cesium - JASE Medical

Sepsis – A Medical Emergency

According to the CDC

  • At least 1.7 million adults in America develop sepsis.
  • At least 350,000 adults who develop sepsis die during their hospitalization or are discharged to hospice.
  • 1 in 3 people who dies in a hospital had sepsis during that hospitalization
  • Sepsis, or the infection causing sepsis, starts before a patient goes to the hospital in nearly 87% of cases.

What is sepsis?

Sepsis is an extreme medical emergency in response to an infection that has triggered an immune response that causes extensive inflammation throughout your body. This can lead to tissue damage, organ failure and even death. Sepsis occurs when an infection in the body weakens the immune system, and the body stops fighting the infection. At the same time your body stops fighting the infection, your body develops blood clots, leading to reduced flow to organs. This leads organ failure and in some instances even death.

Many different types of infections can trigger sepsis, which is a medical emergency. The quicker you receive treatment, the better your outcome will be. Most cases of sepsis start as a bacterial infection. Some cases of sepsis are from viral or fungal infections.

Symptoms of sepsis

The symptoms of sepsis are specific across populations, and can appear differently in children compared to adults- but can include:

  • Fever and chills
  • Very low body temperature
  • Peeing less than usual
  • Fast heartbeat
  • Nausea and vomiting
  • Diarrhea
  • Fatigue or weakness
  • Blotchy or discolored skin
  • Sweating or clammy skin
  • Confusion, change in mental status
  • Shallow breathing

Sepsis complications-if not treated or treatment started late

  • Kidney failure
  • Dead tissue (gangrene) on fingers and toes, leading to amputation
  • Lung, brain, or heart damage
  • A higher risk of infections over time
  • Sepsis can be deadly in between 25% and 40% of cases.

Risk Factors for Sepsis

Anyone can get sepsis, however the following groups more at risk for developing sepsis:

  • Over 65- as we age our immune systems weaken
  • Infants, very young children, pregnant women
  • People with indwelling catheters, along with respiratory devices, ports and IV sites-these are all entry points for infection.
  • Severe, open injuries- or extensive burns
  • Chronic conditions such as diabetes. Poorly controlled blood sugars feed infection. Other risk factors include cancer, lung disease, immune system disorders, and kidney disease.
  • Dementia and Alzheimer’s patients are unable to express discomfort or pain and are at risk for urinary tract infections-which can lead to sepsis if not treated.
  • Recently hospitalized or recent surgery
  • On steroid therapy- steroids weaken immune system

Sepsis is most commonly associated with the following types of infections:

Note: Sepsis is NOT contagious

  • Lung infections (like pneumonia)
  • Urinary tract infections
  • Skin infections (especially burns)
  • Infections of the digestive system

Prevent infections by

  • Practicing good hygiene- hand washing, keep infected wounds covered, wear gloves during dressing changes.
  • Take care of chronic conditions- especially immune system disorders
  • Diabetics are prone to infections- keep blood sugars under control
  • In the case of Alzheimer’s and dementia patients monitor urine for obvious signs of urinary tract infection.

Prevent sepsis by:

  • Monitoring any lung, urinary tract, wound or gastrointestinal infections and getting appropriate antibiotic therapy (if indicated) started before symptoms of sepsis emerge.

According to the NIH:

  • A single oral dose of the antibiotic azithromycin can reduce the risk of postpartum sepsis and death among women who deliver vaginally by one-third, according to a large multi-country clinical trial funded by the National Institutes of Health. Azithromycin is one of the antibiotics in the Jase case- use only on the instruction of your care provider.

If sepsis is suspected

Seek emergency care immediately

Sepsis symptoms can develop and deteriorate rapidly

The sooner an intervention is started the higher your chance of survival. If sepsis symptoms are mild, you may be sent home with oral antibiotics. Two antibiotics that may be prescribed are supplied in the Jase case- azithromycin and ciprofloxacin.

If sepsis symptoms are severe, you will be admitted to the hospital, given IV fluids, blood pressure monitored, given vasopressors (to constrict blood vessels, which in turn raises blood pressure) and antibiotics along with other supportive therapy.

- Brooke Lounsbury, RN

Medical Content Writer

Lifesaving Medications

Everyone should be empowered to care for themselves and their loved ones during the unexpected.

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3 Medicines That Could Save Your Life Following a Nuclear Blast

As the Russian-Ukraine war escalates, with no end in sight, the threat of nuclear war is ever present. At different times both sides have brought up the possibility of a “limited nuclear war.

We have never been so close to nuclear war- even during the cold war we weren’t this close.

The number of nuclear warheads in use is staggering. It is estimated that there are 12,705 nuclear warheads worldwide. These warheads are spread out between only 9 countries- U.S., Russia, France, China, the UK, Pakistan, India, Israel, and North Korea, Hopefully, cooler heads will prevail, and we will soon see a de escalation of tensions.

Preventing exposure-be prepared

Unfortunately, if a nuclear war is fought in Ukraine the radioactive fallout will travel through wind currents and eventually reach the United States. Some of the radioactivity will have dissipated, but a lot wont.

It is always better to prevent exposure to radioactive materials and fallout than to have to deal with the health effects of radiation exposure.  In previous posts I outlined precautions and preparation tips to help you mitigate and decrease your exposure to radioactive fallout.

In this post, we will discuss three of the more common medicines available in the event of a nuclear blast. Whether the drug is over the counter or prescription, it is highly advised to only take as directed by health officials and in the proper amount. Even OTC meds have serious side effects if not taken as directed.

The three we will discuss are: Potassium iodide, Prussian Blue and EDTA.

Potassium iodide (KI)

(Over the counter, however, seek care provider guidance on how and when to take)

The thyroid gland cannot tell the difference between stable and radioactive iodine.  KI acts to block radioactive iodine from being taken into the thyroid gland, it can help protect this gland from injury. Ingesting iodide tablets (KI) flood the thyroid gland and can protect the thyroid gland from absorbing the radioactive iodine from a nuclear incident.

It is also important to know what KI cannot do. KI cannot protect parts of the body other than the thyroid from radioactive iodine. KI cannot protect the body from any radioactive elements other than iodine. If radioactive iodine is not present, then taking KI is not protective.

How to take potassium iodide

Only take potassium iodide if state or local health authorities suggest you do so. During an emergency, health officials will send out an announcement. Your health department will then tell you when it’s OK to take potassium iodide. They’ll also tell you when you can stop the medication.

Excerpt from FDA recommendations:

How much potassium iodide (KI) should I take?

The FDA has approved two different forms of KI—tablets and liquid—that people can take by mouth after a nuclear radiation emergency. Tablets come in two strengths, 130 milligram (mg) and 65 mg. The tablets are scored so they may be cut into smaller pieces for lower doses. Each milliliter (mL) of the oral liquid solution contains 65 mg of KI.  According to the FDA, the following doses are appropriate to take after internal contamination with (or likely internal contamination with) radioactive iodine:

  • Adults should take 130 mg (one 130 mg tablet OR two 65 mg tablets OR two mL of solution). Children who are adult size (greater than or equal to 150 pounds) should take the full adult dose, regardless of their age.
  • Women who are breastfeeding should take the adult dose of 130 mg.
  • Children between 3 and 18 years of age should take 65 mg (one 65 mg tablet OR 1 mL of solution).
  • Infants and children between 1 month and 3 years of age should take 32 mg (½ of a 65 mg tablet OR ½ mL of solution). This dose is for both nursing and non­nursing infants and children.
  • Newborns from birth to 1 month of age should be given 16 mg (¼ of a 65 mg tablet or ¼ mL of solution). This dose is for both nursing and non­nursing newborn infants.
  • NOTE: Newborn infants should only be given potassium iodide under the direction of a healthcare provider. Their underdeveloped thyroid is at risk for developing low thyroid. Thyroid function tests are indicated after iodide has been administered and the radioactive event has passed.

Medical conditions in which taking potassium iodide may be harmful:

Taking KI may be harmful for some people because of the high levels of iodine in this medicine.

You should not take KI if:

  • you know you are allergic to iodine (If you are unsure about this, consult your doctor.
  • A Seafood or shellfish allergy does not necessarily mean that you are allergic to iodine.
  • Certain skin disorders (such as dermatitis herpetiformis or urticaria vasculitis).
  • People with thyroid disease (for example, multinodular goiter, Graves’ disease, or autoimmune thyroiditis)

Food and Drug interactions

There are no known food or drug interactions when taking potassium iodide

Side Effects of potassium iodide

When taken as directed KI has few side effects.

Some of the more common side effects are:

  • Skin rashes
  • Inflammation of the salivary glands
  • GI upset

Prussian Blue (COMMON BRAND NAME(S): Radiogardase

(By prescription only)

Note- Do NOT ingest Prussian blue pigment sold commercially, this practice is dangerous and potentially harmful.

Prussian blue is a pill that may be used in a radiation emergency to help remove radioactive cesium and thallium from the body. Prussian blue traps radioactive cesium and thallium in the intestines and keeps them from being reabsorbed by the body. Prussian blue decreases the half-life of cesium by 33% and from 3.8 to 2.2 days for thallium, The rate of cesium and thallium elimination is proportional to the dose and duration of Prussian blue.

Prussian blue comes in capsule form, and can be taken with or without food, however it is advised to take with food to stimulate secretion of cesium or thallium.

Treatment should be initiated as soon as possible after contamination is suspected. Even when delayed, treatment is effective and should not be withheld.

Dosage:

For oral dosage form (capsules):

For cesium poisoning:

  • Adults and teenagers—3 grams (6 capsules) three times a day.
  • Children 2 to 12 years of age—1 gram (2 capsules) three times a day.
  • Children younger than 2 years of age—Use and dose must be determined by your doctor.

For thallium poisoning:

  • Adults and teenagers—3 grams (6 capsules) three times a day.
  • Children 2 to 12 years of age—1 gram (2 capsules) three times a day.
  • Children younger than 2 years of age—Use and dose must be determined by your doctor.

Notify your care provider before taking if:

  • You are pregnant or nursing.
  • Have any allergic reactions to Prussian blue coloring in foods or medications.
  • Arrhythmia (heart rhythm problem) or
  • Electrolyte imbalance—Use with caution. May make these conditions worse.
  • Blockage of the intestines or constipation
  • Stomach or bowel problems—May increase risk for constipation.
  • Liver disease—May not work properly in patients with this condition

Treatment may last 30 days or longer.

Food and Drug interactions

There are no known food interactions.

The absorption of many drugs decreases when Prussian blue is added. Some of these are:

Side effects that you should report to your doctor or health care professional as soon as possible:

  • Skin rash, itching or hives, swelling of the face, lips, or tongue
  • Fast, irregular heartbeat
  • Muscle pain or weakness, cramps

Mild side effects:

  • blue colored stools
  • constipation
  • upset stomach

EDTA

A prescription medicine, given by injection into the vein (intravenously) or into the muscle (intramuscularly) when used to treat radiation and lead poisoning. It is also found in pill form.

In addition to treating poisonings by radioactive materials such as plutonium, thorium, uranium, and strontium, EDTA is used to treat lead poisoning and brain damage caused by lead poisoning.

EDTA has many other uses, from treating calcium deposits in the eye (eyedrops) to high calcium levels in the blood (hypercalcemia) and treating heart rhythm problems.

Drug and food interactions

Allergy to EDTA has been reported, however no interactions with food

Drugs: There are 21 known drug interactions with EDTA

Side effects

  • EDTA is safe when used as a prescription medicine, as eye drops, and in small amounts as a preservative in foods.
  • EDTA can cause abdominal cramps, nausea, vomiting, diarrhea, headache, low blood pressure, skin problems, and fever.
  • It is UNSAFE to use more than 3 grams of EDTA per day, or to take it longer than 5 to 7 days. Too much can cause kidney damage, dangerously low calcium levels, and death.

Special Precautions and Warnings(From RX List website):

  • Pregnancy and breast-feeding: EDTA seems to be safe when used in food amounts. The safety of larger amounts is unknown.
  • Asthma: Nebulizer solutions containing disodium EDTA as a preservative can cause the breathing tubes to narrow in some people with asthma. The size of the dose determines the amount of the narrowing.
  • Heart rhythm problems: EDTA might make heart rhythm problems worse.
  • Diabetes: EDTA might interfere with blood sugar control because it can interact with insulin.
  • Low calcium levels in the blood (hypocalcemia): EDTA can decrease serum calcium levels, making hypocalcemia worse.
  • Low potassium (hypokalemia): EDTA can bind with potassium and increase the amount of potassium that is flushed out in the urine. This might cause potassium levels to drop too low, especially in people who have low levels to begin with. If you have this problem, don’t use EDTA.
  • Low magnesium levels in the blood (hypomagnesemia): EDTA can bind with magnesium and increase the amount of magnesium that is flushed out in the urine. This might cause magnesium levels to drop too low, especially in people who have low levels to begin with. If you have this problem, don’t use EDTA.
  • Liver problems and hepatitis: EDTA might make liver disease worse. Avoid using EDTA if you have a liver condition.
  • Kidney problems: EDTA can harm the kidney and might make kidney disease worse. EDTA doses should be reduced in patients with kidney disease. Avoid using EDTA if you have severe kidney disease or kidney failure.
  • Seizures (epilepsy): There is some concern that EDTA might increase the risk of seizure in people with epilepsy or in people who tend to have seizures. EDTA can cause severe decreases in blood levels of calcium, and this can cause a seizure.

 

- Brooke Lounsbury, RN

Medical Content Writer

Lifesaving Medications

Everyone should be empowered to care for themselves and their loved ones during the unexpected.

Recent Posts

Keeping you informed and safe.

How Prepared are You for a Modern-Day Carrington Event?

How Prepared are You for a Modern-Day Carrington Event?

(Part 1 of 2) What was the Carrington Event of 1859? Named after amateur astronomer Richard Carrington, who discovered a coronal mass ejection (CME) headed for earth in the early morning hours of September 1, 1859. On that fateful morning, telegraph communications...

Join Our Newsletter

Our mission is to help you be more medically prepared. Join our newsletter and follow us on social media for health and safety tips each week!