Sepsis with liver failure

How can you link sepsis and liver failure with a high lactate ... 

Liver transplantation is the method of choice in all patients with acute liver failure whose spontaneous survival rate without a transplant is <20%, taking into account all the parameters. Criteria proposed by King s College or Clichy provide a useful basis for assessment. The crucial factor, however, remains the choice of the appropriate time for carrying out the transplantation (i.) the possibility of eliminating decompensation by means of regeneration should be exploited (2.) delayed indications should not result in complications which would prevent a transplantation from being carried out (e. g. brain-stem herniation, sepsis). 

Protein metabolism depends on both kidney and liver function therefore, protein requirements will be altered with decreased kidney or liver function (see Chap. 139). Critical illness (e.g., sepsis, burns, or trauma) will result in a hypercatabohc state in which there is increased protein synthesis and degradation. Consequently, protein requirements wiU be increased to 1.5 to 2 g/kg per day. In burn patients, protein requirements may be as high as 2.5 to 3 g/kg per day. Liver failure typically results in the need for protein restriction (0.5 g/kg per day) except if a hypercatabohc state is also present, in which case the requirement may be increased to 1.5 g/kg per day. Protein needs in renal failure are variable and affected by the various renal replacement therapies available. The apphcation of these guidelines requires both chnical judgment and frequent monitoring of renal and liver function, serum chemistries, chiucal condition, and nutrition outcomes (see Chap. 139). 

A 41-year-old Caucasian man presenting sudden unconsciousness, tachyarrhythmia and fever of 40 °C was referred to the ICU. Sepsis was suspected and intravenous antibiotics were initiated. Liver failure was diagnosed but patient started to recover slowly. On day 23, a culture of a central venous catheter tip was positive with Candida glabrata. Anidulafundin was started with... 

She was admitted to intensive care with type 1 respiratory failure (low oxygen). She had rising lactate, chest sepsis and worsening liver function tests and raised INR. 

Liposomal ATP protected human endothelial cells from energy failure in a cell culture model of sepsis (21). ATP-L increased the number of ischemic episodes tolerated before electrical silence and brain death in the rat (22,23). In a hypovolemic shock-reperfusion model in rats, the administration of ATP-L increased hepatic blood flow during shock and reperfusion of the liver (24). The addition of the ATP-L during cold storage preservation of rat liver improved its energy state and metabolism (25,26). Co-incubation of ATP-L with sperm cells improved their motility (27). Finally, biodistribution studies demonstrated significant accumulation of ATP-L in ischemia-damaged canine myocardium (28). 

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