Impact factor 0.175

Signa Vitae

Journal of Intensive Care and Emergency Medicine

Clonidine for neonatal abstinence syndrome: a single neonatology department’s experience

Abstract

Clonidine has been shown effective in reducing sympathetic hyperactivity in neonatal abstinence syndrome (NAS). The aim of this study was to analyze clinical and laboratory characteristics of a group of newborns treated with clonidine for NAS due to maternal drug addiction and due to withdrawal from opioid analgesic therapy. Only one full–term newborn presented with metabolic acidosis and hyperkalemia; in others no clinical or laboratory adverse effects were detected. This report emphasizes the importance of alertness to potential adverse effects of clonidine therapy, and discusses possible pathophysiological aspects of hyperkalemia and metabolic acidosis during treatment for NAS.

Key words: newborn, sympathetic hyperactivity, metabolic acidosis, hyperkalemia

Read More

Biochemical changes in the patient’s plasma after red blood cell transfusion

Abstract

Introduction. The study aimed at in vivo assessment of the impact of administered red blood cells (RBCs) concentrates on the plasma levels of K+, lactate, pH, Na+, Ca++ and glucose, depending on the volume and age of administered products. Biochemical changes occurring during the storage of these products were studied in vitro simultaneously.
Materials and methods. Arterial blood samples were collected in vivo from patients before and after RBCs transfusion and plasma levels of biochemical parameters were determined. A group of 80 RBCs samples was analyzed simultaneously, with the samples being equally distributed throughout the recommended storage time of 1–35 days.
Results. The age of RBCs concentrate results in increased potassium and lactate levels and decreased pH, sodium and glucose levels in the RBCs samples. The concentrations were in the following ranges: potassium 4.0–40.5 mmol/L; lactate 4.1–28.0 mmol/L; pH 7.0–6.65; sodium 137–116 mmol/L; glucose 29.0–14.0 mmol/L. A prospectively selected group of 46 patients were administered a total of 354 RBCs units. The mean age of RBCs concentrates was 16.18 days. The number of administered RBCs units ranged from 2 to 38, a mean of 7.7 RBCs units/patient. The administration of 1 RBCs unit was associated with a mean in vivo increase of the potassium level by 0.07 mmol/L and lactate level by 0.13 mmol/L.
Conclusion. The administration of larger amounts of RBCs concentrates may lead to an increase in the patient’s plasma levels of potassium and lactate. This increase is proportional to the age and volume of RBCs.

Key words: red blood cells, transfusion, hyperkalemia, lactate

Read More

Successful resuscitation of out of hospital cardiac arrest patients in the emergency department

Abstract

Background. We examined factors associated with the successful resuscitation, in the emergency department (ED), of adult, out-of-hospital cardiac arrest (OHCA) patients.
Methods. The study cohort consisted of adult patients (over 18 years of age) who presented to the ED in 2009 with a diagnosis of cardiac arrest. Data were retrieved from the institutional database.
Results. A total of 122 adult, non-traumatic, OHCA patients were enrolled in the study. There were no significant differences between the sustained return of spontaneous circulation (ROSC) and non-sustained ROSC groups in initial body temperature (P = 0.420), time to successful intubation (P = 0.524), time to first intravenous epinephrine injection (P = 0.108), blood sugar levels (P = 0.122), hematocrit (P = 0.977), cardiac enzymes (P = 0.116) and serum sodium level (P = 0.429). Leukocytosis (P = 0.047) and cardiac rhythm of pulseless ventricular tachycardia/ ventricular fibrillation and pulseless electrical activity (P = 0.022), were significantly associated with sustained ROSC. In contrast, patients with more severe acidosis (P = 0.003) and hyperkalemia (P < 0.001) had a reduced likelihood of achieving sustained ROSC. After multiple variable logistic regression analysis adjusting for variables, the correlation between sustained ROSC and leukocytosis and hyperkalemia remained high (leukocytosis, P = 0.007, odds ratio [OR] 3.655, 95% CI 1.422-9.395; hyperkalemia, P = 0.001, OR 0.169, 95% CI 0.057-0.500)
Conclusion. Patients suffering an OHCA were appropriately resuscitated after arriving at the ED. Successful resuscitation in adult OHCA victims was determined by the patient’s status, in particular their white blood cell count and potassium level.

Key words: adult out of hospital cardiac arrest, return of spontaneous circulation, in-hospital phase, hyperkalemia, leukocytosis

Read More

© 2019. Signa Vitae. Except where otherwise noted, content on this site is licensed under a Creative Commons Attribution 4.0 International license.