Publications

Abstract BACKGROUND Liver transplant patients who develop hyperlactatemia are at increased risk of postoperative morbidity and mortality, but there are few data on longer-term outcomes. We therefore investigated whether arterial lactate concentration obtained immediately after surgery, at the time of admission to the intensive care unit (ICU), was associated with 1-year mortality. METHODS : In this retrospective cohort study, all patients who underwent liver transplant surgery between September 2013 and December 2019 were screened for inclusion. Patients who underwent combined transplantation surgery and those with a history of previous liver transplantation (i.e., redo surgery) were not included. Logistic regression modeling included univariate and multivariate analyses. Receiver operating characteristic (ROC) curves and areas under the curves (AUROCs) were calculated. Lactate thresholds and association with outcome were analyzed for specificity, sensitivity, and Youden’s index. RESULTS : Of 226 patients included, 18.4% died within 1-year of liver transplantation. Immediate postoperative lactate concentration was independently associated with 1-year mortality with an odds ratio (OR) of 1.35 (95% CI: 1.16 to 1.59; p<0.001) per mEq/L increase in lactate and an AUROC of 0.80 (95% CI: 0.72 to 0.87; p<0.001). A lactate concentration of 2.25 mEq/L (cut-off determined using Youden’s index) was associated with increased 1-year mortality with a sensitivity of 0.71 and a specificity of 0.72. CONCLUSION : Increased arterial lactate concentration on admission to the ICU immediately after orthotopic liver transplantation is independently associated with increased 1-year mortality. Trial Registration: Not Applicable

We report a case of severe hypokalemia and flaccid muscle paralysis following a suicide attempt associating the calcium channel blocker amlodipine, the antidepressant fluoxetine and barium carbonate. Despite rapid correction of severe, life-threatening hypokalemia, areflexic quadriplegia persisted, suggesting a direct effect of barium on muscle cells. Continuous veno-venous hemodiafiltration (CVVHDF) was initiated. We determined barium concentration in the urine, plasma, and hemodiafiltrate during CVVHDF. We subsequently calculated the amounts of barium eliminated both by the CVVHDF and the kidneys. CVVHDF triples the measured barium elimination, reduced serum barium half-life by a factor of three, stabilized serum potassium levels, and rapidly improved motor strength, with complete neurological recovery within 24 h. Presentation and treatment of barium intoxication are discussed.

Society of Critical Care Medicine; 27th Educational and Scientific Symposium; San Antonio, Texas, USA; February 4-8, 1998: Poster Hall: Thursday, February 5, 1998 5: 45-7: 15 pm; Friday, February 6, 1998 11: 40 am-1: 00 pm; Saturday, February 7, 1998 11: 40 am-1: 00 pm: Poster Presentations: Cardiovascular

Annoni, Filippo1; Fontana, Vito2; Brimioulle, Serge3; Creteur, Jacques3; Vincent, Jean-Louis3; Taccone, Fabio Silvio2 Author Information