Adequacy of Lipid Emulsion Administration Prescription Rate in a Single Center

PURPOSE: IV-lipid emulsion can be a nutritional supplement to provide essential fatty acids and energy for patients who need total parenteral nutrition support. The recommended administration dose of lipid emulsion is less than 2.5 g/kg/d and the rate should not exceed 0.15 g/kg/h for adult patients. The purpose of this study is to evaluate the adequacy of the currently prescribed administration rate of IV-lipid emulsion in a single center. METHODS: We analyzed 1,739 lipid emulsion administration prescriptions in 1,095 patients over 18 years old at Ajou University Hospital from January 1, 2014 to March 31. RESULTS: The median prescription rate of total lipid emulsion was 0.134 (0.012~1.125) g/kg/h, and the exceeding portion of maximum recommended infusion rate was 36.9%. The median administration prescription rate of lipid emulsion was faster in 500 mL emulsions, compared to 250 mL emulsion (0.146 g/kg/h vs. 0.075 g/kg/h; P<0.001) and at emergency room (ER), compared to general ward (0.154 g/kg/h vs. 0.123; P<0.001). The exceeding portion of maximum recommended infusion rate of lipid emulsion was also higher in 500 mL emulsion, compared to 250 mL emulsion (52.2% vs. 30.4%; P<0.001) and at ER, compared to general ward (52.1% vs. 30.4%; P<0.001). Triglyceride level was higher in exceeding recommended infusion rate compared to less, but not statistically significant (119 mg/dL vs. 261 mg/dL; P=0.202). CONCLUSION: Administration prescription rate of lipid emulsion exceeded the recommended rate and this feature was dominant in 500 mL emulsion and at ER. Education and monitoring of lipid emulsion prescription is needed for appropriate lipid administration and prevention of fat overload syndrome.

Use of Continuous Venovenous Hemodiafiltration to Enhance the Elimination of Serum Pentobarbital before Diagnosis of Brain Death / 대한이식학회지

Continuous venovenous hemodiafiltration (CVVHDF) was used to eliminate pentobarbital from the blood of a 30-year-old potentially brain dead male patient with traumatic intracranial hemorrhage after a motorcycle accident. The Acute Physiology and Chronic Health Evaluation (APACHE) II score of hospital day 1 was 24, but by day 8 it was 36, when the patient was considered to be brain dead. To control seizures and reduce intracranial pressure, pentobarbital had been administered in a continuous flow (2,880 mg/day for 5 days). Coma can be induced by pentobarbital at a serum level of 1~5 mg/dL. However, drug intoxication should be excluded from a brain death evaluation; therefore, the patient was not given any drug for approximately 88 hrs after ceasing pentobarbital in order for serum level to dip below 0.5 mg/dL (which is the hypnotic level). At 48 hours from CVVHDF, the pentobarbital level was close to the hypnotic level (0.1~0.5 mg/dL). Before stopping, the serum level of pentobarbital was 3.89 mg/dL and between 48 and 72 hours from CVVHDF, 4 cycles of pentobarbital half-life elimination (0.24 mg/dL) could be measured. Therefore, we suggest that in case of potential brain dead patients who have been administered pentobarbital, CVVHDF can enhance the elimination of pentobarbital from the circulatory system and shorten the waiting time for a brain death evaluation.

A case of imflammatory linear verrucous epidermal nervus / 대한피부과학회지

Inflammatory linear verrueous epidermal nevus (ILVEN) first mentioned by Unna in 1896 is a rare variant of epidermal nevus characterized clinically by early onset in childhood, moderate to marked pruritus and persistent clinical course and histopathologically by predominant features of a chronic dermatitis or psoriasis. We present tbe first recorded case of a typical ILVEN developed in a 20-year-old Korean male, who has had an intensely pruritic linear verrucous patch, involving the entire length of the posterior aspeet of right upper extremity, volar aspect of right thumb and nails of ind.ex and ring finger since 5 years. Microscopic examination of the skin, biopsy specimens from the lesion on the right elbow joint area and the palm showed hyperkeratosis witb focal parakeratosis, moderate to marked acanthosis and elongation of rete ridges and papilla with mild exocytosis and moderate perivascular lymphocytic infiltration. Literature were reviewed.

Nitroblue Tetrazolium dye Reduction Test (NBT) in Patients with Pulmonary and Skin Tuberculosis / 대한피부과학회지

No abstract available.

A Study on Delayed Cutaneous Hypersensitivity Reaction to Various Skin Test Antifgens in Patients with Leprosy / 대한피부과학회지

Several investigators have attempted to clarify th well-known phenomenon of anergy in lepromatous leprosy during past two decades, utilizing various methods of immunologic assessrvent, including response to skin test antigens, active skin sensitization with strong allergens, skin homograft survival rate, imrnunopathology of lymphnodes, in vitro blastogenic response by antigens or mitogens of lymphocytes, lymphokine production in vitro and measurement of peripheral T and B cell ratio. Howcver, there is no general agreement as to the cellular irnmunologic status of leprosy patients b tween various investigators. The present study was undertaken to evaluate the ability to mount cutaneous hypersensitivity reactions to various skin test antigens and to investigate active sensitization with DViCB in patients with leprosy. Ten polar lepromatous (LL) and 12 polar tuberculoid (TT) p-tients who have been treated at Department of Dermatology, National Iviedical Center and Seoul Nationa,l University Hospital were the subjects. The subjects have rcceived regular antileprosy chemotherapy with DDS and the average duration of treatment in LL and TT groups was 6. 2 and 4. 7 years, respectively. The control group included 10 healthy physicians and nurs-s. Skin test antigens includ=d lepromin (1 x10' bacilli,ml'), PPD (Parke-Davis 5ppJ/0.1ml), SK-SD (Lederle, 40 u SK and 10 u SD/0.1 ml), Candidin (Hollister stier Lab 1: 1000 dilution) and DNCB aceton solution in the concentrations of 1000ug,/0.1ml for sensitization and 100ug/0.1ml for challenge, respcctively. Skin reactions were read 48 hours after intraderrnal injection of 0.1 rnl of each antigen anci th.' metho4 of DNCB sensitization was same as described elsewhere. The result showed that in polar lepromatous leprosy patients, the skin reactivity to various antigens were generally decroased, as cornpared to both th healthy control group and polar tuberculoicl patients, especially to lepromin, PPD and I')NCB sensitization (p<0.05, respectively). We concluded thxt lepromatous leprosy patients were especially unresponsive to mycobacterial antigcns(lepromin and PPD) and to newly administered antigen (DNCB) and tbe possible mechanism was discussed.