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Management Overview

Given a mitochondrial patient's severe response to infection, when cultures (bacterial or viral) are obtained as part of an infection work-up, antibiotics or anti-viral intervention should probably be started and discontinued later if cultures are negative.  When treatment is begun only when a culture turns positive 48 hours (or longer) after presentation, the patient's clinical status may have deteriorated, leading to a more prolonged course of illness and perhaps a higher risk of complications.

General patient support includes providing adequate calories and fluids to maintain hydration and reduce the severity of fatigue and weakness.  Extra fluid should be provided when fever is present, when there is a history of significant sweating, and in patients who because of vascular dysautonomia have an increased fluid need (see AUTONOMIC DYSREGULATION).  Anti-pyretic therapy is indicated.

PROTOCOLS for the management of patients in the PCP's office and in the ER follow.

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