Variations in plasma levels of adenosine 3',5'-monophosphate during clinical sepsis.

Plasma levels of adenosine 3',5'-monophosphate were measured in 43 patients with bacterial infections of varying degrees of severity. The most severely ill patients, who died within 48 hours of study, had the highest levels of plasma adenosine 3',5'-monophosphate, 38.4+/-29.

Sepsis--the Wayne State University Symposium--part III. Bacteremia and endotoxemia: a discussion of their roles in the pathophysiology of gram-negative sepsis.

Bacteremia, or the presence of live bacteria in the bloodstream, does not seem a prerequisite for septic shock. Indeed, only a small portion of all patients who sustain gram-negative bacteremia ever develop the shock syndrome. Endotoxin in the laboratory model is capable of producing a number of pathophysiological alterations which can partly explain the varied picture of septic shock seen in man.

Shock in the emergency department.

Shock continues to be associated with a high mortality rate primarily because of delays in diagnosis and therapy. To diagnose shock early, and thereby increase the chances of reversal before there is extensive deterioration of vital organs, one should look for any decrease in pulse pressure, urine output, urine sodium concentration, alertness or any increase in urine osmolarity, tachypnea or tachycardia. Systolic hypotension, oliguria, metabolic acidosis and a cold clammy skin are late signs of shock.

Approach to acid-base problems in the critically ill and injured.

The use of the Henderson-Hasselbalch equation and the relationships between bicarbonate levels and the pCO2 or carbonic acid concentration in evaluating acid-base abnormalities are explained. The etiology, pathophysiology, diagnosis and treatment of respiratory alkalosis and acidosis and metabolic alkalosis and acidosis are discussed. The results of laboratory tests should be examined in relation to the patient's condition and consistency with other laboratory tests.

Fluid and electrolyte problems in the emergency department.

In management of fluid and electrolyte problems in the emergency department several important principles are: (1) never completely trust the laboratory, (2) abnormalities should be treated at approximately the rate at which they developed, (3) correct only half the calculated deficit at a time and reevaluate the patient, (4) the highest priority in treatment is maintenance of intravascular volume and tissue perfusion. The osmolarity of fluid compartments as related to the fluid and electrolyte responses to stress and resultant fluid requirements for basic needs, current losses and deficits of fluid and electrolytes are discussed in depth. The characteristics of volume, sodium, potassium, chloride, bicarbonate, calcium and magnesium deficits and how to correct them are outlined.

Acute respiratory failure.

There appears to be a great similarity between all of the various types of Adult Respiratory Distress Syndromes (ARDS) in that they are all characterized by progressively increasing interstitial edema in the lungs and a reduced functional residual capacity. Early diagnosis is mandatory and therapy should be started as soon as there is a reasonable suspicion, based on the patient's injury or illness and the previous condition of his lungs, that acute respiratory failure is developing. Sepsis, shock, CNS or thoracic disease and trauma are important associated factors.