Coagulopathy from

Side effects from crystalloids primarily involve fluid overload and electrolyte disturbances of sodium, potassium, and chloride.23 Dilution of coagulation factors can also occur resulting in a dilutional coagulopathy.24 Two clinically significant reasons LR is different from NS is that LR contains potassium and has a lower sodium content (130 versus 154 mEq/L or mmol/L). Thus, LR has a greater potential than NS to cause... 

Generally, the major adverse effects associated with colloids are fluid overload, dilutional coagulopathy, and anaphy-lactoid/anaphylactic reactions.24,32 Although derived from pooled human plasma, there is no risk of disease transmission from commercially available albumin or PPF products since they are heated and sterilized by ultrafiltration prior to distribution.24 Because of direct effects on the coagulation system with the hydroxyethyl starch and dextran products, they should be used cautiously in hemorrhagic shock patients. This is another reason why crystalloids maybe preferred in hemorrhagic shock. Furthermore, hetastarch can result in an increase in amylase not associated with pancreatitis. As such, the adverse-effect profiles of the various fluid types should also be considered when selecting a resuscitation fluid. 

Decompensated liver disease is complicated by jaundice, refractory ascites, bacterial peritonitis, coagulopathy, and variceal bleeding and may require liver transplantation. The number of liver transplants for decompensated cirrhosis doubled from 1990 to 2004, when 5845 cadaveric (orthotopic) liver transplants were performed (65). 

A 65-year-old man, with metastatic carcinoma of the prostate was treated with flutamide 250 mg/day orally followed after 6 days by 7.5mg leuprolide intramuscularly. Two days later he developed bleeding and hematomas. His hemoglobin fell from 12.4 to 7.8 g/dl and he had a disseminated intravascular coagulopathy. 

What to do Be wary if people from a community that attended the same event, meal, party, or restaurant present with similar signs of bleeding disorders. Ingestion of superwarfarins may go unnoticed when these are mixed with food, and signs or symptoms are delayed 36 to 48 h. Consequently, the victims may not associate the ingestion with the coagulopathy. 

Vasopathies may arise from direct injuries to the vessel wall, but also from pathological changes in the vessel wall or in the endothelium. It can be expected that vasopathies will occur or become more severe during the course of various liver diseases or with concomitant coagulopathy. 

There have been over 50 published reports of acute pancreatitis associated with valproate (SEDA-18, 70) (84), including several confirmed by rechallenge. Deaths have occurred from hemorrhagic pancreatic necrosis complications can include pleural and pericardial effusions, coagulopathy, pseudocyst, ascites, wound infection, and pneumonia (SED-13, 151) (85). Hepatotoxicity can coexist. There is suggestive evidence that end-stage renal insufficiency (SEDA-22, 92) and mental retardation (84) can be predisposing factors. 

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