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Persistent-Heparin-Induced-Thrombocytopenia-Treate
Persistent-Heparin-Induced-Thrombocytopenia-Treate
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The document consists of two main sections: the first discussing the combination of hydrocortisone, vitamin C, and thiamine in treating severe sepsis and septic shock, and the second detailing a case of Heparin-Induced Thrombocytopenia (HIT) treated with intravenous immunoglobulin (IVIg).<br /><br />In the first section, the emphasis is on the potential metabolic and protective roles of thiamine, especially in septic patients who are often thiamine deficient. Thiamine deficiency can exacerbate the conversion of glyoxylate to oxalate, which may lead to hyperoxalosis—a condition worsened by renal impairments. The authors incorporate thiamine into a "metabolic cocktail" hypothesizing its ability to mitigate hyperoxalosis and reduce mortality in septic patients. Studies referenced suggest that thiamine can decrease the risk of acute kidney injury, alleviate oxidative stress, and improve endothelial function in the sepsis context. The document also mentions synergy between vitamin C, corticosteroids, and potentially thiamine in protecting against sepsis-related damage.<br /><br />The second section narrates the medical case of a 58-year-old woman with persistent HIT despite standard treatments like argatroban and fondaparinux. HIT is a condition resulting from antibodies against platelet factor 4 (PF4) bound to heparin, leading to dangerous blood clots and decreased platelet counts. The patient failed to respond to typical anticoagulation therapies, but showed a significant improvement after receiving high-dose IVIg, which rapidly normalized her platelet count. This case underlines IVIg's potential as a treatment for severe, refractory HIT, consistent with findings by other researchers.<br /><br />This document essentially highlights the evolving approaches in managing complex conditions like sepsis and HIT and underscores the role of vitamin supplementation and alternative therapies in enhancing treatment outcomes.
Keywords
hydrocortisone
vitamin C
thiamine
severe sepsis
septic shock
Heparin-Induced Thrombocytopenia
intravenous immunoglobulin
metabolic cocktail
hyperoxalosis
alternative therapies
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