacologia , Hemodinâmica/efeitos dos fármacos , Adulto , Idoso , Idoso de 80 Anos ou mais , Cuidados Críticos , Dopamina/administração & dosagem , Feminino , Antebraço/irrigação sanguínea , Humanos , Infusões Intravenosas , Masculino , Microcirculação/efeitos dos fármacos , Microcirculação/fisiopatologia , Pessoa de Meia-Idade , Músculo Esquelético/irrigação sanguínea , Fluxo Sanguíneo Regional/efeitos dos fármacos , Sepse/tratamento farmacológico , Sepse/fisiopatologia , Resistência Vascular/efeitos dos fármacosRESUMO
PURPOSE: Several experimental and clinical studies have demonstrated a direct bronchoconstrictor effect of opioids on smooth bronchial musculature following iv administration. The aim of this study was to evaluate the effects of alfentanil on respiratory system mechanics in a group of ASA I patients ventilated mechanically during general anesthesia. CLINICAL FEATURES: Twenty consecutive ASA I patients (ten men and ten women) scheduled for general surgery interventions were studied (mean age 45.4 +/- 9.9 yr, mean weight 61.9 +/- 6.7 kg). Exclusion criteria were a history of chronic obstructive pulmonary disease, asthma or other pulmonary disease, atopy, wheezes, smoking and age below 18 yr. Subjects were randomly divided in two groups: Group A, receiving alfentanil at a 15 microg x kg(-1) dose and Group B receiving alfentanil at a 30 microg x kg(-1) dose. Respiratory mechanic variables were acquired at baseline (T0) and after three, ten and 15 min (T1, T2 and T3, respectively). We compared the basal values to the values measured at each time interval; basal values, prior to drug administration, served as control for each patient. P values < 0.05 were considered statistically significant. RESULTS: We did not observe significant differences in respiratory mechanic variables after the administration of alfentanil, 15 and 30 microg x kg(-1). More specifically, respiratory system compliance and the different subcomponents of respiratory system resistances (i.e., maximum, minimum and delta resistance of respiratory system) were within normal limits and did not vary after alfentanil administration. CONCLUSION: No respiratory adverse effect was reported after alfentanil iv administration.