Multi-organ failure

Patients at greatest risk for mortality from acute pancreatitis are those who have multi-organ failure (e.g., hypotension, respiratory failure, or renal failure), pancreatic necrosis, obesity, volume depletion, greater than 70 years of age, and an elevated APACHE II score.3,4 The Acute Physiology, Age, and Chronic Health Evaluation (APACHE) II score is a rating scale of disease severity in critically ill patients. 

Multi-organ failure syndrome Patients recovering from dehydration myeloma... 

Organ failure Fatalities associated with multi-organ failure and various degrees of hepatic failure have been reported. Most cases occurred in association with other serious events (eg, status epilepticus, overwhelming sepsis), making it impossible to identify the initiating cause. 

The spectrum of gastrointestinal tract infections (GTI) cover a wide spectrum from asymptomatic Helicobacter pylori gastritis to self-limiting viral gastroenteritis to food poisoning to bacterial enterocolitis to antibiotic-associated Clostridium difficile colitis to typhoid fever with sepsis and multi-organ failure. 

Complications included acute respiratory distress syndrome, renal failure, and multi-organ failure. Evidence that the clinical spectrum of human H5N1 infections is not restricted to pulmonary symptoms was provided by a reported case of possible central nervous system involvement in a Vietnamese boy who presented with diarrhea, followed by coma and death. Influenza H5N1 virus was isolated from throat, rectal, blood, and cerebrospinal fluid specimens, suggesting widely disseminated viral replication. 

Keywords Hemosorption Multi-organ failure Activated carbon... 

LPS can provoke a multi-organ failure, due to the secretion of acute-phase reactants such as platelet-activating factor (PAF), TNF-a, and LBP. Multi-organ failure is also due to the secretion of prostaglandin E2 (PGE2) and inflammatory cytokines such as TNF-a, IL-ip, IL-6, whose production may increase the secretion of the acute-phase reactant, LBP [63], thus constituting an amplifying loop. The presence of a tumor may modify this host response as will be discussed below. 

While dozens of such healthy volunteer studies have been safely conducted, the catastrophic syndrome of T cell activation and depletion, cytokine release, and multi-organ failure seen in the 2006 Tegenero 1412 phase I study [34] reminded clinical investigators, sponsors, and regulatory agencies of the very... 

Stein GY, Fradin Z, Ori Y, Singer P, Korobko Y, Zeidman A. Phencyclidine-induced multi-organ failure. Isr Med Assoc J 2005 7(8) 535-7. 

Rare multi-organ failure associated with Stevens Johnson syndrome, toxic epidermal necrolysis or drug hypersensitivity syndrome... 

Adsorbents are used in medicine mainly for the treatment of acute poisoning, whereas other extracorporeal techniques based on physico-chemical principles, such as dialysis and ultrafiltration, currently have much wider clinical applications [1]. Nevertheless, there are medical conditions, such as acute inflammation, hepatic and multi-organ failure and sepsis, for which mortality rates have not improved in the last forty years. These conditions are usually associated with the presence of endotoxin - lipopolysaccharide (LPS) or inflammatory cytokines - molecules of peptide/protein nature [2]. Advantages of adsorption over other extracorporeal techniques include ability to adsorb high molecular mass (HMM) metabolites and toxins. Conventional adsorbents, however, have poor biocompatibility. They are used coated with a semipermeable membrane of a more biocompatible material to allow for a direct contact with blood. Respectively, ability of coated adsorbents to remove HMM solutes is dramatically reduced. In this paper, preliminary results on adsorption of LPS and one of the most common inflammatory cytokines, TNF-a, on uncoated porous polymers and activated carbons, are presented. The aim of this work is to estimate the potential of extracorporeal adsorption technique to remove these substances and to relate it to the porous structure of adsorbents. 

Severe sepsis and septic shock are common and are associated with a mortality rate which is still around the 50% mark. There are an estimated 751,000 cases of sepsis or septic shock in the United States each year, and they are responsible for as many deaths as acute myocardial infarction [63]. The transition from a systemic inflammatory response syndrome, typical of the initial onset of a septic shock, to severe sepsis, multi-organ failure, and irreversible shock, involves a multitude of pathogenic changes. 

All causes of acute gastroenteritis All other causes of multi-organ failure Arsenic poisoning... 

Not including findings of multi-organ failure beginning 24-72 hours after acute exposure involving systems listed... 

Disseminated intravascular coagulation, multi-organ failure... 

Patients who receive prompt symptomatic and supportive care following castor bean ingestion are likely to survive, with a fatality rate for treated patients of approximately 2% (Rauber and Heard, 1985). In fatal cases, death usually occurs on the third day or later and is due to multi-organ failure (Franz and Jaax, 1997). The most common findings at autopsy are ulceration of the mucosa of the stomach and small intestine, necrosis of mesenteric lymph nodes, hepatic necrosis and nephritis (Franz and Jaax, 1977). 

Coal Tar Products. A 70-year-old man died following ingestion of an unspecified amount of "industrial" creosote (presumably coal tar creosote) (Bowman et al. 1984). Death was attributed to multi-organ failure and occurred 30 hours after admission to the hospital. It is not known if this man had a history of prior coal tar creosote ingestion. Death has been reported to occur in adults and children 14-36 hours after the ingestion of about 7 and 1-2 g coal tar creosote, respectively (Lewin 1929). Thus, ingestion of creosote can be fatal to humans, but the dose level required to produce death cannot be accurately estimated from these reports. 

H)rperthermia (raised body temperature). As anyone who has removed their coat while chopping logs on a cold winter s day will testify, physical exertion produces heat. In the case of strychnine poisoning, body temperatures of 43°C (109°F) have been documented in patients who have survived but come perilously close to multi-organ failure. 

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