ICU Sepsis — help!

[Rinse & rePeat]

This protocols success hasn’t been replicated unfortunately despite many practitioners giving it a try.

Also, OP knows what Sepsis is but he might be confronted with a non-microbiologicaly caused phenomenon that shares mechanisms with sepsis but really isn’t. But a sort of lactate-poisoning because of impaired enzyme-complexes

That is certainly something to explore, but the OP has been in my C. diff thread when her father was dealing with it a month ago. I am just assuming it is the same family member.

 

[LeeLemonoil]

That is certainly something to explore, but the OP has been in my C. diff thread when her father was dealing with it a month ago. I am just assuming it is the same family member.

Ok, didn’t know that. Sorry.

 

[Rinse & rePeat]

Ok, didn’t know that. Sorry.

No no don’t be sorry. Your angle is very valuable and could still be what she is looking for, as well as others.

 

[healthiswellth]

Thank you all, yes it is my father—there are so many confounding factors in his case.

He is in remission from cns B cell lymphoma and his mri shows encephalopathy/bbb breakdown most likely due to intrathecal chemo. He keeps going to the hospital for sepsis symptoms but no infection is found. We’ve stopped chemo last month and in past couple days he started having cns -related sleep apnea and his co2 went high and he became unresponsive so they put him on machine to bring it down—-After it normalized, he became a little more responsive.
CT showed inflammation in lung which is new and most likely bc micro-aspiration due to the bipap machine that brought down his co2. There’s some inflammation In Intestines most likely due to the c diff he had a couple weeks ago.
His blood chemistry is normalizing. They have intubated him so they can safely run tests to see why he suddenly became more unresponsive (prior to this he was sleeping like 18 -20 hours a day which we were hoping would get better the further away we moved from chemo). EEG basically shows he is very drowsy. So they are saying either it’s infection, and antibiotics will help or lymphoma has returned and it’s not appearing in imaging and we may need to restart chemo.

Right now we are trying to get him to become responsive. What would increase brain activity?

They will give him nutrients Bs, d, e, k Mag, selenium, copper, zinc, baby aspirin through NG tube. That’s what I’ve managed so far.

Anything topical that might help?

 

[Pablo Cruise]

“For medical professionals​

• Sepsis treatment protocol​

  Vitamin C: 1.5 g IV q 6 hourly for 4 days or until discharge from the ICU.
  Hydrocortisone: 50mg IV q 6 hourly for 4 days or until discharge from the ICU. Taper is not required.
  Thiamine: 200mg IV q 12 hourly for 4 days or until discharge from the ICU. Alternative dosing: 100mg IV q 6 hourly for 4 days.
  

  Read the entire Marik sepsis protocol”​

A cure for sepsis? | EVMS Magazine 9.4

The last I read glucocorticosteroids did not necessarily help in sepsis. I did read a study that showed Doxycycline 100mg IV bid along with the other prescribed abx's was helpful.

 

[Rinse & rePeat]

The last I read glucocorticosteroids did not necessarily help in sepsis. I did read a study that showed Doxycycline 100mg IV bid along with the other prescribed abx's was helpful.

I am expert in curing sepsis, so your input is a good piece to a puzzle.

 

[haidut]

He is in remission from cns B cell lymphoma

How did they decide he is in remission and the lactic acidosis is not due to the cancer flaring up? Has he had his LDH (among other things) levels tested? Often, LDH is high when cancer comes back and/or is progressing. There is also something called "tumor lysis syndrome" and it can cause sepsis too. It is exceedingly common in blood cancers like your dad's, and it usually caused by the chemotherapy.

Tumor lysis syndrome - Wikipedia

en.wikipedia.org

It is distinctly possible that the hospital is playing "dumb" on purpose in order to avoid liability. If their treatment caused his sepsis through the tumor lysis, then they could be legally liable (at least in the US). So, they just pretend like they don't know what is causing it. Of course, it may also simply be a case of not "connecting the dots" by the medical workers.
Anyways, thiamine and niacinamide may be helpful for the lactic acidosis, which is probably the main danger for a person with sepsis.

Niacinamide Causes Dramatic Increase In Nad And Fall In Lactate

The good things about this study is that it is human and as such the doses are directly relevant. Given that the patient had MELAS, the niacinamide dose used was on the high end but still quite reasonable and comparable to the human trials of niacinamide in Alzheimer disease and stroke. The...

raypeatforum.com

Thiamine Reduces Both Lactate And Ammonia

The study was with humans and also included exercise, which makes thiamine even more interesting to athletes. The type of thiamine used was TTFD, which is the scientific name for allithiamine, and the dose was 10mg/kg. That would mean a total daily dose in the range of 600mg-900mg for most...

raypeatforum.com

Thiamine Normalizes Pyruvate / Lactate Levels In Rats With Cancer

Russian study, so I can't get the actual paper and see route of administration, but it was likely oral or intraperitoneal. Human equivalent dosage is 100mg - 150mg daily. http://www.ncbi.nlm.nih.gov/pubmed/664448

raypeatforum.com

Majority Of Cancer Patients Have Vitamin B1 (thiamine) Deficiency

This is a great study since it directly highlights the metabolic connection between excess lactic acid and cancer. Thiamine deficiency results in lactic acid buildup, and all cancer patients have excess lactic acid due to the Warburg effect. foodconsumer.org - Cancer patients may need thiamine...

raypeatforum.com

Also, something in those tests does not add up. A person with high lactic acid cannot really have high CO2. To the contrary - people with lactic acidosis usually have very low CO2 on blood tests. So, not sure what is going on but you may want to point out that little paradox to the doctors...

 

[Rinse & rePeat]

I am expert in curing sepsis, so your input is a good piece to a puzzle.

I AM NOT AN EXPERT in curing sepsis. I hate spell check sometimes ughh…

 

[Rinse & rePeat]

The last I read glucocorticosteroids did not necessarily help in sepsis. I did read a study that showed Doxycycline 100mg IV bid along with the other prescribed abx's was helpful.

I AM NOT AN EXPERT in curing sepsis. I hate spell check sometimes ughh…

 

[healthiswellth]

@haidut — lumbar puncture was clean and 3 MRIs in the course of 1.5 months didn’t show anything—although since there was significant post-treatment change— so areas with lymphoma might be hidden or microscopic.... His oncologist highly suspects the lymphoma is there because he is not clinically improving.

He gets chemo treatment further away from our home and we end up at our local ER for the sepsis-related symptoms so one challenge has been that 2 different teams of doctors are seeing him so I think connecting the dots is a problem even though I supply his main team with all of the labs from our local hospital. Other than lymphoma flare-up they also mentioned Possible paraneoplastic syndrome but the likeliest of that is low.

His Venipuncture results always show high lactic acid and low CO2. Within the past week he developed a kind of cns-related apnea which led to his arterial CO2 becoming high, and thus needing to be intubated. Oncologist thinks lymphoma is back/ may have not gone away fully because of the cns-related apnea that has developed, and bc he is at a lower level of consciousness.

Last LDH check was high (mid-treatment)- no further check was done since subsequent lumbar and MRIs were clean.

What they have recommended pending the lumbar puncture results to check for cancer, is that we go with steroids and 1 of the chemotherapy agents (because they think that’s all that he can tolerate, and that it might slow the progression enough that he will be able to have some quality of life).

Thank you for the TLS suggestion— if it already isn’t the case, he might be at risk for it going forward.

I would appreciate any other advice any of you all may have regarding addressing the cancer (I am thinking to do high dose b1/b3 that was mentioned elsewhere for DLBCL) in addition to the single oral chemo agent. I would prefer not to do the chemo agent (imbruvica) at all but I am not the sole decision- maker and we’re a family with MDs in the mix...)

They have brought down his lactic acid and fixed Co2 with fluids, IV thiamine, but it’s a recurrent problem, so I am hoping we can get to bottom of it.


@Rinse & rePeat — thank you - I had read about doxy 100mg Possibly being effective For blood cancers so we had him on that for a while before. Maybe we can restart if it’s protective against sepsis also.

 

[healthiswellth]

@haidut— which idealabs products do you recommend— oral meds right now won’t work and especially if large doses are needed, topical may be our only route.

I had purchased pyrucet - but am not able to use it right now Bc low food/carb intake.

 

[healthiswellth]

our newest imaging shows a recurrence in a new area of the brain.

 

[Dolomite]

I’m sorry to hear that. It will explain the failure to get rid of the sepsis. @Nemo had a brain tumor that she used progesterone and aspirin to recover from after surgery but without chemotherapy. I don’t know how it would help your relative, though.

 

[healthiswellth]

Well that’s the thing, he’s in ICU no longer a sepsis risk, They got his blood chemistry under control but Bc the recurrence is in area that controls breathing, he’s still intubated for central apnea. They will restart the single chemo that they feel he can tolerate to see if this new lesion can go away and he can regain ability to control breathing and be removed from ventilator and leave iCU...

 

[healthiswellth]

@yerrag had posted about his experience with progesterone and we have progest-e but right now I think it’s too strong for him because of a similar experience.

 

[healthiswellth]

Hi everyone,

Still in icu— so a free a week of being sepsis-free, my father again “randomly” became septic—- his kidney function went from excellent to out of range within hours, his bp dropped, hr went up, and developed a fever (peak 102)—- blood work show high lactic acid. So here we are again.

He has been on one immunotherapy agent and steroids for the past 4 days to deal with the recurrent lymphoma.

Now, again, they are checking him for infection (so far urinalysis is clean). Currently added vasopressors, fluids, antibiotics, and tylenol.

His last uric acid check was normal. They will check again.

Any thoughts anyone?

 

[healthiswellth]

Hi everyone,

Still in icu— so a free a week of being sepsis-free, my father again “randomly” became septic—- his kidney function went from excellent to out of range within hours, his bp dropped, hr went up, and developed a fever (peak 102)—- blood work show high lactic acid. So here we are again.

He has been on one immunotherapy agent and steroids for the past 4 days to deal with the recurrent lymphoma.

Now, again, they are checking him for infection (so far urinalysis is clean). Currently added vasopressors, fluids, antibiotics, and tylenol.

His last uric acid check was normal. They will check again.

Any thoughts anyone?

Typo— after* a full week of being sepsis-free

 

[healthiswellth]

Also diarrhea (x5 in 18 hours)

 

[Rinse & rePeat]

Hi everyone,

Still in icu— so a free a week of being sepsis-free, my father again “randomly” became septic—- his kidney function went from excellent to out of range within hours, his bp dropped, hr went up, and developed a fever (peak 102)—- blood work show high lactic acid. So here we are again.

He has been on one immunotherapy agent and steroids for the past 4 days to deal with the recurrent lymphoma.

Now, again, they are checking him for infection (so far urinalysis is clean). Currently added vasopressors, fluids, antibiotics, and tylenol.

His last uric acid check was normal. They will check again.

Any thoughts anyone?

I am just gonna throw this out there, because of my husband’s situation, is he taking the Protonics the hospital doles out to every patient?

 

[healthiswellth]

No I made them change it to famotidine since he contracted c diff last month