By Stanley Davidson, Sir; J Alastair Innes
Illnesses & problems
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Extra resources for Davidson's essentials of medicine
Uid should be given to ensure that the intravascular volume is not the limiting factor in determining oxygen delivery. Vasoactive drugs are often used in the ICU. 5). In most cases a vasoconstrictor 30 CRITICAL CARE AND EMERGENCY MEDICINE • 3 such as noradrenaline (norepinephrine) is necessary to increase SVR and BP, while an inotrope (dobutamine) may be necessary to maintain cardiac output and prevent regional ischaemia. SPECIFIC THERAPIES Corticosteroids: Assessment of the pituitary–adrenal axis is difﬁcult in the critically ill but up to 30% of patients may have adrenal insufﬁciency.
V. Pabrinex). There is no treatment for Korsakoff’s syndrome once it has arisen. • Disulﬁram can be given as a deterrent to patients who have difﬁculty resisting the impulse to drink after becoming abstinent. It blocks the metabolism of alcohol, causing acetaldehyde to accumulate, and leads to an unpleasant reaction if alcohol is consumed (headache, ﬂushing and nausea). • Acamprosate has recently been introduced to maintain abstinence by reducing the craving for alcohol. • Many but not all who become dependent on alcohol relapse after treatment.
4%) to normalise [H+]. Patients are often very dehydrated, and ﬂuid loss from vomiting and sweating must be replaced. Urinary alkalinisation is indicated for adult patients with salicylate concentrations of 600–800 mg/l. It is critical to check that urine pH has increased to >8. Haemodialysis should be considered if serum salicylate is >800 mg/l; if there is resistant metabolic acidosis; or if there are severe CNS effects (coma, convulsions). NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS) Overdose of most NSAIDs usually causes little more than minor GI upset, including mild abdominal pain, vomiting and diarrhoea.