Effects of Ringer’s sodium pyruvate solution on serum tumor necrosis factor-α and interleukin-6 upon septic shock

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Abstract

Objective:

To study the effects of Ringer’s sodium pyruvate solution on tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) upon septic shock.

Methods:

Ninety emergency patients with septic shock were divided into a treatment group and a control group by random draw. The control group was resuscitated with 50 ml of compound sodium chloride (Ringer’s solution), and the treatment group was given 50 ml of Ringer’s sodium pyruvate solution. Both groups were basically treated.

Results:

All patients were successfully resuscitated. After treatment, extravascular lung water index, intrathoracic blood volume index, systemic vascular resistance index and cardiac index of the two groups were significantly improved compared with those before treatment (P<0.05). However, there were no significant inter-group differences at different time points (P>0.05). Blood lactic acid level, central venous oxygen saturation index and urine output were also improved after treatment, with significant inter-group differences (P<0.05). Serum TNF-α and IL-6 levels of both groups significantly decreased after treatment (P<0.05), and the levels of the treatment group were significantly lower than those of the control group (P<0.05). During 28 days of follow-up, the mortality rate of the treatment group (4.4%) was significantly lower than that of the control group (20.0%) (P<0.05).

Conclusion:

Patients with septic shock are complicated with disordered expressions of inflammatory factors. During resuscitation, Ringer’s sodium pyruvate solution can effectively promote blood circulation, mitigate inflammation and maintain acid-base equilibrium, thus decreasing the prognostic mortality rate.

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Most cited references 24

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Early versus delayed administration of norepinephrine in patients with septic shock

Xiaowu Bai, Wenkui Yu, Wu Ji … (2014)

Introduction This study investigated the incidence of delayed norepinephrine administration following the onset of septic shock and its effect on hospital mortality. Methods We conducted a retrospective cohort study using data from 213 adult septic shock patients treated at two general surgical intensive care units of a tertiary care hospital over a two year period. The primary outcome was 28-day mortality. Results The 28-day mortality was 37.6% overall. Among the 213 patients, a strong relationship between delayed initial norepinephrine administration and 28-day mortality was noted. The average time to initial norepinephrine administration was 3.1 ± 2.5 hours. Every 1-hour delay in norepinephrine initiation during the first 6 hours after septic shock onset was associated with a 5.3% increase in mortality. Twenty-eight day mortality rates were significantly higher when norepinephrine administration was started more than or equal to 2 hours after septic shock onset (Late-NE) compared to less than 2 hours (Early-NE). Mean arterial pressures at 1, 2, 4, and 6 hours after septic shock onset were significantly higher and serum lactate levels at 2, 4, 6, and 8 hours were significantly lower in the Early-NE than the Late-NE group. The duration of hypotension and norepinephrine administration was significantly shorter and the quantity of norepinephrine administered in a 24-hour period was significantly less for the Early-NE group compared to the Late-NE group. The time to initial antimicrobial treatment was not significantly different between the Early-NE and Late-NE groups. Conclusion Our results show that early administration of norepinephrine in septic shock patients is associated with an increased survival rate.

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Severe delayed autoimmune haemolytic anaemia following artesunate administration in severe malaria: a case report

Loic Raffray, Marie-Catherine Receveur, Mathilde Beguet … (2014)

Background Parenteral artesunate is recommended as first-line therapy for severe and complicated malaria. Although its efficacy has been proven, long-term safety profile is still under evaluation. Several cases of delayed haemolytic anaemia occurred after initial clinical improvement and resolution of parasitaemia in non-immune travellers and children living in endemic areas. Reports have generated concern that this phenomenon might be related to the treatment itself, either by direct toxicity or immune-related mechanism. This is a report of the first case of autoimmune haemolytic anaemia following treatment of severe malaria initially managed with parenteral artesunate with strong indication for drug-immune related mechanism. Case A 17-year old Ivoirian female travelling in France presented with fever, headache and abdominal pain seven days after her arrival. Physical examination was indicative of septic shock while blood analysis showed normal haemoglobin level, but profound thrombocytopaenia and hyperlactataemia. Blood smear analysis showed Plasmodium falciparum infection with a parasitaemia of 0.8%. Severe malaria was diagnosed according to the WHO criteria. The patient was initially managed with artemether/lumefantrine combination and then parenteral artesunate for 48 hours. Empiric antibiotic course was also initiated with ceftriaxone, metronidazole, gentamycin, and then piperacillin and ciprofloxacin. At day 14, haemoglobin dropped to 4.6 g/dL with biologic features indicative of haemolysis (LDH 658 U/L, haptoglobin <0.15 g/L). At that time, parasitaemia was negative and other infections or hereditary disorders were excluded, while Coombs’ direct antiglobulin test was positive for IgG and C3d. Antinuclear antibodies were absent. Further investigations evidenced drug-induced antibodies related to artesunate. It was concluded a drug-mediated autoimmune haemolytic anaemia. A corticosteroids regimen was initiated at 1 mg/kg/day. Outcome was favourable and corticosteroids were progressively tapered during two months. At present the patient’s condition remains stable without recurrence of haemolytic anaemia. Conclusion This is the first case of delayed haemolytic anaemia related to artesunate with a strong indication for drug-immune related mechanism. Further research is warranted to better characterize this plausible cause of post-treatment haemolysis following parenteral artesunate administration in severe malaria patients. Electronic supplementary material The online version of this article (doi:10.1186/1475-2875-13-398) contains supplementary material, which is available to authorized users.

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Drug reaction with eosinophilia and systemic symptoms syndrome (DRESS) syndrome associated with azithromycin presenting like septic shock: a case report

Narin Sriratanaviriyakul, Lam-Phuong Nguyen, Mark C Henderson … (2014)

Introduction Drug reaction with eosinophilia and systemic symptoms syndrome is a potentially life-threatening cutaneous hypersensitivity reaction characterized by extensive mucocutaneous eruption, fever, hematologic abnormalities including eosinophilia and/or atypical lymphocytosis, and extensive organ involvement. The drugs most often responsible for causing drug reaction with eosinophilia and systemic symptoms syndrome are anticonvulsants, antimicrobial agents and antipyretic or anti-inflammatory analgesics. Although azithromycin is widely prescribed in clinical practice, serious cutaneous reactions from this agent have been rarely described. We report the first adult case of drug reaction with eosinophilia and systemic symptoms syndrome associated with azithromycin. Case presentation A 44-year-old previously healthy Caucasian man with history of tobacco use presented to his primary care physician with fever and productive cough. He was prescribed azithromycin, promethazine hydrochloride and dextromethorphan hydrobromide syrup. One week later, he developed a blistering erythematous rash over both hands, which over the next two weeks spread to involve nearly his entire body surface, sparing only his face. He was admitted to an outside hospital with signs of systemic inflammatory response syndrome and severe sepsis, presumably from a skin infection. Despite aggressive therapy he deteriorated, with worsening diffuse erythema, and was transferred to our institution. He developed multiple organ failure requiring ventilatory and hemodynamic support. Pertinent laboratory studies included a leukocytosis with a white blood cell count of 17.6×109/L and 47% eosinophils. A skin biopsy showed evidence of spongiotic lichenoid dermatitis with eosinophils and neutrophils, compatible with a systemic drug-induced hypersensitivity reaction. Our patient was started on high-dose steroids and showed dramatic improvement within 48 hours. Conclusions We report the first adult case of drug reaction with eosinophilia and systemic symptoms syndrome associated with azithromycin exposure. Clinicians should be aware of this potentially devastating complication from this commonly prescribed medication.

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Author and article information

Journal

Journal ID (nlm-ta): Pak J Med Sci

Journal ID (publisher-id): PJMS

Title: Pakistan Journal of Medical Sciences

Publisher: Professional Medical Publications (Pakistan )

ISSN (Print): 1682-024X

ISSN (Electronic): 1681-715X

Publication date (Print): 2015

Volume: 31

Issue: 3

Pages: 672-677

Affiliations

[1 ]Wei Dong, Department of Critical Care Medicine, Second District, Shandong Jining No. 1 People’s Hospital, Jining 272011, China

[2 ]Guannan Zhang Shandong Jining No. 1 People’s Hospital, Jining 272011, China

[3 ]Feng Qu, Chief Physician, Department of Critical Care Medicine, Second District, Shandong Jining No. 1 People’s Hospital, Jining 272011, China

Author notes

Correspondence: Feng Qu, E-mail: qufengdccm@ 123456126.com ; 13583759108@ 123456163.com

Article

Publisher ID: PJMS-31-672

DOI: 10.12669/pjms.313.7170

PMC ID: 4485293

SO-VID: cee33c75-172b-4607-8071-e29edaed629b

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 25 December 2014

Date revision received : 16 February 2015

Date accepted : 11 March 2015

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Unexplained mortality differences between septic shock trials: a systematic analysis of population characteristics and control-group mortality rates
Authors: Harm-Jan S. de Grooth, Jonne Postema, Stephan Loer …

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Effects of Ringer’s sodium pyruvate solution on serum tumor necrosis factor-α and interleukin-6 upon septic shock

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International Journal of Applied Technology in Medical Sciences

Most cited references 24

Early versus delayed administration of norepinephrine in patients with septic shock

Severe delayed autoimmune haemolytic anaemia following artesunate administration in severe malaria: a case report

Drug reaction with eosinophilia and systemic symptoms syndrome (DRESS) syndrome associated with azithromycin presenting like septic shock: a case report

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