Bilirubin is a by-product of heme metabolism. Heme is largely derived from the hemoglobin in senescent red blood cells and is oxidized in the spleen, liver, and other organs by two isoforms of the enzyme heme oxygenase, in the presence…
Divergent patient populations: Trauma versus sepsis Noncardiac intensive care units (ICUs) predominantly manage coagulopathy in patients with trauma or sepsis. Although trauma is known as the third most frequent cause of death in the United States, sepsis, which is not…
Introduction Anemia is defined as a reduction in the circulating red cell mass, the hemoglobin concentration, or both with an associated decrease in the oxygen-carrying capacity of blood. It is among the most common clinical problems encountered among critically ill…
Introduction Alterations in glucose metabolism are common in the intensive care unit (ICU). The adverse effects of uncontrolled hyperglycemia, especially in a critically ill patient, are fairly well described. Management strategies for hyperglycemia in the critically ill patient have gone…
Abnormal serum calcium concentration is a common finding in critically ill patients. The prevalence of hypocalcemia in intensive care unit (ICU) patients ranges from 70% to 90% when total serum calcium is measured and from 15% to 50% when ionized…
Magnesium is an important ion that participates as a cofactor in over 300 enzymatic reactions, especially in those involving adenosine triphosphate (ATP). Hypomagnesemia is common in critically ill patients and is associated with increased mortality. , Cellular physiology and metabolism…
Introduction Disturbances in the phosphate balance are common in critically ill patients, but are not always easy to relate to specific symptoms. Dysphosphatemia, however, may cause a significant increase in multiorgan failure. In a Swedish critical care cohort, more than…
Potassium (K + ) is the most abundant intracellular cation and is maintained within narrow physiologic limits. Although reported values vary, the normal serum K + level in humans typically ranges from 3.5 to 5.0 mEq Alterations in electrolyte concentrations…
Acid-base disorders Acid-base disorders can be quantified by using the physiologic, base-excess, and physiochemical approaches (Stewart method). The bicarbonate [HCO 3 − ] buffer system plays a central role in the physiologic and base-excess methods. They share nearly common explanations…
Oliguria is one of the most common problems faced by clinicians in the intensive care unit (ICU). The goal of this chapter is to understand the reasons for oliguria and provide an evidence-based, practical, physiology-based approach to diagnosing and treating…