Levetiracetam use during extracorporeal membrane oxygenation in an adolescent patient

Abstract
Extracoporeal membrane oxygenation (ECMO) is a form of advanced life support which is reserved for respiratory or cardiac failure. Drug properties are affected and there are limited studies of medication use in this form of life support. We describe the case of a 16-year-old male deployed on ECMO for refractory respiratory failure who was receiving levetiracetam for seizures. A pharmacokinetic study was performed to determine drug levels through different points in the ECMO circuit and in the patient. Pharmacokinetic parameters were similar in healthy pediatric patients suggesting that ECMO does not affect the pharmacokinetic parameters of levetiracetam. To the authors’ knowledge, this is the first report of levetiracetam use during ECMO in a pediatric patient.


Unusual presentation of clozapine-induced abdominal compartment syndrome

Abstract
Clozapine-induced gastrointestinal hypomotility is common side effect of this drug. It can lead to various degrees of colon obstruction. In rare cases, it can be life-threatening since severe colon obstruction can lead to colon perforation, colon necrosis and ischemia and septic shock. In all these cases, there had been some complaints of constipation or abdominal symptoms prior fatal event. Here, we are reporting a case that had rapidly progressed to cardiac arrest in which the initial symptom was dyspnea instead of abdominal complaint.

Unusual presentation of clozapine-induced abdominal compartment syndrome


Prediction of colloid osmotic pressure from albumin and/or hemodynamics in pigs undergoing hemorrhagic shock

Abstract
Background and purpose: Colloid osmotic pressure (COP) is strongly affected during by hemorrhagic shock (HS) and imbalances may result in pulmonary and systematic oedema. Measurement of COP is therefore crucial in order to monitor changes and to react to critical levels. The aims of this study were to examine the time-course effects on COP and albumin in pigs undergoing controlled HS, and to investigate whether albumin and/or hemodynamic parameters are relevant predictors of COP during HS.
Methods: 18 pigs randomly assigned in a blinded manner to one of three groups. Group 1: sham (n=4); group 2: hemorrhage control (n=7) and group 3: hemorrhage + adenosine, lidocaine and Mg2+/adenosine, lidocaine (ALM/AL) (n=7). COP was measured using a commercially available oncometer.
Results: Group 2 experienced the greatest change in absolute and relative COP-values during the experiment, while group 1, as expected, experienced the smallest change. Strong correlations were seen between COP and albumin for group 2 (0.84, p<0.001) and for group 3 (0.82, p<0.001), whereas moderate to negligible correlations were seen between COP and the hemodynamic parameters. Conclusion: Pigs subjected to HS compensated unexpectedly well compared to pigs not exposed to HS (sham). It is possible to predict COP from albumin, which may be clinically relevant in situations where an oncometer is not accessible. Further studies are needed if these findings are to be transferred to humans.


Antimicrobial resistance patterns of Staphylococcus aureus in the intensive care unit at a tertiary hospital

Abstract
Purpose: The objective of the present study is to determine the pattern of antimicrobial resistance of Staphylococcus aureus (S. aureus) in the Intensive Care Unit at a tertiary hospital in Mexico.
Methods: 1,511 cultures in general surgery, internal medicine, neurosurgery and the ICU were analyzed, the sample pool was limited to ICU patients and out of those, only samples positive for S. aureus were included, meticillin resistance was confirmed.
Results: Of a total of 1,511 samples, 206 (13.63%) were culture positive for S. aureus. In the ICU, antimicrobial resistance to beta-lactams (penicillin, ampicillin, cephalothin, cefotaxime, cefazolin, amoxicillin/Ac. clavulanate and imipenem) averaged 73.52%; for clindamycin was 65.12%; ciprofloxacin 59.09%, erythromycin 65.31% and for vancomycin was 6.52%.
Conclusions: The present study showed a high incidence of MRSA in an Intensive Care Unit at a tertiary hospital.

Antimicrobial resistance patterns of Staphylococcus aureus in the intensive care unit at a tertiary hospital


Severe abdominal pain in a Jehovah’s Witness patient

A 76-year-old lady, with past medical history of hypertension, presented to the hospital with complains of severe right upper abdominal pain for 6 days prior to admission. A complete laboratory evaluation was non-revealing. An emergency computed tomography (CT) scan of the abdomen and pelvis revealed a hepatic artery aneurysm measuring 4 x 4 x 6 cm with unstable appearance (Figures 1,2,3). As the patient was a Jehovah’s Witness, and was not going to consent to receive any blood or blood product transfusion if needed, she was taken to the angiography suite emergently where a hepatic artery angiogram was performed. This was followed by embolization with an 8 mm coil, with successful reduction in the size of the aneurysm.

Severe abdominal pain in a Jehovah’s Witness patient