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Hyperosmolar Hyperglycemic State, or HHS, is a serious and life-threatening complication of type 2 diabetes mellitus. It is characterized by three main features: severe hyperglycemia, profound dehydration, and elevated serum osmolality, all occurring without significant ketoacidosis.HHS typically develops in older adults or individuals with limited access to fluids. This may result from illness, cognitive impairment, or medications such as diuretics or corticosteroids. These factors reduce...
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Diabetic ketoacidosis (DKA) is a metabolic emergency characterized by hyperglycemia, ketonemia, and metabolic acidosis. It results from severe insulin deficiency and an excess of counterregulatory hormones, leading to uncontrolled lipolysis, ketogenesis, and widespread electrolyte and fluid disturbances.Pathophysiology The central event in DKA is a profound loss of insulin action. Without insulin, glucose uptake in insulin-dependent tissues is impaired, while hepatic glucose production...
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Introduction:For diagnosing acute pyelonephritis, a comprehensive patient history is collected to identify symptoms such as dysuria, frequent or urgent urination, flank pain, or costovertebral angle (CVA) tenderness that may suggest a kidney infection.Physical ExaminationDuring the physical examination, CVA tenderness is assessed. This involves gentle percussion over the costovertebral angle, where tenderness often indicates a kidney infection.Diagnostic TestsUrinalysis: Used to identify white...
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Healthcare-associated infections (HAIs) occur in a healthcare facility while a person receives care for another ailment. This category also includes work-related infections among healthcare staff.
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Diabetic Ketoacidosis l: Introduction01:25

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DefinitionDiabetic ketoacidosis (DKA) is an acute, life-threatening complication of diabetes mellitus, characterized by a triad of hyperglycemia (blood glucose >250 mg/dL), ketonemia or ketonuria, and metabolic acidosis (arterial pH <7.30 and serum bicarbonate <18 mEq/L). It results from insulin deficiency combined with elevated levels of counterregulatory hormones—glucagon, catecholamines, cortisol, and growth hormone—leading to increased lipolysis, hepatic...
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Atypical pneumonia, often caused by Mycoplasma pneumoniae, is a form of pulmonary infection that differs from the classical presentation of bacterial pneumonia in both its cause and clinical symptoms. Mycoplasma pneumoniae is a pleomorphic bacterium notable for its lack of a rigid cell wall. This structural characteristic imparts resistance to beta-lactam antibiotics and significantly influences the bacterium’s behavior within the human host.Other pathogens responsible for the disease...
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Cecal Ligation Puncture Procedure
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Sepsis-associated hyperlactatemia.

Mercedes Garcia-Alvarez1,2, Paul Marik3, Rinaldo Bellomo4,5

  • 1Department of Anaesthesiology, Hospital de Sant Pau, Carrer de Sant Quintí 89, Barcelona, 08026, Spain. merced.garcia@austin.org.au.

Critical Care (London, England)
|November 15, 2014
PubMed
Summary
This summary is machine-generated.

Sepsis-associated hyperlactatemia (SAHL) is not solely due to tissue hypoxia but likely results from increased aerobic glycolysis. This elevated lactate may represent an adaptive survival response, not just a marker of poor outcomes.

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Area of Science:

  • Critical Care Medicine
  • Biochemistry
  • Pathophysiology

Background:

  • Sepsis-associated hyperlactatemia (SAHL) is a recognized predictor of mortality in sepsis and septic shock.
  • Traditionally, SAHL has been attributed to tissue hypoxia and anaerobic glycolysis, guiding resuscitation strategies.
  • Recent evidence challenges this paradigm, suggesting alternative explanations for elevated lactate levels.

Purpose of the Study:

  • To re-evaluate the underlying mechanisms of SAHL in sepsis.
  • To challenge the traditional interpretation of SAHL as solely indicative of tissue hypoxia or 'oxygen debt'.
  • To explore the potential adaptive role of lactate production in sepsis.

Main Methods:

  • Review of existing experimental and human studies on SAHL.
  • Analysis of the relationship between SAHL, stress response, and aerobic glycolysis.
  • Evaluation of lactate oxidation as a bioenergetic mechanism.

Main Results:

  • Accumulating evidence suggests SAHL is primarily driven by increased aerobic glycolysis due to adrenergic stimulation, not solely anaerobic glycolysis.
  • Studies indicate that SAHL may function as an adaptive survival mechanism, enhancing bioenergetic efficiency.
  • Lactate oxidation appears to play a significant role in the observed hyperlactatemia.

Conclusions:

  • The understanding of SAHL requires revision beyond the traditional hypoxia-driven model.
  • SAHL may represent a beneficial adaptive response to critical illness, facilitating energy production.
  • Clinicians should interpret lactate concentrations in sepsis resuscitation considering these updated biological principles.