acenocoumarol and Shock--Septic

Although traditionally observed in patients with end-stage renal disease and secondary hyperparathyroidism, calciphylaxis has been reported in patients with normal renal and parathyroid function. There is no evidence-based therapy available. The use of sodium thiosulfate (STS) has been increasingly described. Herein we describe two patients who responded well to this treatment.

Topics: Acenocoumarol; Aged; Aged, 80 and over; Atrial Fibrillation; Calciphylaxis; Comorbidity; Diabetes Mellitus, Type 2; Drug Substitution; Female; Heparin, Low-Molecular-Weight; Humans; Hyperparathyroidism, Secondary; Livedo Reticularis; Obesity; Peripheral Vascular Diseases; Risk Factors; Shock, Septic; Thiosulfates; Urinary Tract Infections; Vitamin D Deficiency

Pylephlebitis is the septic thrombosis of the portal vein. Hypercoagulability and intra-abdominal sepsis are the main predisposing factors. A 25-year-old man presented to a primary health care center complaining of fever, epigastric pain, and jaundice. He was initially diagnosed with a gastrointestinal infection and alcoholic hepatitis and, due to his unstable clinical status, was referred to the emergency room. A diagnosis of acute pylephlebitis complicated with septic shock was made. Treatment with a wide-spectrum antibiotic and anticoagulation was initiated. Fifteen days later, recanalization of the portal vein was achieved and clinical status was improved. Pylephlebitis following gastrointestinal infection is a potential cause of septic shock.

Topics: Acenocoumarol; Acute Disease; Adult; Anti-Bacterial Agents; Anticoagulants; Bacteremia; Escherichia coli Infections; Heparin; Humans; Jaundice; Male; Phlebitis; Portal Vein; Radiography; Shock, Septic; Ultrasonography; Venous Thrombosis

Topics: Abdominal Pain; Acenocoumarol; Aged; Aged, 80 and over; Emergency Treatment; Factor VII; Factor VIIa; Female; Humans; International Normalized Ratio; Laparotomy; Recombinant Proteins; Risk Assessment; Shock, Septic; Thrombosis

Two patients with developing venous gangrene of the lower extremity and contraindications to systemic thrombolytic therapy are presented. Low-dose intraarterial burst therapy with urokinase provided rapid amelioration of symptoms and avoided amputation without any serious bleeding complications in both patients.

Topics: Acenocoumarol; Adult; Anticoagulants; Contraindications; Female; Gangrene; Heparin; Humans; Infusions, Intra-Arterial; International Normalized Ratio; Leg; Leg Ulcer; Plasminogen Activators; Shock, Septic; Thrombolytic Therapy; Thrombophlebitis; Ultrasonography; Urokinase-Type Plasminogen Activator; Venous Thrombosis

Topics: Acenocoumarol; Animals; Blood Cell Count; Blood Coagulation Tests; Blood Platelets; Blood Proteins; Cholesterol; Dietary Fats; Endotoxins; Hemorrhage; Hemorrhagic Disorders; Rats; Salmonella typhi; Shock, Septic; Shock, Surgical; Thrombosis; Triamcinolone