tetracycline and Shock

Within 24 hours of returning from a five-week holiday in Pakistan a 15-year-old girl developed vomiting and massive diarrhoea leading to severe dehydration with hypovolaemic shock. The diastolic blood pressure was no longer measurable and prerenal renal failure occurred with a serum creatinine of 4.4 mg/dl and metabolic acidosis (pH 7.21, base excess-16.9 mmol). Initially treatment consisted of rehydration (day 1: 9280 ml, day 2: 4850 ml). The patient's condition rapidly improved and she had voluminous stools. A concurrent urinary infection due to Klebsiella pneumoniae was first treated with cotrimoxazole. As a new strain of Vibrio cholerae, serogroup O 139, was isolated from stool, treatment was changed to tetracycline (50 mg/kg daily). Regaining a good general state she was transferred to an isolation ward on the 6th hospital day. The isolated cholera organism belongs to a nonagglutinating serogroup which is indistinguishable clinically and epidemiologically from the classical Vibrio strains which cause cholera. Since the end of 1992 this new serogroup has been causing an explosive spread of cholera in Bangladesh and India.

Topics: Adolescent; Agglutination Tests; Cholera; Dehydration; Feces; Female; Fluid Therapy; Germany; Humans; Klebsiella Infections; Klebsiella pneumoniae; Pakistan; Serotyping; Shock; Tetracycline; Travel; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vibrio cholerae

Shock must be treated by correcting the cause, for any treatment of hypotension or shock, as such, is only an adjunctive measure; but the hemodynamic manifestations also need treatment. Vasopressors are helpful and effective under the right circumstances. Unless the blood volume is normal, the use of drugs that block the sympathetic nervous system (e.g., phenoxybenxamine) can be extremely hazardous and hasten death. However, the effect of adrenergic blocking drugs in endotoxic shock and other types of toxic shock is still to be determined; use of such drugs should be considered experimental until the results have been studied more extensively. Clinically, the most common forms of vascular shock are associated with blood loss, myocardial infarction, and endotoxemia. Characteristic hemodynamics of each situation are presented tabularly, and the physicians need to understand the differences is emphasized. The pharmacology of vasopressors, relating primarily to hemodynamic considerations and the response to vasopressors when severe reduction in blood pressure is associated with the shock syndrome is discussed. Drugs that stimulate the adrenergic receptors in the heart and blood vessels, with the exception of isoproteronol, are commonly referred to as vasopressors. The adrenergic stimulators may be classified into 3 groups: alpha (phenylephrine hydrochloride), beta (epinephrine), and alpha-beta (l-norepinephrine). Because alpha stimulators do not usually increase cardiac output, alpha-beta and beta-adrenergic stimulators are generally the most useful for treating shock. Routine use of adrenergic stimulators with the exclusion of other therapies, however, is generally unwarranted.

Topics: Bacteria; Chloramphenicol; Epinephrine; Humans; Isoproterenol; Metaraminol; Methoxamine; Morphine; Myocardial Infarction; Nalorphine; Norepinephrine; Phenoxybenzamine; Phenylephrine; Shock; Shock, Septic; Streptomycin; Tetracycline; Vasoconstrictor Agents

Topics: Acute Kidney Injury; Cholecystitis; Cholera; Dehydration; Diarrhea; Gangrene; Humans; Hyperaldosteronism; Hypokalemia; Parotitis; Respiratory Tract Diseases; Shock; Tetany; Tetracycline; Vibrio cholerae; Water-Electrolyte Balance

Topics: Anaphylaxis; Anti-Bacterial Agents; Cephalosporins; Chloramphenicol; Drug Hypersensitivity; Enterocolitis, Pseudomembranous; Malabsorption Syndromes; Penicillin Resistance; Penicillins; Shock; Streptomycin; Tetracycline

Topics: Ampicillin; Angina Pectoris; Anti-Bacterial Agents; Bacteriological Techniques; Diagnosis, Differential; Drug Therapy; Emergencies; Genital Diseases, Female; Humans; Hydrocortisone; Hypoxia; Metaraminol; Sepsis; Shock; Shock, Septic; Surgical Wound Infection; Tetracycline

Topics: Acidosis; Anti-Bacterial Agents; Endotoxins; Humans; Shock; Tetracycline

Topics: Animals; Anti-Bacterial Agents; Blood-Brain Barrier; Chlortetracycline; Dogs; Fluorescence; Lagomorpha; Metabolism; Mice; Oxytetracycline; Protein Synthesis Inhibitors; Rabbits; Research; Shock; Tetracycline

Bacteremic shock is second in frequency only to myocardial infarction as a cause of hypotension and death in hospitalized medical patients. The clinical course is marked by fever, usually with chills, and hypotension with a full pulse and warm extremities, followed by shock, often resistant to treatment. Anticipation of this complication in patients with certain predisposing diseases or factors facilitates early recognition of the symptoms and signs of bacteremic shock and prompt treatment. Early and effective treatment of the offending infection often prevents progression of hypotension to the stage of frank vascular collapse.

Topics: Anti-Bacterial Agents; Antibiotics, Antitubercular; Emergencies; Humans; Hypotension; Metaraminol; Methicillin; Myocardial Infarction; Norepinephrine; Phenoxybenzamine; Sepsis; Shock; Shock, Septic; Streptomycin; Tetracycline

Topics: Adrenocorticotropic Hormone; Aminosalicylic Acid; Aminosalicylic Acids; Anaphylaxis; Anti-Bacterial Agents; Aspirin; Body Constitution; Chloramphenicol; Cortisone; Drug Hypersensitivity; Otolaryngology; Penicillins; Physiology; Procaine; Shock; Shock, Septic; Skin Tests; Streptomycin; Surgical Procedures, Operative; Tetracycline; Toxicology

Topics: Humans; Inflammation; Myocardial Infarction; Pancreatitis; Shock; Tetracycline