Severe ovarian hyperstimulation syndrome
David K. Gardner, Ariel Weissman, Colin M. Howles, Zeev Shoham in Textbook of Assisted Reproductive Techniques, 2017
Individual treatment will depend on the severity of the syndrome. Mild forms of OHSS require little more than reassurance, since it is well established that mild symptoms usually resolve, in the absence of pregnancy, within two weeks of receiving hCG. If a pregnancy ensues, mild symptoms may progress, but rarely by more than one degree in severity. In patients with moderate ascites and mild hemoconcentration (hematocrit <45%), bed rest and abundant liquid intake should be prescribed. The tendency towards intravascular volume depletion and hyponatremia may be treated with oral isotonic electrolyte solutions; sports drinks, popular among athletes, are particularly suitable because they are engineered for optimal rehydration. The patient should be vigilant in noting any decreases in urine output, significant weight gain, or abdominal bloating as self-assessed by daily abdominal girth measurement. These findings, if present, may be the first warning signals of accumulation of ascitic fluid and worsening hemoconcentration. A hematocrit >45%, or 30% increased over baseline, indicates that the condition has entered the category of severe OHSS and that hospitalization is required.
Clinical Toxicology of Snakebite in North America
Jürg Meier, Julian White in Handbook of: Clinical Toxicology of Animal Venoms and Poisons, 2017
Swelling is especially prominent in bites by the eastern diamondback and may be less marked in bites by the Mojave, prairie, timber, red, Pacific, black-tailed rattlesnakes6, copperhead, pygmy rattler, and massasauga snakes5. Lymphangitis and regional lymph nodes tenderness often occur25. Progressive ecchymosis is also seen because of leakage of red blood cells into subcutaneous tissue. Ecchymosis and discoloration of the skin may appear within minutes or hours in the area of the snakebite. Hemorrhagic blebs may also occur within several hours for similar reasons. of interest, hemoconcentration may initially be present as a result of the leakage of fluid into subcutaneous tissue, followed by a decrease in hemoglobin over several days from blood loss secondary to coagulopathy5.
Stimulation of Endogenous Fibrinolysis
Cornelis Kluft in Tissue-Type Plasminogen Activator (t-PA): Physiological and Clinical Aspects, 1988
Fibrinogen is an important determinant of plasma and blood viscosity; α2-macroglobulin may also contribute.33 Stanozolol reduced plasma viscosity in normal subjects,206,208,209 probably partly due to reduced fibrinogen levels.208 However, reduction in blood viscosity may be prevented by an increase in hematocrit.231 This has been observed with other anabolic steroids194,195,200 and is due to increased erythropoiesis.194,195 Increased levels of the initial enzyme in hemebiosynthesis, γ-aminolaevulinic acid synthetase, have been found during treatment with danazol232 and stanozolol.233 Significant increases in platelet count have also been observed with stanozolol209,215 and danazol,198,199 presumably due again to an effect on bone marrow production. Danazol increased platelet aggregation to adenosine diphosphate and collagen,198 whereas stanozolol did not, at least in hemophiliacs.215 No effect of danazol on platelet adhesiveness was reported.198 Stanozolol did not affect the leukocyte count in volunteers.209
Mirror Syndrome with Severe Postpartum Presentation following Stillbirth and Shoulder Dystocia
Published in Fetal and Pediatric Pathology, 2020
Pawel Bartnik, Joanna Kacperczyk-Bartnik, Aneta Malinowska-Polubiec, Ewa Romejko-Wolniewicz
Mirror syndrome (MS) is a condition occurring in pregnancy, characterized by a “triple edema”—a sequence of fetal, placental, and consequently maternal edema [1]. The most common clinical causes include rhesus immunization, viral infections, twin-to-twin transfusion syndrome, congenital heart defects and fetal tumors [2]. The direct, molecular-level cause of MS is unknown, however one hypothesis suspects “trophoblastic debris” released from placenta [3]. Symptoms are similar to pre-eclampsia, but hemodilution occurs instead of hemoconcentration [4]. Acute kidney injury (AKI) occurs in up to 25% of patients with MS [1]. There are multiple cases presented in the literature in which the reversal of fetal hydrops led to the resolution of maternal signs [5–8]. In some cases, especially those including congenital anomalies, the causative treatment is not yet available. In those situations delivery usually resolves the problem in a matter a few days [1]. Braun et al. analyzed in 2010 that in only 4 of 56 reviewed cases the MS was diagnosed postpartum [1]. In all of these patients however, maternal signs were present before birth [9,10]. The most recent review, published in 2017, analyzed a total of 74 clear cases [2]. In none of the reported cases was the development of MS associated with complicated delivery [1,2].
Cutaneous-hemolytic loxoscelism following brown recluse spider envenomation: new understandings
Published in Clinical Toxicology, 2020
Justin K. Loden, Donna L. Seger, Henry A. Spiller, Li Wang, Daniel W. Byrne
The following definitions were used: tachycardia (HR >100 beats per minute [bpm] in adults or > normal in age group [31]), hypertension (systolic BP >150 mmHg in adults or > normal in age group [31]), hypotension (systolic BP <90 mmHg in adults or < normal in age group [31]), hyperkalemia (K > 5.5 mEq/L), hypokalemia (K < 3.5 mEq/L), elevated creatinine (increase >50% baseline), acidosis (CO2 < 22 mEq/L or pH <7.35), hyperlactatemia (lactate >2.2 mmol/L), rhabdomyolysis (creatine kinase >300 U/L or positive myoglobinuria), alkaline urine (pH >6.9), elevated transaminases (AST or ALT >100 U/L), hematuria (≥5 red blood cells [RBCs] on microanalysis). The presence of hemolysis was determined by the medical toxicologist(s) taking care of the patient at the time of evaluation and based on laboratory data, most specifically declining hemoglobin/hematocrit. Hemolysis onset time was defined as the time in days from envenomation to hemolysis (with 0.0 days being 0–24 h, 1.0 days being 24–48 h, etc.). If the onset time was not determined, then it was reported as unavailable. Hemolysis duration was defined as the time in days from hemolysis onset until the hemoglobin/hematocrit stabilized and the urine dipstick was negative for blood. Time to emergency department (ED) presentation was defined as the time in days from envenomation to ED presentation (with 0.0 days being 0–24 h, etc.).
Physiology of sweat gland function: The roles of sweating and sweat composition in human health
Published in Temperature, 2019
One of the proposed uses of sweat composition as a biomarker is the prediction of hydration status from sweat electrolyte concentrations or some ratio of [Na], [Cl], and/or [K] [186–189]. However, a fundamental issue with this assertion is that sweat [Na] and [Cl] are known to vary considerably within and among individuals; and a change in hydration status is only one of many factors that could play a role in this variability [132]. This is further complicated by the fact that dehydration could have differential effects on sweat [Na] and [Cl]. Dehydration-induced hemoconcentration would increase extracellular [Na] and in turn increase Na of the primary sweat, in theory leading to a small increase in final sweat [Na]. On the other hand, dehydration would also be expected to reduce sweating rate (Figure 3), which would, in turn, lead to lower sweat [Na]. Other factors such as heat acclimatization, exercise intensity, environment, diet, and sweat stimulation/collection methodology influence sweat [Na] and [Cl] (Table 1). These confounding factors likely explain the discrepancy in results across studies measuring sweat composition and changes in hydration status. Dehydration has been associated with increased [134,153,190], decreased [191,192], or no change [193–195] in sweat [Na] and [Cl]. Sweat [K] and pH are also poor indicators of hydration status [190]. Additionally, sweat composition (Na, Cl, K, pH, lactate) explains very little of the variation in individuals’ sweating rate during exercise [147,149].
Related Knowledge Centers
- Anemia
- Dehydration
- Polycythemia
- White Blood Cell
- Platelet
- Blood
- Red Blood Cell
- Blood Test
- Complete Blood Count
- Hemoglobin