Acute skin failure
Biju Vasudevan, Rajesh Verma in Dermatological Emergencies, 2019
Metabolic abnormalities: Basal metabolic rate (BMR) increases as a compensatory mechanism for hypothermia. Increased BMR leads to negative nitrogen balance, increased urinary nitrogen, and hypoalbuminemia. Hypercatabolic state due to destruction of cells results in hypoproteinemia, hyperglycemia, glycosuria, decreased insulin secretion, relative insulin resistance, and pancreatitis. Shivering, which is a compensatory mechanism for hypothermia, also increases energy consumption [8,13]. Hypoproteinemia (mainly hypoalbuminemia) results due to loss of protein in oozing. Combined protein loss may amount to approximately 150–200 g/day in TEN [5,15]. Diffuse scaling in exfoliative dermatitis and psoriasis leads to protein loss of approximately 50–100 g/day [16]. Hypoproteinemia also leads to delayed healing.
Diagnostic Approach to Fulminant Hepatitis in the Critical Care Unit
Cheston B. Cunha, Burke A. Cunha in Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Dengue fever (DF) is a febrile illness endemic in tropical countries; it is caused by the infection of one of four dengue viruses spread by the Aedes aegypti or Aedes albopictus mosquitoes. Dengue-related ALF has been well-described in the literature and occurs more commonly among children, with few incidences in adults. The incubation period is 3–14 days. Clinical features include fever, abdominal pain, nausea/vomiting, skin rash, and anorexia. Liver involvement in DF includes hepatomegaly and transient variable liver test abnormalities (AST > ALT) [31]. Hypoproteinemia, hypoalbuminemia, and coagulation abnormalities have been reported [32,33]. Diagnosis is based on the detection of viral nucleic acid in serum by RT-PCR assay or via detection of viral antigen non-structural protein 1 with enzyme-linked immunosorbent assay (ELISA). Immunoglobulin IgM is also widely used for definitive diagnosis [34]. There is no specific therapy for DF, and treatment includes fluids and supportive care.
Assessment and Treatment for Malnutrition of COVID-19 Patients
Wenguang Xia, Xiaolin Huang in Rehabilitation from COVID-19, 2021
This method of measurement includes albumin, transferrin, and retinol-binding protein. The persistent presence of hypoproteinemia in patients is a reliable indicator of malnutrition, which generally reflects the nutritional status in the last 2–3 weeks. The initial measurement value of albumin below 25 g/L indicates a poor prognosis; however, due to the long half-life of albumin, it cannot be used for continuous monitoring. In contrast, the half-life of prealbumin and binding protein is short, which is better for the dynamic assessment of nutritional status and nutritional treatment efficacy. Indicators related to the nutritional status of patients with severe COVID-19 are often reduced to varying degrees. For example, the serum prealbumin level of severe COVID-19 patients is often lower than 100 g/L, and some critically severe patients are even lower than 70 g/L or even below 50 g/L.
Report of Four Cases of Endogenous Klebsiella Pneumoniae Endophthalmitis Originated from Liver Abscess with Eye Complaints as the Initial Presentations
Published in Ocular Immunology and Inflammation, 2022
Jun Zhu, Fang Chen, Zhenggao Xie
In summary, all patients had eye problems as the initial complaints and were diagnosed with EE with liver abscess as the primary lesion. The common underlining condition of these patients was diabetes. They all had symptoms of common cold in varying degrees like fever, chills, or fatigue at the onset. Confirming the initial diagnosis of EE was not hard but it was not straightforward to locate the primary lesion. None of the abdominal ultrasonography suggested liver abscesses. Abdominal enhanced CT and MRI were essential to establish the diagnosis. Hypoproteinemia presented in all patients. All patients had sepsis and two of them even suffered from complicated septic shock. Except for case 3, the other patients were referred to relevant department (ICU or endocrine department) for further treatment, so PPV was not performed promptly. Eventually, three patients underwent PPV including one patient, whose sclera had melted and she underwent evisceration instead of PPV. Unfortunately, the inflammation still could not be controlled in the rest of the two patients after PPV so they eventually underwent evisceration (Table 1).
Does the nutritional status of acute stroke patients affect the neurological status in the early post-stroke period?
Published in Neurological Research, 2020
Krzysztof Wierzbicki, Maciej Horyniecki, Dawid Mamak, Mateusz Szopa, Justyna Buchała, Grzegorz Stawarz, Szymon Florek, Monika Adamczyk-Sowa
Biochemical indicators still remain crucial in the assessment of the nutritional status, of which most important include total protein, albumin, transferrin, pre-albumin, creatinine and nitrogen levels [42]. Hypoproteinemia (serum total protein <5.5g/dl) showed a significant association with the development of clinical features of malnutrition [43]. Albumin level <35g/dl is commonly recognized as a useful indicator of malnutrition in the elderly [43]. The mean serum albumin level in patients who developed malnutrition was 3.16 ± 0.5 compared to 3.39 ± 0.4 in patients without malnutrition (p = 0.046) [43] In our study, Pearson’s correlation analysis showed a negative correlation between the NIHSS score on admission and the serum albumin level, on the basis of which patient’s condition can be also predicted. However, it should be borne in mind that their usefulness is limited in inflammatory conditions and in liver and kidney diseases.
Prognostic Significance of the Preoperative Controlled Nutritional Status Score in Lung Cancer Patients Undergoing Surgical Resection
Published in Nutrition and Cancer, 2021
Jingjing Shao, Jing Li, Xun Lei Zhang, Gaoren Wang
This is the first meta-analysis investigating the use of the CONUT score as a prognostic indicator of lung cancer. Serum albumin is one of the most commonly used indicators to assess nutritional status. Previous studies have shown that low albumin levels were related to poor nutritional status and clinical outcomes in various cancers, including colorectal cancer, stomach cancer, breast cancer, and lung cancer. Patients with good nutrition and healthy livers, producing normal amounts of albumin, have good resistance to disease and tumor growth. Albumin is inhibited by inflammatory cytokines, such as tumor necrosis factor-α, IL-1, and IL-6, which promote tumor development (18). Since cancer affects its metabolism, albumin can be used to reflect physical conditions. Different immune functions, especially cell-mediated immune functions, are affected by hypoproteinemia. Patients with postoperative hypoproteinemia have increased infections. It is not clear whether correcting hypoproteinemia can reduce postoperative complications or cancer recurrence. Further study is needed to investigate whether it can effectively improve the survival rate and reduce postoperative complications and tumor recurrence (5).