1/3. Multiple systems organ failure: II. The effect of infusion of amino acids and glucose.amino acids and dextrose infusion were given for short periods of time to a young man whose basal state is characterized in the previous paper in this series, and their effects were documented in terms of plasma concentrations and splanchnic extraction. The basal state measurements show in the acute trauma state and its subsequent starvation state a largely balanced splanchnic extraction of amino acids but at a decreasing rate. Amino acid (FreAmine) infusion at low rates on this background produced a large increase in extraction of a largely balanced mixture of amino acids but a minimal change in glucose release. The septic state is characterized in both the basal and amino acid infusion state by splanchnic extraction of an unbalanced mixture of amino acids which is deficient in branched-chain amino acids and in relative excess of glucogenic amino acids with increased glucose release and increased utilization of amino acids for gluconeogenesis. In early sepsis this state can largely be repaired by exogenous amino acid infusion but in late sepsis can only be partially repaired. The data suggest that the patient in late sepsis should have a branched-chain rich amino acid mixture and that the hepatic failure of sepsis is strongly associated with peripheral release of an unbalanced mixture of amino acids secondary to enhanced branched-chain catabolism. Infused glucose produces a large increase in the plasma glucose but also improves the balance of the splanchnic amino acids extracted. The statistical validity of the preceding statements are examined in detail in the manuscript.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
2/3. Subgaleal hemorrhage in the neonate.Subgaleal hemorrhage in the neonate, a possible complication of vacuum extraction, is a medical emergency. Neonates delivered with the assistance of vacuum extraction and displaying any signs of neurologic disturbance, blood loss, or anemia should be evaluated promptly for the possibility of hemorrhage. A case report is provided in this article to describe recognition and management of a neonate in hypovolemic shock after vaginal birth assisted by vacuum extraction.- - - - - - - - - - ranking = 0.75keywords = extraction (Clic here for more details about this article) |
3/3. Subgaleal hematoma causing hypovolemic shock during delivery after failed vacuum extraction: a case report.Subgaleal hematomas are potentially lethal intracranial bleedings, occurring most commonly in the neonate after difficult vacuum extraction. We report a case of hypovolemic shock occurring at birth after failed extraction and subgaleal bleeding. Subgaleal hematomas may form because of preexisting risk factors (e.g., coagulopathy), but vacuum extraction itself predisposes an infant toward subgaleal bleeding. Although the frequency of these bleedings has decreased with introduction of silicone extraction cups, the risk of subgaleal bleeding after vacuum extraction continues to be increased for primiparous women; severe dystocia, occiput lateral or posterior head presentations; and repeated, forceful, or prolonged use of vacuum suction. The presence of ballotable cranial fluid collections and signs of volume loss in a neonate raise the possibility of subgaleal bleeding. Treatment, if the subgaleal hematoma is symptomatic, requires restoration of blood volume and control of bleeding, inasmuch as these hematomas can be fatal if not treated. Prevention may require limitation of the frequency and duration of vacuum assistance in high-risk infants.- - - - - - - - - - ranking = 2.25keywords = extraction (Clic here for more details about this article) |