Lactate levels are commonly evaluated in acutely ill patients. Although most often used in the context of evaluating shock, lactate levels can be elevated for many reasons. While tissue hypoperfusion may be the most common cause of elevation, many other etiologies or contributing factors exist. Clinicians need to be aware of the many potential causes of lactate level elevation as the clinical and prognostic importance of an elevated lactate level varies widely by disease state. Moreover, specific therapy may need to be tailored to the underlying cause of elevation. The present review is based on a comprehensive PubMed search between the dates of January 1, 1960, to April 30, 2013, using the search term lactate or lactic acidosis combined with known associations, such as shock, sepsis, cardiac arrest, trauma, seizure, ischemia, diabetic ketoacidosis, thiamine, malignancy, liver, toxins, overdose, and medication. We provide an overview of the pathogenesis of lactate level elevation followed by an in-depth look at the varied etiologies, including medication-related causes. The strengths and weaknesses of lactate as a diagnostic/prognostic tool and its potential use as a clinical end point of resuscitation are discussed. The review ends with some general recommendations on the management of patients with elevated lactate levels.

https://www.mayoclinicproceedings.org/article/S0025-6196(13)00555-7/pdf

Etiology and Therapeutic Approach to Elevated Lactate Levels

A review on recent advances in chitosan based composite for hemostatic dressings.

OBJECTIVES: This investigation was conducted to test the value of Neutrophil Lymphocyte Ratio (NLR), which has been shown in some recent studies to be a prognostically im - portant and an easy-to-measure inflammatory marker, in patients presenting to Emergency Service with stroke (ischemic and hemorrhagic) and transient ischemic attack. MATERIALS AND METHODS: A total of 868 patients were enrolled, who presented to our Emergency Service with cerebrovascular acci - dent (stroke and transient ischemic attack) and admitted to Neurology Clinic. Demographic char - acteristics and comorbidities of patients were recorded. The patients were divided into 3 groups as acute ischemic stroke (AIS), acute he - morrhagic stroke (AHS) and transient ischemic attack (TIA). Patients with AIS were classified in - to subgroups in terms of TOAST (trial of 10172 stroke treatment) criteria. Admission NLR levels were compared across all groups. RESULTS: A total of 868 patients were enrolled, 51.6% of which were male and 48.4% were female. AIS rate was 75.3%, AHS rate was 14.3% and TIA rate was 10.7%. In all of patients, mortality rate was 10.7%. NLR was significantly higher in pa - tients who died ( p < 0.001). NLR level in patients with TIA was significantly lower than those of AIS and AHS groups ( p < 0.001). Among AIS sub - groups, NLR level was significantly higher in group with great artery atherosclerosis or atherothrom - bosis compared to other groups ( p < 0.001). CONCLUSIONS: NLR may be used as a simple and easy-to-measure marker for prediction of short-term prognosis and in-hospital mortality in both ischemic and hemorrhagic stroke patients.

/pdf/neutrophil-lymphocyte-ratios-in-stroke-subtypes-and-37q0cvkff9.pdf

Neutrophil lymphocyte ratios in stroke subtypes and transient ischemic attack.

Complications and validity of pulmonary angiography in acute pulmonary embolism

PolySTAT-modified chitosan gauzes for improved hemostasis in external hemorrhage

BACKGROUND: The aim of this study was to determine the epidemiology and clinical features of the trauma in elderly patients, to investigate the factors influencing mortality and morbidity and to make a contribution to the national trauma data. METHODS: We retrospectively investigated the medical records of three hundred seventy-one trauma patients (231 males (62,3%); 140 females (37,7%); mean age 71,9), aged 65 and older presenting to our hospital. Patients' census data, diagnosis, dispositions, prognosis, trauma scores (GCS (Glasgow Coma Score), RTS (Adult Trauma Score), ISS (Injury Severity Score)), sites of injury were analyzed. RESULTS: During the study period 187.326 patients were admitted to our emergency department (ED). A total of 9.520 patients were trauma patients. There were 371 patients 65 years and older. Mean GCS, mean RTS and mean ISS were 13,6, 11,3, and 9,3 respectively. A total of 213 patients were hospitalized. Mean length of stay was 7,9 days. Sixty-six patients were discharged from the ED. Mortality rate was 10,2% (38/371). The mechanism of injury, injury severity, increasing age were predictors of mortality (p<0.001). Major injuries included head trauma (36,4%), extremity trauma (36,4%), and thoracic trauma (18%). Head trauma and abdominal trauma were significantly more frequent in the nonsurvivors (p<0.001 and p=0.02 respectively). CONCLUSION: Injury severity and increasing age were the predictors of mortality. Also pedestrian- vehicle collision patients were high mortality rate than the other trauma mechanisms. The most common injured organs were head and extremities. Language: en

Trauma in the elderly patients in Bursa.

BACKGROUND The purpose of this study was to define the epidemiologic properties and correlation of physiological and anatomical risk factors with the mortality rate among patients with thorax trauma and to ensure early prediction of severe trauma. METHODS Files of 371 cases were retrospectively examined. Their initial state in the emergency department was analyzed in terms of mortality development. Age, gender, trauma mechanism, systolic blood pressure and respiration type on admission, accompanying injuries, thorax pathology, trauma scores, and treatment approaches in exitus and surviving cases were compared. Survival probabilities and unexpected mortality rates were computed using the Trauma Revised Score-Injury Severity Score (TRISS). RESULTS Age, hypotension, pathologic respiration, blunt injury, accompanying injury, abdominal trauma, high Injury Severity Score (ISS), and low Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), and TRISS were the factors affecting mortality, and presence of blunt injuries, TRISS 22 and GCS <13 were found to be independent prognostic factors. The strongest factor indicating mortality was TRISS. Thirty-four of 307 cases with survival probability of over 50% died. CONCLUSION In the presence of factors affecting mortality, patients with thorax trauma should be evaluated as being in a high-risk group and treatment strategies must be aggressive. Case analysis based on the TRISS model would further reveal the mistakes and may improve patient care.

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Factors affecting mortality in patients with thorax trauma.

This study was performed to investigate the relationships between markers of inflammation in serum (interleukin-6 [IL-6], interleukin-10 [IL-10], and granulocyte elastase [GE]), severity of injury, and clinical outcomes, and to evaluate the predictive value of these markers for major complications and mortality. This study, which was conducted between August 2003 and May 2005, examined patients older than 16 y who were admitted to the Emergency Unit of the Uludag University Medical School within 12 h after trauma, and who had traumatic hemorrhagic shock (THS) at admission. Three groups were established: the THS group (n=20), the pure hemorrhagic shock (PHS) group (n=20), and the healthy control group (n=20). Demographic data were recorded for all subjects, and blood samples were taken for lactate, base excess, GE, IL-6, and IL-10 measurements. The Glasgow Coma Score, the Revised Trauma Score, the Injury Severity Score, the New Injury Severity Score, and the Trauma Score-Injury Severity Score were calculated; complications and final clinical outcomes were monitored. A total of 35 men and 25 women were included in the study; mean patient age was 41+/-17 y. In the THS group, scores were as follows: Revised Trauma Score, 10.2+/-2.2; Trauma Score-Injury Severity Score, 0.86+/-0.2; Injury Severity Score, 24.8+/-9.0; and New Injury Severity Score, 32.7+/-9.0. IL-6, IL-10, lactate, and base excess levels in the THS group were significantly higher than those in the PHS and healthy control groups. The serum GE level of the THS group was significantly higher than that of the healthy control group, but it did not differ significantly from that of the PHS group. Complications such as sepsis, acute respiratory distress syndrome, and multiple organ failure occurred in 50% of the THS group and in 20% of the PHS group. Mortality was 30% in the THS group and 10% in the PHS group. In the THS group, no significant differences were noted between markers of inflammation and trauma scores of patients who died and those who survived. The investigators concluded that although the levels of markers of inflammation increased in THS patients, they were inadequate for predicting mortality and the development of complications such as acute respiratory distress syndrome, multiple organ failure, and sepsis. A larger study based on the use of serial marker measurements is warranted.

Relationships Between Markers of Inflammation, Severity of Injury, and Clinical Outcomes in Hemorrhagic Shock

BACKGROUND In this study, the hemostatic efficacy of Celox® in rats under hypothermia or warfarin treatment was investigated. METHODS A total of forty-eight Sprague-Dawley female rats weighing 200-350 g were used in the study. Six experimental study groups were designed, as follows: Group 1: Normothermia + compression; Group 2: normothermia + Celox®; Group 3: hypothermia + compression; Group 4: hypothermia + Celox®; Group 5: normothermia + warfarin + compression; and Group 6: normothermia + warfarin + Celox®. RESULTS Celox® provided effective hemorrhage control in all three tested groups. There was a statistically significant difference between compression and Celox® implementation in all groups in terms of hemostasis (p-values for the normothermia, hypothermia and warfarin groups were p<0.05, p<0.01 and p<0.01, respectively). Furthermore, the compression numbers were significantly lower in all of the groups that received Celox ® than in those in which compression alone was applied (p-values for the normothermia, hypothermia and warfarin groups were p<0.01, p<0.01 and p<0.001, respectively). CONCLUSION Celox® provides effective hemorrhage control under conditions of normothermia, hypothermia and use of the oral anticoagulant agent warfarin.

Hipotermi ve varfarin uygulanan şiddetli femoral arter kanamalı sıçan modelinde kitosan lineer polimer’in (Celox®) hemostatik etkinliği

RESULTS: The mean age of the patients was 59.28±16.79, and 55% of the patients were male. The common symptoms of the patients were dyspnea (14.7%), fever (13.7%), and systemic deterioration (11.9%); but the most and least frequent electrolyte imbalances were hyponatremia and hypermagnesemia, respectively. Most frequent fi ndings in physical examination were confusion (14%), edema (10%) and rales (9%); and most frequent pathological findings in ECG were tachycardia in 24%, and atrial fi brillation in 7% of the patients. Most frequent comorbidity was malignancy (39%). Most frequent diagnoses in the patients were sepsis (11%), pneumonia (9%), and acute renal failure (7%). CONCLUSIONS: Electrolyte imbalances are of particular importance in the treatment of ED patients. Therefore, ED physicians must be acknowledged of their fl uid-electrolyte balance dynamics and general characteristics.

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Fatma Özdemir

Papers

Trauma in the elderly patients in Bursa.

Factors affecting mortality in patients with thorax trauma.

Relationships Between Markers of Inflammation, Severity of Injury, and Clinical Outcomes in Hemorrhagic Shock

Hipotermi ve varfarin uygulanan şiddetli femoral arter kanamalı sıçan modelinde kitosan lineer polimer’in (Celox®) hemostatik etkinliği

General characteristics of patients with electrolyte imbalance admitted to emergency department.