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Hemorrhagic shock and encephalopathy syndrome--the markers for an early HSES diagnosis.

Rinka H, Yoshida T, Kubota T, Tsuruwa M, Fuke A, Yoshimoto A, Kan M, Miyazaki D, Arimoto H, Miyaichi T, Kaji A, Miyamoto S, Kuki I, Shiomi M - BMC Pediatr (2008)

Bottom Line: Seven of the patients had elevated liver enzymes and creatine kinase (CK) upon admission.Twenty-four hours after admission, all 8 patients needed vasopressor infusion to maintain blood pressure.However, the elevated liver enzymes and CK upon admission, hypotension in the early stage after admission with refractory acid-base disturbance to fluid resuscitation and vasopressor infusion are useful markers for an early HSES diagnosis and helpful to indicate starting intensive neurological treatment.

View Article: PubMed Central - HTML - PubMed

Affiliation: Emergency and Critical Care Medical Center, Osaka City General Hospital, Osaka, Japan. rinkahiroshi@hotmail.com

ABSTRACT

Background: The hemorrhagic shock and encephalopathy syndrome (HSES) is a devastating disease that affects young children. The outcomes of HSES patients are often fatal or manifesting severe neurological sequelae. We reviewed the markers for an early diagnosis of HSES.

Methods: We examined the clinical, biological and radiological findings of 8 patients (4 months to 9 years old) who met the HSES criteria.

Results: Although cerebral edema, disseminated intravascular coagulopathy (DIC), and multiple organ failure were seen in all 8 cases during their clinical courses, brain computed tomography (CT) scans showed normal or only slight edema in 5 patients upon admission. All 8 patients had normal platelet counts, and none were in shock. However, they all had severe metabolic acidosis, which persisted even after 3 hours (median base excess (BE), -7.6 mmol/L). And at 6 hours after admission (BE, -5.7 mmol/L) they required mechanical ventilation. Within 12 hours after admission, fluid resuscitation and vasopressor infusion for hypotension was required. Seven of the patients had elevated liver enzymes and creatine kinase (CK) upon admission. Twenty-four hours after admission, all 8 patients needed vasopressor infusion to maintain blood pressure.

Conclusion: CT scan, platelet count, hemoglobin level and renal function upon admission are not useful for an early diagnosis of HSES. However, the elevated liver enzymes and CK upon admission, hypotension in the early stage after admission with refractory acid-base disturbance to fluid resuscitation and vasopressor infusion are useful markers for an early HSES diagnosis and helpful to indicate starting intensive neurological treatment.

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Time course of base excess for the first 24 hours after admission.
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Figure 1: Time course of base excess for the first 24 hours after admission.

Mentions: All the patients exhibited a severe metabolic acidosis with the BE range from -16.0 to -4.4 mmol/L (median, -10.3 mmol/L) upon admission. The acid-base disturbances were maintained with the BE range from -14.4 to -4.1 mmol/L (median, -7.6 mmol/L) at 3 hours, and from -15.2 to -3.1 mmol/L (median, -4.7 mmol/L) at 12 hours after admission with infusion of fluids and/or norepinephrine. The metabolic acidosis was refractory to intensive treatment with mechanical ventilation, infusion of fluids and/or norepinephrine at 24 hours with the BE range from -8.3 to -3.1 mmol/L (median, -4.9 mmol/L; Figure 1). Sodium bicarbonate for metabolic acidosis was not administered because the blood pH was kept in the normal range (7.35–7.45) with effective ventilation.


Hemorrhagic shock and encephalopathy syndrome--the markers for an early HSES diagnosis.

Rinka H, Yoshida T, Kubota T, Tsuruwa M, Fuke A, Yoshimoto A, Kan M, Miyazaki D, Arimoto H, Miyaichi T, Kaji A, Miyamoto S, Kuki I, Shiomi M - BMC Pediatr (2008)

Time course of base excess for the first 24 hours after admission.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2577649&req=5

Figure 1: Time course of base excess for the first 24 hours after admission.
Mentions: All the patients exhibited a severe metabolic acidosis with the BE range from -16.0 to -4.4 mmol/L (median, -10.3 mmol/L) upon admission. The acid-base disturbances were maintained with the BE range from -14.4 to -4.1 mmol/L (median, -7.6 mmol/L) at 3 hours, and from -15.2 to -3.1 mmol/L (median, -4.7 mmol/L) at 12 hours after admission with infusion of fluids and/or norepinephrine. The metabolic acidosis was refractory to intensive treatment with mechanical ventilation, infusion of fluids and/or norepinephrine at 24 hours with the BE range from -8.3 to -3.1 mmol/L (median, -4.9 mmol/L; Figure 1). Sodium bicarbonate for metabolic acidosis was not administered because the blood pH was kept in the normal range (7.35–7.45) with effective ventilation.

Bottom Line: Seven of the patients had elevated liver enzymes and creatine kinase (CK) upon admission.Twenty-four hours after admission, all 8 patients needed vasopressor infusion to maintain blood pressure.However, the elevated liver enzymes and CK upon admission, hypotension in the early stage after admission with refractory acid-base disturbance to fluid resuscitation and vasopressor infusion are useful markers for an early HSES diagnosis and helpful to indicate starting intensive neurological treatment.

View Article: PubMed Central - HTML - PubMed

Affiliation: Emergency and Critical Care Medical Center, Osaka City General Hospital, Osaka, Japan. rinkahiroshi@hotmail.com

ABSTRACT

Background: The hemorrhagic shock and encephalopathy syndrome (HSES) is a devastating disease that affects young children. The outcomes of HSES patients are often fatal or manifesting severe neurological sequelae. We reviewed the markers for an early diagnosis of HSES.

Methods: We examined the clinical, biological and radiological findings of 8 patients (4 months to 9 years old) who met the HSES criteria.

Results: Although cerebral edema, disseminated intravascular coagulopathy (DIC), and multiple organ failure were seen in all 8 cases during their clinical courses, brain computed tomography (CT) scans showed normal or only slight edema in 5 patients upon admission. All 8 patients had normal platelet counts, and none were in shock. However, they all had severe metabolic acidosis, which persisted even after 3 hours (median base excess (BE), -7.6 mmol/L). And at 6 hours after admission (BE, -5.7 mmol/L) they required mechanical ventilation. Within 12 hours after admission, fluid resuscitation and vasopressor infusion for hypotension was required. Seven of the patients had elevated liver enzymes and creatine kinase (CK) upon admission. Twenty-four hours after admission, all 8 patients needed vasopressor infusion to maintain blood pressure.

Conclusion: CT scan, platelet count, hemoglobin level and renal function upon admission are not useful for an early diagnosis of HSES. However, the elevated liver enzymes and CK upon admission, hypotension in the early stage after admission with refractory acid-base disturbance to fluid resuscitation and vasopressor infusion are useful markers for an early HSES diagnosis and helpful to indicate starting intensive neurological treatment.

Show MeSH
Related in: MedlinePlus