Medical staff and administrators should recognize that families of critically ill patients have particular needs that help them cope with having their loved ones in an intensive care unit. Simple changes in philosophy and policy would greatly decrease the anxiety these families experience.

Acute kidney injury (AKI) is defined as an abrupt decrease in kidney function, with the most severe form requiring some method of renal replacement therapy (RRT). The use of RRT is required in 5-10% of critically ill patients who develop severe AKI. Renal replacement therapy can be provided as either intermittent hemodialysis or one of the various modes of continuous renal replacement therapy (CRRT), with CRRT potentially conferring an advantage with respect to renal recovery and dialysis independence. There is no difference in mortality when comparing low (\ 25 mLÁkg -1 Áhr -1 ) vs high ([ 40 mLÁkg -1 Áhr -1 ) RRT dosing. Continuous renal replacement therapy may be run in different modes of increasing complexity depending on a given patient's clinical needs. Regional citrate anticoagulation is recommended as the therapy of choice for the majority of critically ill patients requiring CRRT.

Mauriac syndrome is a rare disorder that can present with the single feature of glycogenic hepatopathy in children and adults with poorly controlled diabetes mellitus. An often underrecognized finding of glycogenic hepatopathy is lactic acidosis and hyperlactatemia. Primary treatment of glycogenic hepatopathy is improved long-term blood glucose control. Resolution of symptoms and hepatomegaly will occur with improvement in hemoglobin A1C. We present here a case of a young adult female presenting to the intensive care unit with Mauriac syndrome. This case demonstrates exacerbation of lactic acidosis in a patient with glycogenic hepatopathy treated for diabetic ketoacidosis with high dose insulin and dextrose.

IntroductionLightning is the second most common storm-related cause of death. The mortality following lightning strike is 10% to 30% and a large proportion of these people suffer cardiopulmonary arrest at the time of the strike. Much less commonly, solid organ injuries occur from either primary or secondary blunt force trauma.Case presentationTo the best of our knowledge, this is the first case report in the literature of an isolated esophageal rupture caused by lightning strike blunt force trauma.ConclusionsSolid organ injuries are often underappreciated in lightning strikes. Blast injury to patients by lightning strikes should prompt clinicians to search for occult organ injury.