Tools for the Diagnosis and Management of Nervous System Diseases
Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw in Hankey's Clinical Neurology, 2020
Multislice CT scanners commonly are asked to perform the axial nonhelical CT slice technique because of radiation considerations, particularly in routine follow-up scans. The radiation source and the radiation detectors are arrayed in a “donut” configuration around the patient. Both the radiation detectors and the radiation source spin around as the patient moves on a sliding table through the scanner during the acquisition. Patients who are pregnant or potentially pregnant should not undergo CT unless absolutely essential. Elective CT in a female should be delayed until either a negative pregnancy test is confirmed, or the patient is in the first half of the menstrual cycle. Contrast-induced nephropathy can result in metformin accumulation and, rarely, precipitate metformin-related lactic acidosis. Electronic media allow the viewer to alter the windows to maximize the opportunity to see CT signs of early stroke or subtle subdural hematomas.
Sepsis and Sirs
T.M. Craft, P.M. Upton in Key Topics In Anaesthesia, 2021
An initial insult triggers the production of proinflammatory cytokines. These cytokines activate leukocytes and endothelium, and promote neutrophil- endothelial-cell adhesion and migration into tissues. The trapped leukocytes discharge a series of secondary inflammatory mediators, including other cytokines, prostaglandins and proteases. Ischaemia-reperfusion injury is also implicated in the inflammatory process. It generates toxic oxygen free radicals that cause cell membrane lipid peroxidation and increased membrane permeability. Some organs are particularly susceptible to ischaemia and hypoxia and may then form the trigger for multiple organ failure. Blood flow to the gut is not autoregulated for pressure; gut blood flow falls in response to reductions in cardiac output. The activation of leukocytes and other cellular elements causes capillary obstruction, endothelial cell injury and microvascular shunting. The development of lactic acidosis is a global indicator of tissue hypoxia. Earlywarning of tissue ischaemia and hypoxia at a regional level may provide the opportunity for earlier intervention with the possibility of improving patient outcome.
The Urinary System and Its Disorders
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss in Understanding Medical Terms, 2020
Since the urinary system eliminates a variety of wastes, alterations in urinary function can quickly alter the composition of the blood. Renal tubularacidosis is hypokalemic (abnormally low serum potassium) in nature, while hypoaldosteronism can lead to metabolic acidosis, which is hyperkalemic. Starvation can lead to ketoacidosis, and kidney failure leads to lactic acidosis. The most frequently performed laboratory test related to the urinary system is a urinalysis. Frequency and urgency generally indicate a relative decrease in bladder capacity, which may result from loss of elasticity caused by infection or inflammation or may be related to bladder mucosal injury from stones, tumors, or infections. Urinalysis usually includes qualitative evaluation for the presence of protein, glucose, ketones, and blood and determination of urinary pH and osmolarity. An image of the bladder is a cystogram, which is part of a urogram or may be performed separately. The urinary system may also be visualized by ultrasonography.
A patient with Graves' disease who survived despite developing thyroid storm and lactic acidosis
Published in Upsala Journal of Medical Sciences, 2010
Tetsuhiro Yoshino, Daisuke Kawano, Takeo Azuhata, Tsukasa Kuwana, Rikimaru Kogawa, Atsushi Sakurai, Katsuhisa Tanjoh, Tatsuo Yanagawa
A 56-year-old woman with Graves' disease presented with the complaints of diarrhea and palpitations. Physical examination and laboratory data revealed hypothermia and signs of mild hyperthyroidism, heart failure, hepatic dysfunction with jaundice, hypoglycemia, and lactic acidosis. The patient was diagnosed as having developed the complication of thyroid storm in the absence of marked elevation of the thyroid hormone levels, because of the potential hepatic and cardiac dysfunctions caused by heavy alcohol drinking. A year later, after successful treatment, the patient remains well without any clinical evidence of heart failure or hepatic dysfunction. Thyroid storm associated with lactic acidosis and hypothermia is a serious condition and has rarely been reported. Prompt treatment is essential even if the serum thyroid hormone levels are not markedly elevated. We present a report about this patient, as her life could eventually be saved.
B-Cell Lymphoma, Thiamine Deficiency, and Lactic Acidosis
Published in Baylor University Medical Center Proceedings, 2017
Umair Masood, Anuj Sharma, Sonny Nijjar, Karthikeyan Sitaraman
Type B lactic acidosis is found in the absence of tissue hypoperfusion, can be associated with malignancies, and can be caused by thiamine deficiency. We present a patient who presented with an abdominal mass that biopsy disclosed to be a diffuse large B-cell lymphoma. Because thiamine deficiency is a rare cause of lactic acidosis in cancer, the patient was treated with intravenous thiamine with rapid normalization of the lactic acid level. The level prior to treatment was low. The case emphasizes a rare cause of lactic acidosis.
Neurological impairments in hypoxic neonates and lactate levels
Published in Neurological Research, 2018
Miljana Z. Jovandaric, Svetlana J. Milenkovic
Introduction: Metabolic acidosis with increasing lactate concentration develops due to the lack of oxygen in the tissues. Objectives: The effect of lactic acidosis on neurological development in the first year of life. Materials and Methods: Our study included 50 newborns with perinatal hypoxia requiring oxygen therapy and 50 healthy newborns. pH, pCO2, pO2, base excess (BE) and lactates from arterialized capillary blood were determined in both groups of newborns, in the first and second hours after birth, and neurological development in the first year of life was estimated. Results: pH, pCO2, pO2, BE and lactates differed significantly between the groups in the first and second hours after birth p
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