Diagnosing acute acid-base disorders

František Duška, Petr Waldauf

Vnitr Lek 2019, 65(6):400-404 | DOI: 10.36290/vnl.2019.073  

Traditional diagnostic approach to acute acid-base disorders is based on the assessment of bicarbonate buffer system, in which pH is determined by the ratio of [HCO₃^-] to pCO₂. This, in turn, creates basis for distinguishing metabolic and respiratory disorders, and defines the term "compensation". The use of electroneutrality advantageously complements the bicarbonate-based approach when dealing with complex acid-base disorders. It is possible to simplify this approach so it can be applied only using mental arithmetics. In principle, the space created by strong ion difference (which can be simplified to [Na⁺]-[Cl^-])...

Oncologic emergencies

Thomas Karvunidis, Martin Matějovič

Vnitr Lek 2019, 65(6):405-415 | DOI: 10.36290/vnl.2019.074  

Oncologic emergencies and life-threatening cancer-related and treatment-related complications are the net effect of gradually increasing incidence of malignant diseases, improvement of therapeutic options and survival of oncologic patients. These complications are relatively specific for such population of patients and they are quite rare within the individuals without malignancy. Selected oncological emergencies are discussed in this review.

Extracorporeal removal techniques in toxicology: part 1

Jaroslav Raděj, Jan Horák, Martin Harazim, Martin Matějovič

Vnitr Lek 2019, 65(6):416-424 | DOI: 10.36290/vnl.2019.075  

Supporting clearance of a toxic substance by an extracorporeal removal technique is one of the advanced treatment methods applied in poisoned patient management. General indications stem from toxicokinetics of the poison while individual indications are determined by poisoning severity. The first part of this review deals in detail with particular options of extracorporeal treatment in toxicology and also with its specific application when treating lithium and salicylates poisoning or dabigatran overdose. The aim of this review is to facilitate the clinician's and nephrologist's decision making whether to indicate this invasive procedure, to communicate...

Extracorporeal removal techniques in toxicology: part 2

Jaroslav Raděj, Jan Horák, Martin Harazim, Martin Matějovič

Vnitr Lek 2019, 65(6):425-432 | DOI: 10.36290/vnl.2019.076  

The second part of the review deals in detail with the diagnostics and treatment of toxic alcohols poisoning and management and indication of extracorporeal removal techniques in intoxication with other drugs, theophylline, valproic acid, metformin and metformin associated lactic acidosis, respectively. The extracorporeal treatment enhances the clearance of the toxin and corrects patient's metabolic disturbances as well. It is necessary to use this treatment in severe intoxications. Indication of this invasive procedure falls within clinician's and nephrologist's competence being advised by a toxicologist. This review could help make fast decisions.

Delirium in the intensive care unit

Renata Černá Pařízková

Vnitr Lek 2019, 65(6):433-439 | DOI: 10.36290/vnl.2019.077  

Delirium in intensive care patients occurs with high prevalence and is associated with increased morbidity and mortality, worse long-term clinical outcome and higher economic costs. The article describes the pathophysiology, risk factors and individual types of delirium in patients in the intensive care. The current concepts of access to patients in intensive care are presented with the aim of early detection, treatment and prevention of delirium development.

Sepsis mimics

Thomas Karvunidis, Martin Matějovič

Vnitr Lek 2019, 65(6):440-448 | DOI: 10.36290/vnl.2019.078  

Number of identical pathophysiological mechanisms is shared by sepsis and other clinical conditions and diseases. This could lead to their nearly similar clinical phenotype. However, the early discrimination of them is crucial - treatment of particular diseases differs significantly, and the mortality of the vast majority of them is considerable. The differential diagnostics possibilities together with brief description of selected clinical conditions are discussed within the review.

The role of palliative care in acute care setting

Ondřej Kopecký, Kateřina Rusinová, Michal Kouba, Iva Macová

Vnitr Lek 2019, 65(6):449-455 | DOI: 10.36290/vnl.2019.079  

While terminal palliative care focuses primarily on the management of symptoms of immediate dying, early palliative care provides an opportunity for the patient and his loved ones to understand the trajectory of the illness, to receive support for coping with the diagnosis, increase the quality of decision-making to match the patient's values and preferences. The emphasis is on realistic expectations of the outcome of treatment and timely anticipation of further disease course. The paper focuses on an overview of the evidence of palliative and supportive interventions, comparing the different trigger mechanisms for palliative intervention and presents...

Z odborné literatury

Vnitr Lek 2019, 65(6):458-460  

K životnímu jubileu prof. MUDr. Heleny Tlaskalové Hogenové, DrSc.

Jindřich Lokaj, Jiri Mestecky

Vnitr Lek 2019, 65(6):456-457