Common Presentations of Rare Drug Reactions and Atypical Presentations of Common Drug Reactions in the Intensive Care Unit
Adverse drug events (ADRs) are a significant source of iatrogenic injury that may be challenging to diagnose and treat. Patient outcomes range from mild symptoms to death. Critically ill children are at unique risk for ADR development because of age-dependent pharmacokinetic differences and off-label prescribing. (Source: Critical Care Clinics)
Source: Critical Care Clinics - April 1, 2022 Category: Intensive Care Authors: Justinn M. Tanem, John P. Scott Source Type: research

Zebras Seize the Day
This article highlights rare but important causes of SE across the continuum of care from neonates to adults. (Source: Critical Care Clinics)
Source: Critical Care Clinics - April 1, 2022 Category: Intensive Care Authors: Dana Harrar, Lileth Mondok, Samuel Adams, Raquel Farias-Moeller Source Type: research

Autoimmune Encephalitis: Distinguishing Features and Specific Therapies
Autoimmune encephalitis is characterized by subacute onset of the altered mental status that can rapidly progress to autonomic instability and refractory seizures requiring intensive care. It is mediated by autoantibodies that bind to synaptic surface proteins and alter their function. In contrast to many autoimmune CNS diseases, there is often little detectable inflammatory damage to the brain making it difficult to diagnose. Early engagement of a multidisciplinary team is essential to obtaining a complete diagnostic workup and instituting definitive therapy as early as possible to optimize outcomes. Diagnosis, treatment,...
Source: Critical Care Clinics - April 1, 2022 Category: Intensive Care Authors: Dominic O. Co, Jennifer M. Kwon Source Type: research

Diagnostic Time-Outs to Improve Diagnosis
Diagnostic errors harm patients. While the underlying causes of diagnostic error and the settings in which they occur are diverse, the use of a cognitive forcing function in the form of a diagnostic time-out can mitigate the risk of diagnostic error. Barriers to the implementation of diagnostic time-outs remain. In our survey of neonatal intensive care unit (NICU) providers, perceived time constraints were universally cited as a barrier. Attending neonatologists and neonatology nurse practitioners reported decreased perception of the risk of diagnostic error impacting patient outcomes, relative to the perception among neon...
Source: Critical Care Clinics - April 1, 2022 Category: Intensive Care Authors: Sarah Yale, Susan Cohen, Brett J. Bordini Source Type: research

Uncommon Etiologies of Shock
This article reviews uncommon etiologies of shock classified in the following categories: distributive, hypovolemic, cardiogenic, and dissociative shock. (Source: Critical Care Clinics)
Source: Critical Care Clinics - April 1, 2022 Category: Intensive Care Authors: Shilpa Narayan, Tara L. Petersen Source Type: research

Uncommon Causes of Acute Kidney Injury
Acute kidney injury (AKI) is one of the most important complications of critical illness and a significant public health concern. AKI is commonly associated with sepsis, cardiac dysfunction, and exposure to nephrotoxic medication; however, less common causes of AKI can lead to devastating patient outcomes when the underlying diagnosis is missed or delayed. These uncommon causes of AKI fall into 3 large categories: structural, immune mediated, and microvascular, including various types of thrombotic microangiopathy. Kidney imaging, urine studies, and serum hemolytic studies should be a routine part of the evaluation of AKI ...
Source: Critical Care Clinics - April 1, 2022 Category: Intensive Care Authors: Cassandra L. Formeck, Carlos L. Manrique-Caballero, Hernando G ómez, John A. Kellum Source Type: research

Rapid Onset of Neuromuscular Paralysis or Weakness
The focus of this narrative review is the differential diagnosis of disease involving the peripheral or lower motor neuron component of the neurology of breathing. The clinical context is limited to those conditions leading to admission to the intensive care unit with a time course often described as acute or of rapid onset, meaning within days to weeks. However, the article also reviews those underlying inherited or congenital conditions that may have gone unnoticed until fulminant deterioration with respiratory failure. (Source: Critical Care Clinics)
Source: Critical Care Clinics - April 1, 2022 Category: Intensive Care Authors: Robert Charles Tasker Source Type: research

Genetic Defects that Predispose to Serious Viral Infections
Viral immunity is a complex, multistep process involving both the innate and adaptive immune systems. Genetic defects in the immune system known as primary immune deficiency disorders (PIDDs) can result in viral infections that are severe, recurrent, or recalcitrant to therapy. These infections can lead to respiratory tract disease and pneumonitis, skin disease, and disseminated viral syndromes that affect multiple organs and even the brain. This review will provide a brief overview of immunity to viruses, an overview of PIDDs that result in significant viral susceptibility, as well as a diagnostic approach to these infect...
Source: Critical Care Clinics - April 1, 2022 Category: Intensive Care Authors: James Verbsky Source Type: research

Subtypes and Mimics of Sepsis
Sepsis is a heterogenous and imprecise syndrome that includes multiple phenotypes, some of which are amenable to specific therapies. Developing new therapies for sepsis will require focusing on subsets of patients. Key to improving care is evaluating patients for sepsis mimics and treatable diseases whose manifestations lead to a clinical classification of sepsis. Because sepsis is common, it is easy to overlook unusual causes of organ failure and succumb to confirmation bias about the nature of an illness. Careful attention to medical and family histories, focused diagnostic testing, and subspecialty input can help identi...
Source: Critical Care Clinics - April 1, 2022 Category: Intensive Care Authors: John A. Kellum, Cassandra L. Formeck, Kate F. Kernan, Hernando G ómez, Joseph A. Carcillo Source Type: research

Recognition and Management Considerations of Cardiac Channelopathies in the Intensive Care Unit
The understanding and prevalence of cardiac channelopathies has grown over time. Many patients are asymptomatic but are at risk for malignant arrhythmias during high-acuity medical admissions. Long QT syndrome, Brugada syndrome, and catecholaminergic polymorphic ventricular tachycardia are discussed with specific consideration given for the role these medical conditions play during an intensive care unit admission —for either cardiac or noncardiac reasons. (Source: Critical Care Clinics)
Source: Critical Care Clinics - April 1, 2022 Category: Intensive Care Authors: Anoop Kumar Singh Source Type: research

Pediatric Acute Liver Failure
Pediatric acute liver failure is a rare process that results from many different diseases including toxin ingestion and drug overdose, infections, metabolic and genetic disorders, immune-mediated diseases, and ischemia. Up to 50% of children with acute liver failure will never have an underlying cause found. Early identification, supportive care, and disease-directed therapy are critical. For some children liver transplantation is needed for survival, but many children will recover with appropriate therapy, without the need for transplantation. Nonetheless, overall survival is approximately 50% without liver transplantatio...
Source: Critical Care Clinics - April 1, 2022 Category: Intensive Care Authors: Catherine Larson-Nath, Bernadette Vitola Source Type: research

Primary Causes of Hypertensive Crisis
This article discusses common and rare causes of severe hypertension in infancy, childhood, and adulthood. Clinical features that indicate possible serious underlying disease associated with severe and symptomatic hypertension are outlined. (Source: Critical Care Clinics)
Source: Critical Care Clinics - April 1, 2022 Category: Intensive Care Authors: Scott K. Van Why, Cynthia G. Pan Source Type: research

Undiagnosed and Rare Diseases in Critical Care
Over the last several decades, advances in patient safety as well as diagnostics and therapeutics have led to dramatic improvements in outcomes for patients admitted to the intensive care unit. Nonetheless, many critically ill patients continue to experience adverse outcomes, oftentimes as a result of diagnostic error.1 While some patients may present with atypical manifestations of a common disorder and elude diagnosis, others may have a rare disease whose signs and symptoms mimic a more common disorder or whose features are sufficiently nonspecific so as to preclude accurate and timely diagnosis. (Source: Critical Care Clinics)
Source: Critical Care Clinics - April 1, 2022 Category: Intensive Care Authors: Brett J. Bordini, Robert M. Kliegman Tags: Preface Source Type: research

Undiagnosed and Rare Diseases in Critical Care
Critically ill patients with undiagnosed and rare diseases are at high risk for cognitive diagnostic errors as well as delays in diagnosis that are the result of impaired diagnostic access. Local evaluation teams dedicated to undiagnosed and rare diseases can address both the risk and actuality of diagnostic error, as well as shortfalls in diagnostic access, particularly for patients whose diminished access is a result of critical illness. Features of successful teams are discussed. (Source: Critical Care Clinics)
Source: Critical Care Clinics - April 1, 2022 Category: Intensive Care Authors: Brett J. Bordini Source Type: research

Undiagnosed and Rare Diseases in Critical Care
CRITICAL CARE CLINICS (Source: Critical Care Clinics)
Source: Critical Care Clinics - April 1, 2022 Category: Intensive Care Authors: Brett J. Bordini, Robert M. Kliegman Source Type: research