Objectives: To evaluate the epidemiology of hyperammonemia unrelated to liver failure in the critical care setting. Design: Retrospective case series. Setting: Critically ill patients admitted to ICUs at Mayo Clinic, Rochester, MN (medical ICU, two mixed medical-surgical ICUs, coronary care unit, or the cardiosurgical ICU) between July 1, 2004, and October 31, 2015. Patients: Adult critically ill patients with hyperammonemia not related to acute or chronic liver failure. We excluded patients with diagnosis of moderate or severe liver disease, hyperbilirubinemia, and patients who denied the use of their medical records. Interventions: None. Measurements and Main Results: Of 3,908 ICU patients with hyperammonemia, 167 (4.5%) had no evidence of acute or chronic liver failure. One-hundred one patients (60.5%) were male with median age of 65.7 years (interquartile range, 50–74.5 yr) and median serum ammonia level of 68 µg/dL (interquartile range, 58–87 µg/dL). Acute encephalopathy was present in 119 patients (71%). Predisposing conditions included malnutrition 27 (16%), gastric bypass six (3.6%), total parenteral nutrition four (2.4%); exposure to valproic acid 17 (10%); status epilepticus 11 (6.6%), high tumour burden 19 (11.3%), and renal failure 82 (49.1%). Urea cycle defects were diagnosed in seven patients (4.1%). Hospital mortality was high (30%), and median ammonia level was higher among the nonsurvivors (74 vs 67 µg/dL; p = 0.05). Deaths were more likely in hyperammonemic patients who were older (p = 0.016), had greater illness severity (higher Acute Physiology and Chronic Health Evaluation III score, p
from Emergency Medicine via xlomafota13 on Inoreader https://ift.tt/2KS0NlW
Εγγραφή σε:
Σχόλια ανάρτησης (Atom)
Δημοφιλείς αναρτήσεις
-
Abstract Introduction In recent years, platelet-rich plasma (PRP) has emerged as a promising autologous biological treatment modality fo...
-
Abstract This article on alternative markers of performance in simulation is the product of a session held during the 2017 Academic Emerge...
-
Healthcare Finance News from Emergency Medicine via xlomafota13 on Inoreader http://ift.tt/2xx5f3c
-
Learn how to recognize the signs of sudden cardiac arrest and to administer CPR in less than 5 minutes. from EMS via xlomafota13 on Inorea...
-
Abstract Objective To test the hypothesis that in-hospital outcomes are worse among children admitted during a return ED visit than amon...
-
Publication date: July 2018 Source: The Journal of Emergency Medicine, Volume 55, Issue 1 Author(s): Heather Roesly from Emergency Med...
-
Clinical Research in Cardiology from Emergency Medicine via xlomafota13 on Inoreader http://ift.tt/2xAiteN
-
International Journal of Eating Disorders from Emergency Medicine via xlomafota13 on Inoreader http://ift.tt/2y5Nqsx
Δεν υπάρχουν σχόλια:
Δημοσίευση σχολίου