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Is caval index a sufficient parameter for determining and monitoring dehydration in intoxication patients?
Kemal Sener1, Adem Cakir2, Onder Yesiloglu3
1Department of Emergence Medicine, Republic of Turkey, Ministry of Healthy Başaksehir Çam and Sakura State Hospital, Istanbul, Turkey. drkemalsener@hotmail.com.
Insights
The caval index (CI) effectively helps emergency clinicians assess and monitor fluid needs in intoxication patients. This index shows promise in predicting mortality and guiding resuscitation efforts in the emergency department.
Area of Science:
- Emergency Medicine
- Critical Care
- Toxicology
Background:
- Intoxication cases are rising, leading to increased emergency department visits.
- These patients often present with dehydration due to self-care deficits and substance ingestion.
- The caval index (CI) is a novel tool for assessing fluid status.
Purpose of the Study:
- To evaluate the efficacy of the caval index (CI) in determining and monitoring dehydration in patients with intoxication.
- To assess the correlation of CI with other clinical parameters and patient outcomes.
Main Methods:
- Prospective study in an emergency department involving 90 intoxication patients.
- Caval index (CI) measured by inferior vena cava diameter during inspiration and expiration.
- CI measurements were repeated at 2 and 4 hours post-initial assessment.
Main Results:
- Higher CI levels were observed in hospitalized patients, those with poly-drug use, or requiring inotropic agents.
- Patients receiving inotropic agents and fluids showed increasing CI over time.
- CI and shock index demonstrated high sensitivity and specificity for predicting mortality and correlated with admission systolic blood pressure.
Conclusions:
- The caval index (CI) is a valuable tool for emergency clinicians managing intoxication patients.
- CI aids in determining and monitoring fluid requirements in this patient population.
- CI can assist in predicting patient outcomes, including mortality.
Background:
Cases of intoxication are increasing day by day and these patients are presenting to emergency departments. These patients are usually individuals with poor self-care, inadequate oral intake, and unable to meet their own needs, and may have significant dehydration due to the agents they have taken. The caval index (CI) is a recently used index to determine fluid requirement and response.
Aims:
We aimed to evaluate the success of CI in determining and monitoring dehydration in intoxication patients.
Methods:
Our study was conducted prospectively in the emergency department of a single tertiary care center. A total of ninety patients were included in the study. Caval index was calculated by measuring inspiratory and expiratory inferior vena cava diameters. Caval index measurements were repeated after 2 and 4 h.
Results:
Patients who were hospitalized, took multiple drugs, or needed inotropic agents had significantly higher caval index levels. A further increase in caval index levels was observed on second and third caval index evaluations in patients who received inotropic agents along with fluid resuscitation. Levels of systolic blood pressure recorded at admission (0. hour) showed a significant correlation with caval index and shock index. Caval index and the shock index were highly sensitive and specific at predicting mortality.
Conclusion:
In our study, we found that CI can be used as an index to assist emergency clinicians in determining and monitoring fluid requirement in cases of intoxication presenting to the emergency department.
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