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Data publikacji: 3 czerwca 2025

Data aktualizacji: 31 lipca 2025

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1

Hahn, Robert G. Intravenous fluids in anaesthetic practice. Edited by Michel M. R. F. Struys. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199642045.003.0020.

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Infusion fluids may be regarded as drugs in the perioperative setting. The therapeutic effects of crystalloid solutions are strongly related to the administered volume, while fluids of the colloid type may also improve microcirculation and have anti-inflammatory properties. The anaesthetist should be able to handle all available infusion fluids and be aware of their benefits, limitations, and risks. Fluid administration programmes for surgery are traditionally based on a balance method in which perceived and measured losses are continuously replaced. Two outcome-guided approaches—restrictive a

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2

Hahn, Robert G. Fluid and electrolyte physiology in anaesthetic practice. Edited by Jonathan G. Hardman. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199642045.003.0003.

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The maintenance of body fluid homeostasis is an essential task in perioperative care. Body fluid volumes are tightly controlled by the nervous system, by hormones, and by the kidneys. All these systems are affected by anaesthesia and surgery in ways that must be appreciated by the anaesthetist. Administration of infusion fluids is the key tool to prevent major derangements of the body fluid volumes during before, during, and after surgery. By varying its composition, an infusion fluid can be made to selectively expand or shrink a body fluid compartment. The total osmolality determines whether

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Jörres, Achim, Dietrich Hasper, and Michael Oppert. Fluid overload in acute kidney injury. Edited by Norbert Lameire. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0229.

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A central objective in the management of acute kidney injury is the restoration and maintenance of adequate systemic and renal perfusion, often requiring the parallel administration of fluids and vasoactive drugs. However, hypovolaemia and fluid overload may both predispose the patient to complications and poor outcomes. Therefore, body weight and daily fluid intake/output should be recorded, patients should continuously be assessed for clinical signs of under- or over-hydration, and adequate monitoring of haemodynamic parameters should be performed. Together these parameters constitute the ba

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Greenlee, John E. Cerebrospinal Fluid. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199937837.003.0145.

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Evaluation of cerebrospinal fluid is of essential importance in the diagnosis of central nervous system infections, with a major role in the diagnosis of meningitis and encephalitis. In bacterial and viral meningitis, CSF evaluation is usually straightforward, and well-defined serological and molecular techniques are available for CSF examination in many of the more common viral encephalitides. This is in contrast to CSF evaluation in cases of tuberculous and chronic meningitis, in which organisms may be difficult to detect by culture or polymerase chain methods or antigen detection. This chap

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Myburgh, John, and Naomi E. Hammond. Choice of resuscitation fluid. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0069.

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Fluid resuscitation is a ubiquitous intervention in critically-ill patients. There is wide variation in practice and emerging evidence that the choice of resuscitation fluid may affect outcome in selected patient populations. It is likely that beneficial or adverse effects relate not only to the physicochemical properties of the fluid but also to the volume (dose) and rate of administration. Interstitial oedema is a common side-effect associated with all fluids and its development is associated with organ dysfunction. Crystalloids should be first-choice resuscitation fluids for almost all pati

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Raghunathan, Karthik, and Andrew Shaw. Crystalloids in critical illness. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0057.

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‘Crystalloid’ refers to solutions of crystalline substances that can pass through a semipermeable membrane and are distributed widely in body fluid compartments. The conventional Starling model predicts transvascular exchange based on the net balance of opposing hydrostatic and oncotic forces. Based on this model, colloids might be considered superior resuscitative fluids. However, observations of fluid behaviour during critical illness are not consistent with such predictions. Large randomized controlled studies have consistently found that colloids offer no survival advantage relative to cry

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Zetterberg, Henrik, and Jonathan M. Schott. Fluid Biomarkers Indicative of Neurodegenerative Diseases. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780190233563.003.0008.

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A major unifying feature of neurodegenerative diseases (NDDs) is excessive neuronal loss. Depending on when and where this occurs, patients may express distinct neurological and psychiatric symptoms. Neurodegeneration is accompanied by protein aggregation, inflammation, and microglial activation that may be drivers of the disease or in some circumstances may be protective reactions to the neurodegenerative process. A key development over the past decade has been our ability to leverage these accompanying central nervous system changes to develop clinically impactful biomarkers of specific NDDs

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Anderson, John A., Pierre-Antoine Laloë, and Derek J. Tuffnell. Amniotic fluid embolism (anaphylactoid syndrome of pregnancy). Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198713333.003.0038.

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Amniotic fluid embolus (AFE) is a rare occurrence but consistently remains one of the leading causes of maternal death in the developed world each year. Incidence in the United Kingdom is approximately 1 in 50,000 maternities and this seems to have stayed roughly stable. Quoted survival rates are improving, which may be a reflection of improved understanding and better care. This chapter aims to give an epidemiological background, outline the principles which are believed to underpin the pathophysiological changes which occur in episodes of AFE, and give readers a guide to treatment immediatel

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9

Holder, Helen. Nutrition and hydration. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199642663.003.0010.

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On admission, patients should have nutritional screening and assessment, in order to plan effective peri-operative nutritional care and prevent surgical complications associated with a poor nutritional status. The malnourished patient may require enteral nutrition in the form of oral nutritional supplements or enteral tube feeding. The surgical patient is at risk of peri-operative and/or electrolyte disturbances which can lead to dehydration, fluid overload, and cardiac arrhythmias. Accurate fluid balance monitoring will enable the nurse to identify fluid disturbances, assess the effectiveness

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Biswas, Santanu, and John J. Frank. Management of pericardial tamponade. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0167.

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Cardiac tamponade is an emergency, and definitive therapy is fluid removal by pericardiocentesis. In certain conditions, fluid removal is still the optimal choice, but a conservative approach using haemodialysis may be employed. Factors that influence the management strategy include evaluating the cause, providing haemodynamic support, and choosing the technique. Fluid resuscitation to maintain venous pressure and circulation may be beneficial up to a point, after which, tamponade may be aggravated. While inotropes have theoretical benefit, studies involving humans are few. Fluid removal strat

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Sever, Mehmet Şükrü, and Raymond Vanholder. Acute kidney injury in polytrauma and rhabdomyolysis. Edited by Norbert Lameire. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199592548.003.0252_update_001.

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The term ‘polytrauma’ refers to blunt (or crush) trauma that involves multiple body regions or cavities, and compromises physiology to potentially cause dysfunction of uninjured organs. Polytrauma frequently affects muscles resulting in rhabdomyolysis. In daily life, it mostly occurs after motor vehicle accidents, influencing a limited number of patients; after mass disasters, however, thousands of polytrauma victims may present at once with only surgical features or with additional medical complications (crush syndrome). Among the medical complications, acute kidney injury (AKI) deserves spec

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Timperley, Jonathan, and Sandeep Hothi. Peripheral oedema. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0014.

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Peripheral oedema is a palpable swelling caused by increased interstitial fluid in soft tissues, and can be due to local or systemic disease. Fluid distribution between capillaries and the interstitium is governed by Starling forces. The lymphatic system returns excess fluid and protein from the extracellular, interstitial space to the bloodstream. Thus, interstitial oedema may arise from factors that increase capillary pressure or permeability, factors that reduce plasma colloid osmotic pressure, factors that impede lymphatic drainage, or a combination of these causes. This topic addresses th

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Debaveye, Yves, and Greet Van den Berghe. Pathophysiology and management of pituitary disorders in the critically ill. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0262.

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The pituitary gland plays a predominant role in the endocrine system. Consequently, patients with pituitary diseases or after pituitary surgery present unique challenges to the intensivist. Failure of the anterior pituitary gland to secrete one or more pituitary hormones results in a clinical syndrome known as hypopituitarism. While hypopituitarism is mostly encountered in patients in whom the diagnosis has already been made, acute exacerbation of an undiagnosed insufficiency may occasionally occur. Acute decompensated patients with suspected hypopituitarism should be admitted to an intensive

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14

Grundy, Seamus. Pleural effusion. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0019.

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Pleural effusion is a common clinical problem which can present both to primary and secondary care. The process by which fluid accumulates can be divided into transudative or exudative. Transudative effusions occur in the presence of normal pleura and are caused by increased oncotic or hydrostatic pressures. Exudative effusions are associated with abnormal pleura and are caused either by increased pleural fluid production due to local inflammation or infiltration or by decreased fluid removal which is caused by obstruction of the lymphatic drainage system. Patients may be entirely asymptomatic

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15

Cohen, Jeffrey A., Justin J. Mowchun, Victoria H. Lawson, and Nathaniel M. Robbins. A 59-Year-Old Man with Progressive Difficulties with Balance and Weight Loss. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780190491901.003.0014.

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Paraneoplastic peripheral neuropathies are rare but important to consider in the evaluation of subacute peripheral neuropathy. The clinical and electrophysiological pattern as well as antibody evaluation is essential order to identify a specific paraneoplastic neuropathy. A positive paraneoplastic antibody in the cerebral spinal fluid is not required to make the diagnosis, but is helpful to consider if the serum antibodies are negative. This chapter emphasizes the importance of differential diagnosis and work up. Treatment options are described. Immunotherapy is also an important consideration

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16

Tanaka, Sébastien, and Jacques Duranteau. Management of acute non-cardiogenic pulmonary oedema. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0165.

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Severe capillary leak is an important factor in the pathogenesis of organ dysfunction following inflammatory syndromes such as sepsis-induced acute lung injury and acute respiratory distress syndrome (ARDS). Various interventions, such as a conservative fluid strategy, albumin, and diuretics are designed to maintain an adequate intravascular colloid osmotic pressure, reduce capillary leak and reduce extravascular water. Of these, only a conservative, rather than liberal fluid strategy is currently recommended. Preclinical studies in ARDS and sepsis suggest that preventing microvascular leak ma

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Sainz, Jorge G., and Bradley P. Fuhrman. Basic Pediatric Hemodynamic Monitoring. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199918027.003.0005.

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Physiological monitoring using a variety of technological advances supplements, but does not replace, our ability to distinguish normal from abnormal physiology traditionally gleaned from physical examination. Pulse oximetry uses the wavelengths of saturated and unsaturated hemoglobin to estimate arterial oxygenation noninvasively. Similar technology included on vascular catheters provides estimation of central or mixed venous oxygenation and helps assess the adequacy of oxygen delivered to tissues. End-tidal carbon dioxide measurements contribute to the assessment of ventilation. Systemic art

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Rajendram, Rajkumar. Management of acute pancreatitis in the critically ill. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0191.

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The major causes of morbidity and mortality in acute pancreatitis are organ dysfunction and infection of necrotic tissue. Management should aim to prevent, or to diagnose and treat, the complications of pancreatic inflammation, and any predisposing factors to avoid recurrence. Medical management is essentially supportive with oxygen, intravenous fluids, analgesia, enteral or parenteral nutrition, and correction of metabolic abnormalities. Patients with severe acute pancreatitis are unlikely to resume prompt oral intake so nutritional support is also required. Post-pyloric feeding is not requir

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Ostermann, Marlies, and Ruth Y. Y. Wan. Diuretics in critical illness. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0058.

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Fluid overload and chronic hypertension are the most common indications for diuretics. The diuretic response varies between different types and depends on underlying renal function. In patients with congestive heart failure, diuretics appear to reduce the risk of death and worsening heart failure compared with placebo, but their use in acute decompensated heart failure is questionable. Diuretics are also widely used in chronic kidney disease to prevent or control fluid overload, and treat hypertension. In acute kidney injury, there is no evidence that they improve renal function, speed up reco

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Turner, Neil, and Premil Rajakrishna. Pathophysiology of oedema in nephrotic syndrome. Edited by Neil Turner. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0053.

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The mechanism by which loss of serum proteins into the urine causes expansion of extracellular fluid volume and oedema has become clearer. A key initiating abnormality is avid sodium retention by the kidney, leading to increased whole-body sodium and increased extracellular fluid volume. This appears to be driven primarily by overactivation of the amiloride-sensitive epithelial sodium channel (ENaC) in the collecting duct, activated proteolytically through abnormal filtration of plasminogen, and its activation to plasmin in the nephron. Conventional explanations for nephrotic oedema focused on

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Beed, Martin, Richard Sherman, and Ravi Mahajan. Obstetric and fertility patients. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199696277.003.0013.

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Critical illness in pregnancySevere pre-eclampsia/eclampsiaHELLP syndromeAnaphylactoid syndrome of pregnancyMassive obstetric haemorrhageOvarian hyperstimulation syndromeAny critical illness may complicate pregnancy, or the postpartum period; especially sepsis and thromboembolic disease. Pregnancy-related illnesses may also require critical care intervention, including: pre-eclampsia and eclampsia, the HELLP syndrome, major haemorrhage, and anaphylactoid syndrome of pregnancy (amniotic fluid embolism). As with any critical illness, life-threatening problems are identified and treated first....

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Shmueli, Ehoud. Ascites. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0032.

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Ascites is the accumulation of fluid within the peritoneal cavity. Most patients with ascites usually have a known diagnosis of cirrhosis, malignancy, or heart failure. For patients newly presenting with ascites, the diagnostic problem is usually to differentiate between cirrhosis and malignancy. For patients with established liver disease, ascites represents a deterioration of their liver function, the development of a hepatocellular carcinoma, or another complication. Worsening of preexisting ascites may be due to spontaneous bacterial peritonitis. In malignancy, ascites denotes the developm

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Felbaum, Daniel R., Jonathan H. Sherman, and Walter C. Jean. Pineal Tumors. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190696696.003.0003.

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Pineal region tumors can include a variety of histologies including pineal parenchymal tumor, germ cell tumor, glial tumor, metastasis and meningioma. The workup for pineal region tumors includes standard magnetic resonance imaging for anatomic imaging, as well as cerebrospinal fluid markers to assess for certain germ cell tumors. Cerebrospinal fluid diversion may be necessary if patients present with hydrocephalus. If surgical resection is indicated based on the suspected diagnosis, magnetic resonance venogram is an important study that influences the surgical trajectory. This chapter reviews

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Turney, Ben, and John Reynard. Prevention of idiopathic calcium stones. Edited by John Reynard. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199659579.003.0015.

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The main principles of idiopathic calcium oxalate stone prevention are to maintain dilute urine through increasing fluid intake and to reduce calcium and oxalate excretion. The influence of various urinary factors on the risk of stone formation has been quantified mathematically. Urine volume and urinary oxalate concentration are most influential on the risk of stone formation, while magnesium concentration contributes a small amount to risk. It is estimated that around 50% of stone formers will form another stone within five years. Some stone formers have frequent recurrences. Most stone form

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Marples, David, and Søren Nielsen. Water homeostasis. Edited by Robert Unwin. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199592548.003.0022_update_001.

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Under normal circumstances, the maintenance of water balance is a question of balancing urine output against oral water intake, after allowance for the largely unregulated loss of water through other routes (respiratory, transcutaneous, and via the gastrointestinal tract). Normally, this is managed by the feedback mechanisms controlling thirst and diuresis, but in a medical context it is important to allow for other forms of administration that may not be under the control of the patient, and other routes of fluid loss, such as haemorrhage and drains. Electrolyte and water homeostasis are clos

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Cohen, Jeffrey A., Justin J. Mowchun, Victoria H. Lawson, and Nathaniel M. Robbins. A 48-Year-Old with Progressive Weakness and Pain. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780190491901.003.0005.

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Guillain-Barré syndrome may present in several ways, although predominant proximal weakness is a common feature of the disease to recognize. The differential diagnosis may be extensive and can include infection, vasculitis, toxin exposure, and malignancy. A lumbar puncture must be done with minimal delay to evaluate for cerebrospinal fluid (CSF) albuminocytological dissociation, however results may be normal early in the course of the disease. EMG/NCS are helpful to support the diagnosis, and early treatment with intravenous immunoglobulin (IVIG) is essential. This chapter discusses the clinic

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Chakera, Aron, William G. Herrington, and Christopher A. O’Callaghan. Polyuria. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0057.

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Polyuria describes the passage of more than 3 l of urine a day. This is an arbitrary definition, and the term is commonly applied to patients who are complaining of passing larger than normal volumes of urine. As water excretion is tightly regulated by the body to maintain normal osmolality, water excretion varies greatly depending on intake. Polyuria may be physiological or pathological. A patient with polyuria often presents with nocturia, urination overnight that disturbs sleep. It is usually accompanied by polydipsia (to maintain normal fluid balance). In hospital the commonest causes of p

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Freedman, Mark S., and Mohammad Abdoli. The Importance and Utility of Cerebrospinal Fluid Evaluation in the Diagnosis of Central Demyelinating Diseases. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199341016.003.0008.

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This chapter aims to highlight the diagnostic and prognostic value of cerebrospinal fluid (CSF) findings in multiple sclerosis with a special consideration of distinguishing it from neuromyelitis optica (NMO) and NMO spectrum disorder. Interpretation of CSF findings in daily clinical practice in patients with MS is thoroughly explained. New advances in CSF analysis and recently identified biomarkers may be helpful for diagnosis, help elucidate disease subtype and activity, or aid in prognosis and monitoring of the response to treatment. Characteristics of CSF changes in different subtypes of m

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Winkler, Nicole S. Duct Ectasia. Edited by Christoph I. Lee, Constance D. Lehman, and Lawrence W. Bassett. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190270261.003.0043.

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Duct ectasia is a term used to describe benign dilation of fluid-filled mammary ducts. Duct ectasia is characterized by tubular fluid-filled structures >2 mm in diameter that are commonly bilateral and subareolar in location. Ductal dilation is due to weakened wall elasticity that occurs with age. The ducts fill with secretions that may result in intermittent nipple discharge or chronic inflammation. When duct ectasia involves multiple ducts bilaterally, it can be dismissed on screening mammography; however, a solitary dilated duct should be further evaluated, given the potential for associ

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Arulkumaran, Nishkantha, and Maurizio Cecconi. Cardiac output assessment in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0136.

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Haemodynamic monitoring facilitates effective resuscitation and the rapid assessment of the response to time-dependent vasoactive and fluid therapyin different shock states. Since the introduction of the pulmonary artery catheter, several minimally and non-invasive CO monitoring devices have been introduced to provide continuous monitoring and a dynamic profile of fluid responsiveness. Several of these monitors provide additional haemodynamic parameters including dynamic indices of preload and volumetric indices. Patient outcome is dependent accurate acquisition and interpretation of data and

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Romagnoli, Stefano, and Giovanni Zagli. Blood pressure monitoring in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0131.

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Two major systems are available for measuring blood pressure (BP)—the indirect cuff method and direct arterial cannulation. In critically-ill patients admitted to the intensive care unit, the invasive blood pressure is the ‘gold standard’ as a tight control of BP values, and its change over time is important for choosing therapies and drugs titration. Since artefacts due to the inappropriate dynamic responses of the fluid-filled monitoring systems may lead to clinically relevant differences between actual and displayed pressure values, before considering the BP value shown as reliable, the cri

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Davies, Emily. Blistering rashes. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0069.

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A blister is a fluid-filled, circumscribed elevation of the skin. By convention, blisters are divided by size; blisters less than 0.5 cm wide are called vesicles, and those greater than 0.5 cm wide are called bullae. A blistering rash is used to describe any skin condition which morphologically consists of vesicles or bullae. Vesicles more than 48 hours old may evolve into pustules (pus-filled lesions). Pustular eruptions have not been included in this chapter. Secondary lesions include erosions (partial loss of epidermis), which may occur when a superficial blister ruptures or is scratched, a

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Abhishek, Abhishek, and Michael Doherty. Investigations of calcium pyrophosphate deposition. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199668847.003.0051.

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Joint aspiration and microscopic examination of the aspirated synovial fluid remains the gold standard for the diagnosis of calcium pyrophosphate crystal deposition (CPPD). If synovial fluid aspiration is not feasible, plain radiography and/or ultrasound scanning may be used to detect chondrocalcinosis (CC) which predominantly occurs due to calcium pyrophosphate (CPP) crystals, and this can be used as a diagnostic surrogate for CPPD as suggested by the EULAR Task Force. Acute CPP crystal arthritis often associates with a brisk acute phase response (elevated C-reactive protein (CRP) and/or eryt

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Anitescu, Magdalena, and Chirag Shah. The Vasovagal Reflex and Neuraxial Techniques. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190271787.003.0042.

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Syncope, or the transient loss of consciousness, is one of the leading causes of emergency department visits. Syncope can be neurally mediated, orthostatic, cardiac, or cerebrovascular. Neurally mediated vasovagal syncope is the most frequent form. Diagnostic modalities are tilt- table testing and implantable loop recorders. Therapeutic options usually begin with supportive measures, such as a fluid bolus or changing patient positioning, but complex cases may require vasoactive agents or placement of a pacemaker. In many situations patients who present to the operating room for various surgeri

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Sjoblom, Matthew D., Diane Gordon, and Lori A. Aronson. Hypopituitarism. Edited by Erin S. Williams, Olutoyin A. Olutoye, Catherine P. Seipel, and Titilopemi A. O. Aina. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190678333.003.0041.

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Hypopituitarism is a decreased secretion of pituitary hormones. It is especially concerning during surgery and anesthesia if it results in adrenal insufficiency, hypothyroidism, or diabetes insipidus. Common causes in children include pituitary tumor and/or treatment, traumatic brain injury, and empty sella syndrome. Perioperative management includes recognition of clinical symptoms, such as hypotension, fatigue, polydipsia, and increased urine output. Unrecognized adrenal insufficiency may result in significant morbidity or mortality. Intraoperative treatment may involve stress-dose corticost

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Venkatesh, Bala, and Jeremy Cohen. Pathophysiology and management of adrenal disorders in the critically ill. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0261.

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The existence of the syndromes of relative adrenal insufficiency, or critical illness corticosteroid insufficiency, are debatable. In sepsis, there are alterations in plasma cortisol profiles, and corticotropin responsiveness with marked variability in responses between patients. It is probable that the spectrum of plasma and tissue glucocorticoid changes may represent a ‘sick euadrenal state’ analogous to the sick euthyroid state and may not reflect adrenocortical insufficiency. Treatment of acute adrenal crisis should not be delayed for the results of adrenal testing, and should consist of i

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Nadel, Simon, and Johnny Canlas. Epidemiology, diagnosis, and assessment of meningitis and encephalitis. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0240.

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Despite advances in antimicrobial therapy, central nervous system infections have a high morbidity and mortality. Most pathogens reach the brain by haematogenous spread following invasion through the mucosal surface of the nasopharynx. The cerebrospinal fluid inflammatory response is responsible for most of the deleterious effects of the infection. Understanding this response has allowed a more rational approach to therapy. Patients may present with non-specific features, especially neonates, infants, post-neurosurgical patients, and the elderly. This chapter will review the epidemiology, path

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Dunsmore, Sara, and Joanne M. Bargman. Peritoneal dialysis. Edited by Jonathan Himmelfarb. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0266.

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Many patients tolerate peritoneal dialysis well and experience little difficulty with the process. There are, however, a number of unique complications that can arise in a patient undergoing peritoneal dialysis. While infection remains a significant concern, there are also many non-infectious problems that can occur. Many mechanical complications occur as a result of the increased intra-abdominal pressure associated with the instillation of fluid into the peritoneal cavity. The dialysate solution itself may also play a role in some of the metabolic complications seen. An awareness of the poten

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Haranhalli, Neil, and Jerome J. Graber. Pineal Region Neoplasms. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199937837.003.0131.

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Pineal region tumors include a diverse array of neoplasms arising from various components of the pineal gland, including germ cell tumors, germinomas, teratomas, pineocytomas, pineoblastomas, and tumors derived from glial tissues including gliomas, astrocytomas, oligodendrogliomas, and ependymomas. Benign lesions of the pineal gland can include pineal cysts, calcifications and meningiomas. Metastatic tumors can also be found in the pineal region. Numerous infectious and inflammatory conditions can mimic pineal tumors. Most patients present with symptoms of hydrocephalus or Parinaud’s syndrome.

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Phillips, Mike. Pre-operative optimization. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199642663.003.0005.

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Once a patient has been admitted for surgery, depending upon their pre-operative assessment, they may require a period of optimization in hospital before surgery. Pre-operative optimization will focus the clinical teams on incremental adjustments to baseline physiology and testing to ensure that the patient is in optimal clinical condition prior to surgery. The nursing care of such patients will rely upon surgical knowledge of body systems, such as cardiovascular and respiratory, alongside fluid and electrolyte management, nutrition, and pharmacology. This chapter guides the nurse in the asses

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Rovner, Michelle Sher. Post-Tonsillectomy Bleeding. Edited by Matthew D. McEvoy and Cory M. Furse. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190226459.003.0080.

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Post-tonsillectomy bleeding is a well-described complication that can rapidly evolve into one of the most challenging clinical situations in anesthesia. Tonsillectomy and adenoidectomy is one of the most common pediatric surgical procedures. A frequent indication for this procedure is adenotonsillar hyperplasia associated with obstructive sleep apnea. These children may be very challenging to care for and may have significant respiratory and fluid management issues postoperatively. This situation requires immediate attention and action with regard to resuscitation in a hypovolemic patient in c

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Turney, Ben, and John Reynard. Kidney stones. Edited by John Reynard. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199659579.003.0013.

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The composition of kidney stones is variable and the predisposing factors multifactorial. Consequently, a detailed evaluation of the patient’s lifestyle, diet, fluid intake, medical history, drug history, urinary tract anatomy, blood, and urine biochemistry and stone composition is required determine predisposing factors for stone formation in an individual patient. Combinatorial subtle variants in biochemistry may act synergistically to increase risk of stone formation/recurrence. Many medications may alter blood and/or urine biochemistry and predispose to stone formation. Corticosteroids inc

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Grundy, Seamus. Pleural infection and malignancy. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0143.

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Pleural infection transitions from simple parapneumonic effusion, to complex parapneumonic effusion, to empyema. Primary empyema occurs without an underlying pneumonic process. Pleural infection commonly presents identically to pneumonia with dyspnoea, purulent sputum, and fevers. It may be associated with pleuritic chest pain. Empyema can cause systemic sepsis, leading to cardiovascular instability and multi-organ failure. A malignant pleural effusion arises when malignant cells infiltrate the pleura, resulting in increased production and decreased lymphatic drainage of pleural fluid. Maligna

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Sedel, Frédéric. Krabbe Disease in Adults. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199972135.003.0051.

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Krabbe disease (globoid cell leukodystrophy) is an autosomal recessive lysosomal storage disease caused by mutations in the lysosomal galactocerebrosidase (galactosyl ceramidase) gene. Krabbe disease usually presents as a severe leukodystrophy in early infancy and childhood. In contrast, adult patients usually present with progressive spastic paraparesis. Other signs of the disease include peripheral neuropathy, dysarthria, cerebellar ataxia, pes cavus deep sensory signs, tongue atrophy, optic neuropathy, cognitive decline. Cerebrospinal fluid protein concentration is moderately increased in a

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Howe, Peter. Craniosynostosis Repair. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199764495.003.0028.

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Craniosynostosis is a condition in which one or more of the fibrous sutures in an infant skull fuses prematurely. This may lead to restricted skull and brain growth and elevated intracranial pressure. Many children with craniosynostosis undergo corrective cranioplasty in infancy, an age when the skull is relatively large in proportion to the rest of the body. Depending on the operation, it is common for blood loss to be substantial and exceed the child's estimated blood volume (EBV). Managing this blood loss is challenging and requires careful planning for fluid and blood product administratio

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O’Neal, M. Angela. Acute Headache in Pregnancy. Edited by Angela O’Neal. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190609917.003.0020.

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The case illustrates the characteristics of pituitary apoplexy. This anatomy of the pituitary, which predisposes to the condition, is described. The most common clinical feature is headache. Visual disturbance related to optic chiasm or optic nerve involvement is also common. Pituitary apoplexy is a neuroendocrine emergency. The most important hormone involved is adrenocorticotropic hormone, ACTH. However, there are often multiple hormonal deficiencies: growth hormone, hypothyroidism, and hypogonadotropic deficiency. A high prolactin level may reflect a prolactinoma or be due to hypothalamic i

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Padmanabhan, Rajagopala, and Holt N. Murray. Emergency Vascular Access (DRAFT). Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190612474.003.0025.

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Emergency resuscitation and stabilization of the critically ill patient is a cornerstone of patient care during a rapid response team (RRT) call. The establishment of vascular access, along with airway, breathing, and circulation management is pivotal for the delivery of fluid, blood products, and life-saving medications that can directly impact the morbidity and mortality of critically ill patients. Unfortunately, peripheral venous access may be difficult, if not impossible, to get in some patients. In these, and other select situations, excess time spent attempting to insert a peripheral lin

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Isserman, Rebecca S., and Justin L. Lockman. Intracranial Tumor. Edited by Kirk Lalwani, Ira Todd Cohen, Ellen Y. Choi, and Vidya T. Raman. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190685157.003.0026.

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Intracranial tumors are the most common solid malignancy in pediatrics, with the majority found in the posterior fossa. In these patients, presenting symptoms and signs are frequently related to intracranial hypertension due to obstruction of cerebrospinal fluid flow. Specific cranial nerve palsies and ataxia may also be presenting signs, with or without intracranial hypertension. The anesthesia for surgical resection is nuanced by management of intracranial hypertension, the potential for hemodynamic instability, and postoperative complications resulting from damage to critical brainstem stru

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Keeley, Vaughan. Lymphoedema. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199656097.003.0113.

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Lymphoedema is a chronic oedema developing as a result of failure of the lymphatic system to drain fluid and other substances, such as proteins, from the tissues. It typically affects the limbs but can involve any part of the body. The management of all types of lymphoedema is largely palliative in nature in that there are no surgical or other treatments which offer a cure for the problem in the vast majority of cases. This chapter focuses on oedema associated with advanced cancer and other diseases, encountered towards the end of life with some reference to cancer treatment-related lymphoedem

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Patel, Vikram B. Basics of Fluoroscopy. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199908004.003.0001.

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This chapter reviews the basics of fluoroscopy, including its safe use and the dangers of radiation. Although various interventions have been used to treat pain for decades, use of fluoroscopy has been more prevalent since the mid-1990s. Several studies have shown that using any form of guidance is superior to “blind” procedures, providing better outcomes while reducing the rate of complications. Ultrasound may be safer than fluoroscopy for certain procedures such as joint injections near and around blood vessels. Ultrasound avoids the harmful radiation to the patient, the treating physician,

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