pituitrin and Disseminated-Intravascular-Coagulation

The widespread physiologic changes that follow brain stem death lead to a high incidence of complications in the donor and jeopardize vital organ function. Strategies for the management of organ donors exist whereby the rapid physiologic decline seen after brain stem death can be stabilized by active donor resuscitation so that the functional integrity of potentially transplantable organs is maintained. Understanding the complex physiologic changes that occur after brain stem death is crucial to the development of effective donor management strategies. This article reviews the pathophysiologic changes that occur after brain stem death and discusses controversies in donor management.

Topics: Brain Death; Brain Stem; Diabetes Insipidus; Disseminated Intravascular Coagulation; Endocrine System; Hormones; Humans; Hypotension; Insulin; Lung; Thyroid Gland; Tissue Donors; Vasopressins

In the present review, an attempt has been made to describe the modern concept of circulatory shock (Part I). The shock inducing insults (low circulatory volume/vascular capacity equation, heart failure, or disturbance of cellular metabolism induce physiological defense mechanisms, which result in peripheral vasoconstriction in order to maintain adequate blood pressure and perfusion of vital organs (compensatory phase). However, when the insult is too aggressive or too prolonged, deterioration of the cardiovascular system and cellular function ensues as a result of anaerobic metabolism, loss of vascular tone, reperfusion injury, depression of the reticuloendothelial system, disseminated intravascular coagulation, and myocardial failure (decompensatory phase). This leads to widespread cellular destruction, autodigestion, and finally death of the patient. Recent features of shock therapy will be discussed in part II of this review.

Topics: Animals; Carbohydrate Metabolism; Cardiomyopathy, Dilated; Disseminated Intravascular Coagulation; Energy Metabolism; Hemodynamics; Lipid Metabolism; Mononuclear Phagocyte System; Neurotransmitter Agents; Oxygen Consumption; Proteins; Shock; Shock, Septic; Vasopressins

ADAMTS13 (a disintegrin and metalloprotease with thrombospondin type 1 repeats, member 13) deficiency has been reported in patients with sepsis but its clinical relevance and pathophysiology remain unclear. Our objectives were to assess the clinical significance, prognostic value and pathophysiology of ADAMTS13 deficiency in patients with septic shock with and without disseminated intravascular coagulation (DIC).. This was a prospective monocenter cohort study of patients with septic shock. Von Willebrand Factor, ADAMTS13-related parameters and plasma IL-6 concentration were measured at inclusion to the study. Patients were categorized into three groups according to the presence of ADAMT13 deficiency (<30%) or DIC.. This study included 72 patients with a median age of 59 years (interquartile range (IQR) 50 to 71). Each of the included patients received vasopressors; 55 (76%) were under mechanical ventilation and 22 (33%) underwent renal replacement therapy. Overall, 19 patients (26%) had DIC, and 36 patients had ADMTS13 deficiency (50%). Patients with DIC, ADAMTS13 deficiency or both were more severe at ICU admission. Mortality was higher in septic shock patients from group one. By multivariate analysis, Simplified Acute Physiology Score 2 (SAPS2) score (odds ratio (OR) 1.11/point; 95% CI 1.01 to 1.24) and ADAMTS13 activity <30% (OR 11.86; 95% CI 1.36 to 103.52) were independently associated with hospital mortality. There was no correlation between ADAMTS13 activity and the International Society for Thrombosis and Haemostasis (ISTH) score (rs = -0.97, P = 0.41) suggesting that ADAMTS13 functional deficiency and DIC were independent parameters. IL-6 level was higher in patients with ADAMTS13 activity <30% [895 (IQR 330 to 1843) pg/mL versus 83 (IQR 43 to 118), P = 0.0003).. Septic shock was associated with a functional deficiency of ADAMTS13, independently of DIC. ADAMTS13 functional deficiency is then a prognostic factor for mortality in septic shock patients, independently of DIC.

Topics: ADAM Proteins; ADAMTS13 Protein; Aged; APACHE; Biomarkers; Disseminated Intravascular Coagulation; Female; France; Humans; Interleukin-6; Male; Middle Aged; Multivariate Analysis; Organ Dysfunction Scores; Prognosis; Prospective Studies; Renal Replacement Therapy; Respiration, Artificial; Shock, Septic; Survival Analysis; Vasoconstrictor Agents; Vasopressins; von Willebrand Factor

Topics: Adrenal Insufficiency; Adult; Amputation, Surgical; Anti-Bacterial Agents; Disseminated Intravascular Coagulation; Epoprostenol; Escherichia coli; Escherichia coli Infections; Female; Gangrene; Humans; Hydrocortisone; Hypotension; Kidney Calculi; Leg; Metatarsus; Pain; Platelet Aggregation Inhibitors; Purpura Fulminans; Shock, Septic; Vasopressins

Up to 21% of severe cases of malaria tropica are associated with polyuria and are life-threatening. We describe a 39-yr-old man with malaria tropica who developed disseminated intravascular coagulation, polyuria, and a pituitary lesion. Empiric treatment with vasopressin improved the polyuria. This is the first case of malaria tropica in which central diabetes insipidus has been documented.

Topics: Adrenal Insufficiency; Adult; Diabetes Insipidus, Neurogenic; Disseminated Intravascular Coagulation; Humans; Hydrocortisone; Magnetic Resonance Imaging; Malaria, Falciparum; Male; Natriuresis; Pituitary Gland, Posterior; Polyuria; Pulmonary Embolism; Renal Insufficiency; Vasopressins

Transient episodes of the syndrome of inappropriate anti-diuresis developped in two severe colchicine poisonings. These are the first cases reported. On patient also developped a reversible periphal neuropathy. The similarity of such accidents with vicristine neuro-toxicity is emphasized.

Topics: Adolescent; Alopecia; Bone Marrow Diseases; Diarrhea; Disseminated Intravascular Coagulation; Female; Humans; Hyponatremia; Psychomotor Disorders; Vasopressins; Water Intoxication; Water-Electrolyte Imbalance

Topics: Diabetes Insipidus; Disseminated Intravascular Coagulation; Humans; Infant, Newborn; Infant, Newborn, Diseases; Listeria monocytogenes; Listeriosis; Male; Osmolar Concentration; Sodium; Specific Gravity; Vasopressins; Water Deprivation; Water-Electrolyte Balance