ObjectiveSepsis is a condition associated with a dysregulated inflammatory response to infection with significant morbidity. Recent advances have elucidated the vital role that the short chain fatty acid glycoprotein receptor 43 (FFA2/GPR43) plays in inflammatory and immunomodulatory pathways. We hypothesized that elevated whole blood GPR43 RNA expression would be associated with increased 30-day survival in patients admitted with sepsis. Patients (n = 93) admitted to the intensive care unit with the diagnosis of sepsis underwent quantitative real time PCR within 48 h of intensive care unit admission. Clinical and demographical parameters were retrospectively extracted from the chart and compared to quantitative measurements of GPR43 RNA expression.ResultsUtilizing logistic regression, we found that the odds of mortality decreased for every one-unit increase in GPR43 RNA expression for patients that survived to 30 days [OR = 0.71; 95% CI (0.50, 0.99) p = 0.049]. Using linear regression, we determined that the increase in whole blood GPR43 expression was not associated with whole blood white cell count [r = 0.04; 95% CI (−0.16, 0.24); p = 0.70] or body mass index [r = − 0.07; 95% CI (− 0.23, 0.18); p = 0.81]. We conclude that the GPR43 receptor plays an integral role in survival during and after sepsis.
Patient: Male, 27-year-old Final Diagnosis: Thyroid storm Symptoms: Abdominal pain • agitation • fever • high ileostomy output • tachycardia • tachypnea • weight loss Medication: — Clinical Procedure: — Specialty: Critical Care Medicine Objective: Unusual clinical course Background: Thyroid storm, also known as thyrotoxic crisis, is a rare but life-threatening endocrine emergency that presents with multisystem involvement. Patients present with pronounced signs of hyperthyroidism, fever, tachycardia, and differing severities of multisystem dysfunction and decompensation. Early recognition and prompt initiation of treatment are important. The development of thyroid storm in patients with no established history of underlying hyperthyroidism is rare. Case Report: In this case report, we describe the occurrence of thyroid storm in a 27-year-old man without an established history of underlying thyroid disease, who was admitted to the Intensive Care Unit (ICU) with a high ileostomy output and fever. Although initially treated for possible sepsis, the diagnosis of thyroid storm was made only after a thorough workup was initiated and he was found to have underlying Graves’ disease. Prompt treatment resulted in the resolution of symptoms and avoided potential morbidity and mortality. Conclusions: This case highlights the potential difficulty in diagnosing thyroid storm in a patient admitted to the ICU without an established history of hyperthyroidism. Upgrade in care, timely diagnosis, and initiation of appropriate therapy led to a favorable outcome. Clinicians should consider hyperthyroidism as a possible cause of high ileostomy output, especially when it does not resolve with traditional treatment and no obvious cause can be identified. This case demonstrates the challenges presented when the patient’s history and clinical signs are ambiguous and stresses the importance of “outside the box” thinking.
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