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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Intensive care medicine 21 (1995), S. 352-355 
    ISSN: 1432-1238
    Keywords: Liver ; Metastasis ; Splanchnic ; Oxygen consumption ; Sepsis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Metastatic liver disease can modify the metabolic response to critical illness. Systemic lactic acidosis may arise from an increased production due to inadequate peripheral tissue oxygen transport, altered metabolic function such as depressed pyruvate oxidation or insufficient hepatic clearing capacity due to tumor replacement of functional liver mass. Hepatic venous catheterization in a patient with extensive metastatic melanoma to the liver and adult respiratory distress syndrome indicated a marked disparity between whole body and liver oxygenation which may arise due to a markedly stepped up splanchnic oxygen utilization unmatched by a proportionate rise in regional oxygen delivery. Since some neoplasms may exhibit increased metabolic activity, it is suspected that these metastatic lesions may have contributed to the observed regional hypermetabolism thereby worsening hepatic hypoxia and exacerbating lactic acidosis. This case also illustrates the difficulties in interpreting global indicators of metabolic function and oxygenation in critically ill patients.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-1238
    Keywords: Hormones ; Sepsis ; Insulin ; Glucagon ; Ureagenesis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This is a brief review of the observed hormonal alterations following trauma and sepsis. The major changes noted in the metabolic status of the stressed patient have been characterized by deranged carbohydrate metabolism, altered metabolic rate as measured by oxygen consumption and increased ureagenesis. Each of these phenomena are regulated to a large extent by the specific hormonal profile of the patient. Failure of insulin and growth hormone production have been associated with glucose intolerance, excessive urinary nitrogen loss and a fatal outcome. Glucagon, cortisol and catecholamines exhibit sustained elevation and have been associated with increased metabolic rate and excessive ureagenesis. These changes are usually self limited following trauma but will persist if the patient enters a septic phase. The use of specific nutritional support, namely hypertonic glucose versus a balanced fat emulsion system in the face of sepsis is considered.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1432-1238
    Keywords: Venous oxygen saturation ; Oxygen transport ; Splanchnic
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Central mixed venous oxygen saturation (S $$\mathop v\limits^ - $$ O2) monitoring in critically ill patients to estimate adequacy of peripheral perfusion is gaining increasing popularity. However, a number of unexpected responses, one of which is marked depression of regional (splanchnic) venous oxygen saturation which may coexist with normal or high S $$\mathop v\limits^ - $$ O2, makes interpretation pretation of this parameter difficult. The S $$\mathop v\limits^ - $$ O2 and hepatic venous oxygen saturation levels in seven injured (postoperative) and 15 septic patients were measured. No substantial differences between central and hepatic venous oxygen saturation were noted in nonseptic patients, however, septic subjects exhibited a normal S $$\mathop v\limits^ - $$ O2 of 70.5%±8.7% at a time when the hepatic venous saturation was 55.6%±14.4% which is a significant (p〈0.05) reduction. This reduced oxygen saturation was noted to arise from an increased regional metabolic rate rather than reduced perfusion. Nevertheless, we conclude that a flow limited regional oxygen consumption may potentially exist despite the presence of a normal S $$\mathop v\limits^ - $$ O2 in certain patient subgroups such as septic subjects. Therefore, a normal S $$\mathop v\limits^ - $$ O2 should not be considered as sole criteria to insure optimal oxygen delivery in critically ill patients.
    Type of Medium: Electronic Resource
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