Critical Care WAarticles

  Review/ Turk J Gastroenterol 2015; 26: 197-203   ---------- How to interpret liver function tests in heart failure patients ----------   Liver damage secondary to cardiac failure may result from congestion or hypoperfusion of the organ.   There is no consensus on terminology, but the following has been used:   1. Cardiac Hepatopathy (CH) 2. Ischemic Hepatitis 3. Shock Liver 4. Hypoxic Hepatopathy 5. Acute Cardiogenic Liver Injury (ACLI)   We propose that ACLI provides more details about the underlying pathophysiological process. ----   ∎ Both the American College of Cardiology and European Society of Cardiology Heart Failure Guidelines recommend the inclusion of LFTs in the diagnostic workup of all patients presenting with HF. ----   Acute cardiogenic liver injury is generally asymptomatic, but nausea, vomiting, weakness, right upper quadrant pain, and apathy may be present after a latent period of 2–24 h after the acute event.   In m

  Review/ Blood Purif 2016; 42:214–218 DOI: 10.1159/000448471   ---------- A Protective Kidney-Lung Approach to Improve Outcomes in Mechanically Ventilated Patients ----------   * The predominant cause of death in ARDS is not hypoxemia, which is one of the defining criteria of ARDS, but multiorgan failure. It is well documented that acute kidney injury (AKI) is the most common organ dysfunction in ARDS patients and that in the presence of AKI the mortality rate increases to more than 40%, with the rate rising with AKI severity.   ---- We review 4 disparate but complementary mechanisms that may contribute to the adverse outcome in ARDS patients with evidence of renal failure.     ∎ Fluid Overload (FO)-   » Survivors can be separated from potential non-survivors simply by the degree of FO present on the day of admission and during intensive care unit stay.   » Bioelectrical impedance vector analysis is an emerging tool to assess total body water in crit

  REVIEW/ Journal of Intensive Care (2018) 6:21 ---------- Hypomagnesemia in critically ill patients ----------   Magnesium (Mg) is essential for life and plays a crucial role in several biochemical and physiological processes in the human body.   Distribution (Human Adult): Total = 25 g or 1000 mmol 60% stores in bones 20% in muscles 20% in soft tissues 0.5% in erythrocytes, and 0.3% in serum     Mg is a crucial co-factor in several enzyme systems.   Defining magnesium status: Normal serum concentration of Mg is 1.5 to 1.9 mEq/L   A normal serum level does not exclude magnesium deficiency.   Mg tolerance test are most widely used.   The serum Mg is easily available but may not adequately reflect the body Mg stores because of the physiological distribution of Mg. Notably, normal serum levels may be found even if a patient is intracellularly Mg depleted because intracellular stores are recruited to keep the serum levels within its range.