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Background Hyperlactatemia is common in intensive care unit (ICU) patients. The aim of our retrospective observational study was to analyse the impact of serum lactate on admission on mortality in patients with acute kidney injury (AKI) treated with renal replacement therapy (RRT). Methods During the study period of 4 years, 2939 patients were admitted to the ICU, 503 patients were diagnosed with AKI and 209 of them required RRT. After excluding patients on chronic dialysis and with known malignant disease, we retrospectively analysed 154 patients. Hyperlactatemia was defined as a serum lactate concentration above 4 mmol/L on admission to the ICU. Results The mean age of patients was 62.8 years, and 69.5% were men. The mean Charlson Comorbidity Index (CCI) on admission to the ICU was 3.7 and fifty-six (36.4%) patients had acute hyperlactatemia. All included patients had AKI stage 3 and were treated with RRT, 125 (81.2%) with continuous RRT and 29 (18.8%) with intermittent hemodialysis. The mean length of stay in the ICU was 15.7 ± 13 days and 118 (76.6%) patients died during the 60-day observation period. A Kaplan-Meier survival analysis showed that the survival rate was statistically significantly lower in the group of patients with hyperlactatemia (log-rank; p  = 0.032). The univariate Cox regression analysis showed that serum lactate on admission to the ICU significantly predict 60-day survival (HR 1.075; 95%CI 1.015–1.140; p  = 0.014). In the multivariate Cox regression analysis, which included age, gender, diabetes, hypertension, chronic kidney disease, estimated glomerular filtration rate, serum lactate, CCI and C-reactive protein, only age (HR 1.031; 95%CI 1.007–1.056; p  = 0.011) and serum lactate (HR 1.067; 95%CI 1.004–1.134; p  = 0.035) were independent predictors of mortality. Conclusion Our study underscores the independent association between hyperlactatemia of more than 4 mmol/L on admission to the ICU and increased 60-day mortality in patients with AKI treated with RRT. These findings, which have significant implications for the management and prognosis of critically ill patients with AKI, provide a new understanding of the role of serum lactate in patient outcomes. Trial registration Name of the registry: ClinicalTrials.gov; Trial registration number: NCT06565403; Date of registration, followed by the words 'Retrospectively registered': August, 19,2024; URL of trial registry record: https://clinicaltrials.gov/study/NCT06565403.

Cholinergic syndrome is a common topic at western medical universities yet rarely observed in clinical practice. The treatment involves muscarinic antagonists, acetylcholinesterase reactivation, seizure control, and supportive measures. Here we report a case of a 52-year old Caucasian male who attempted suicide by ingesting a purple crystal powder that turned out to be a mixture of carbofuran and chlormephos. At clinical examination, the patient presented with salivation, perspiration, diarrhoea, bradypnoea, loss of consciousness, and epileptic seizures. Laboratory tests showed low plasma cholinesterase, and we started obidoxime along with supportive intensive care treatment. He was later transferred to the psychiatry department for further diagnostics and treatment.

In a trial involving patients with coma after out-of-hospital cardiac arrest, a strategy targeting mild hypercapnia for 24 hours did not improve neurologic outcomes at 6 months as compared with targeted normocapnia.

Background. Mortality of admitted out-of-hospital cardiac arrest (OHCA) patients is decreasing. Our aim was to evaluate independent predictors of six-month mortality of successfully resuscitated OHCA patients. Methods. We reviewed retrospectively the records of 119 OHCA patients, admitted in 2011 to 2013 (73.1% men, mean age 64 ± 13,5 years) and registered their clinical data, treatments, and predictors of 6-month mortality. Results. Six-month mortality of admitted OHCA patients was 47.5% and was associated significantly with older age (67.7 ± 12.9 years versus 59.9 ± 13 years, p<0.05), mechanical ventilation, longer time of resuscitation (24.6 ± 18.9 sec versus 8.9 ± 8.4 sec, p<0.05), use of vasopressors (87.3% versus 62.5%, p<0.05), and increased serum lactate (8.1 ± 3.9 mmol/l versus 4.5 ± 3.6 mmol/l, p<0.05) but less likely with prior shockable rhythm (38% versus 73.2%, p<0.05), percutaneous coronary intervention (27% versus 55.4%, p<0.05), achieved target temperatures 32°–34°C of mild therapeutic hypothermia (47.6% versus 71.4%, p<0.05), acute coronary syndromes (31.7% versus 51.8%, p<0.05), and neurological recovery (4.8% versus 69.6%, p<0.05) when compared to survivors. Neurological outcome was most significant early independent predictor of 6-month mortality (OR 50.47; 95% CI 6.74 to 377.68; p<0.001). Conclusions. Postcardiac arrest brain injury most significantly and independently predicted 6-month mortality in hospitalized OHCA patients.