MRSA pneumonia mucus plug burden and the difficult airway

An 80-year-old female with a past medical history of chronic obstructive pulmonary disease (COPD), diabetes, and hypertension was initially admitted to the hospital for surgical repair of an incarcerated inguinal hernia. She underwent successful herniorrhaphy with mesh placement. Her post-operative course was complicated by a pelvic hematoma requiring evacuation during an exploratory laparotomy. The patient subsequently developed worsening hypoxia and increased work of breathing. She was placed on supplemental oxygen and as part of her work-up, underwent chest-computed tomography (CT) (Figures A and B). Subsequently, she was admitted to the Intensive Care Unit (ICU).

MRSA pneumonia mucus plug burden and the difficult airway


A randomized controlled trial: Changes of serum sodium levels in children with diarrhea moderate dehydration receiving rehydration therapy with standard hypotonic solution or balanced solution

Abstract
Background: Hyponatremia is a condition that may cause dangerous clinical manifestations. Diarrhea with dehydration is one of the most common causes for hyponatremia. Intravenous hypotonic fluid is used for children with moderate dehydration and isotonic Ringer lactate is used for severe dehydration in several therapy guidelines for diarrhea.
Aims: To investigate the difference in changes of serum sodium levels between rehydration therapy with standard hypotonic solution and balanced solution for children with diarrhea and dehydration.
Design: Randomized controlled clinical trial.
Setting: Emergency unit in Dr. Soetomo General Hospital, Surabaya, Indonesia.
Patients: Forty children aged between 3 months to 12 years old who were diagnosed with diarrhea with moderate dehydration based on Haroen Noerasid’s clinical criteria. Patients were randomly assigned into two groups: standard hypotonic solution therapy group (n=21) and balanced solution therapy group (n=19).
Interventions: Children in the standard therapy group received standard hypotonic solution (Na+ 50 mmol/L), while the other group received balanced solution (Na+ 145 mmol/L) as the main fluid during rehydration therapy.
Results: The mean initial serum sodium levels in the standard hypotonic solution and balanced solution group were 141 mmol/L and 141.4 mmol/L, respectively. The difference was found to be not statistically significant. There was a statistically significant difference between the post rehydration mean serum sodium levels of the standard hypotonic (138.3 mmol/L) and balanced solution group (141.7 mmol/L). The mean reduction of serum sodium levels was 2.48 mmol/L in the standard hypotonic solution group and there was a mean increase of 0.37 mmol/L in the balanced solution group. We found clinically a not significant difference of symptoms of hyponatremia in this study. There was no seizure, neurological inpairment in both treatment groups before and after rehydration.
Conclusions: There were difference changes in serum sodium levels post rehydration therapy by using two different solutions. Balanced solution was more stable and a safer choice to protects against hyponatremia.

A randomized controlled trial- Changes of serum sodium levels in children with diarrhea moderate dehydration receiving rehydration therapy with standard hypotonic solution or balanced solution