Intravascular complications

Diagnostic studies should be performed to identify the source of infection, causative pathogen, and any complications (e.g., abscess, empyema, infected intravascular catheter, etc). 

Pathological findings frequently observed in organs of patients who have died of sepsis include disseminated intravascular coagulation (DIC), manifested as diffuse thrombotic occlusions in the entire microvascular system, associated with alterations in the hemostatic mechanism and clinical signs of hemorrhagic diathesis. Many observations indicate that DIC contributes to the major symptoms of the systemic inflammatory response syndrome (SIRS), which frequently complicate sepsis (HI, H2, H3, T6). 

Ou, M. C., Kambayashi, J., Kawasaki, T., Ueraura, Y., Shinozaki, K., Shiba, E Sakon, M Yukawa, M and Mori, T Potential etiologic role of PAF in two major septic complications disseminated intravascular coagulation and multiple organ failure. Thromb. Res. 73, 227-238 (1994). 

Patients predicted to follow a severe course require treatment of any cardiovascular, respiratory, renal, and metabolic complications. Aggressive fluid resuscitation is essential to correct intravascular volume depletion and maintain blood pressure. IV colloids may be required because fluid losses are rich in protein. Drotrecogin alfa may benefit patients with pancreatitis and systemic inflammatory response syndrome. IV potassium, calcium, and magnesium are used to correct deficiency states. Insulin is used to treat hyperglycemia. Patients with necrotizing pancreatitis may require antibiotics and surgical intervention. 

Superficial skin infections are treated without antibiotics. Local hygiene and disinfection with alcohol prevents spread of furunculosis. Local application of gentian violet in water (1%) is effective for impetigo. All pus collections must be drained by puncture or incision. Antibiotics are required only when systemic signs of infection are present or in patients with a high risk of complications (e.g. to prevent bacteraemia in a patient with prostheses or intravascular devices). 

Diuretic-induced metabolic alkalosis is another adverse effect that may further compromise cardiac function. This complication can be treated with replacement of K+ and restoration of intravascular volume with saline however, severe heart failure may preclude the use of saline even in patients who have received excessive diuretic therapy. In these cases, adjunctive use of acetazolamide helps to... 

Other reports have described serious immunological complications of propylthiouracil in the absence of ANCA, including interstitial nephritis and fatal Stevens-Johnson syndrome in a 90-year-old woman treated for 5 weeks (91) and disseminated intravascular coagulation and vasculitis 2 weeks after the introduction of propylthiouracil in a 42-year-old woman (92). The latter was treated successfully by drug withdrawal and intravenous methylprednisolone. 

RF catheter ablation is complicated by thromboembolism in about 0.6% of patients (23). The risk of stroke from RF ablation may be higher in paroxysmal AF patients with prior TIA (24). As reflected by elevated plasma D-dimer levels, RF ablation has a thrombogenic effect that persists through the first 48 hours after the procedure (25). Activation of the coagulation cascade in RF ablation procedures is not related to the delivery of RF energy, but is related to the placement of intravascular catheters and to the duration of the ablation procedure (26,27). Furthermore, RF lesions themselves have been shown to be thrombogenic (28). The risk of a thromboembolic complication is higher for left-sided ablations... 

MODIFICATIONS OF THE METHOD The technique described by Salazar et al. (1961) uses a stainless steel electrode which is inserted into a coronary artery in the dog and which delivers anodal current to the intravascular lumen. The electrode is positioned under fluoroscopic control which complicates the method. The technique was modified by Rom-son et al. (1980). They placed the electrode directly into the coronary artery of open-chest anaesthetized dogs. 

It should be stressed that baclofen withdrawal is a potentially fatal emergency. Because of the risk of rhab-domyolysis, disseminated intravascular coagulation, acute renal insufficiency, and other organ complications, patients should be transferred to the intensive care unit and given parenteral baclofen. 

This may explain the effectiveness of treating patients with hemophilia who have inhibitors with high doses of factor VIII. Another approach involves the use of prothrombin complex concentrate to treat bleeding episodes in patients with factor VIII inhibitors (38) however, thromboembolic complications related to higher doses of prothrombin complex concentrate have been described, although these are relatively rare (39,40). Thrombotic events are extremely rare when highly purified factor IX is used. Activated prothrombin complex concentrate is also effective in patients with factor VIII inhibitors (41). Serious complications are rare, but disseminated intravascular coagulation has been reported (42). 

---