Three Cases of Hyponatremia Caused by Ingestion of Bowel Preparation Solution for Colonoscopy / 대한신장학회잡지

Hyponatremia resulting from ingestion of large volumes of bowel preparation solution has been reported in patients with alternated renal water handling like renal failure or old age. Colonoscopy-induced hyponatremia was known to be related with an increase in serum arginine vasopressin concentration. Ingestion of bowel preparation solution can lead to diarrhea associated with nausea, vomiting and dehydration, often resulting in raised plasma concentrations of antidiuretic hormone. Besides, non- osmotic stimuli for arginine vasopressin concentrations can be provoked by nausea, vomiting, and intestinal hyperactivity during bowel preparation and colonoscopic procedure. We have experienced three cases of hyponatremia resulting from ingestion of bowel preparation solution for colonoscopy. The factors leading to increased arginine vasopressin secretion seem to be nausea, vomiting and intestinal hyperactivity during bowel preparation for colonoscopy.

Usefulness Of The Measurement Of The Plasma NT-ProBNP Level For The Prediction Of The Postoperative Cardiac Risk In Elderly Patients / 대한내과학회지

BACKGROUND: The prediction of the postoperative cardiac complications is important in the medical management of patients undergoing noncardiac surgery. Several indices have been developed to predict the outcome, but their usefulness has neither been evaluated nor been widely used. The purpose of this study was to assess the NT-proBNP as a prognostic factor for the prediction of the postoperative cardiac risk as compared with the existing cardiac indices in elderly patients undergoing orthopedic surgery. METHODS: From September 2003 to January 2004, we examined 50 patients older than 60 years, who were scheduled to undergo orthopedic surgery. The plasma NT-proBNP concentration, clinical cardiac indices and left ventricular ejection fraction were measured prior to the operation. The postoperative outcomes were followed and predictors for postoperative cardiac risk were identified. RESULTS: Cardiac complications occurred in 22% of the patients. A statistically significant increase in the cardiac complications was observed in the patients with higher plasma concentration of NT-proBNP (p<0.001), higher original cardiac index score (p<0.001), higher revised cardiac index score (p=0.004) and that fell into the major group of the American college of cardiology/American heart association guidelines (p=0.018). The NT-proBNP concentrations were positively correlated with the original cardiac index score (r=0.666, p<0.001), revised cardiac index score (r=0.429, p=0.002) and grouping by the ACC/AHA guidelines (r=0.497, p<0.001). The area under the receiver-operating characteristic curve for the plasma NT-proBNP (0.946, 95% CI) was superior to the other cardiac indices. The optimal cut-off point for the prediction of postoperative cardiac complications occurred at a plasma NT-proBNP, concentration of 539.3 pg/mL and provided a 90.9% sensitivity, 92.3% sensitivity, 79.9% positive predictive value and 97.3% negative predictive value. The independent predictors for postoperative adverse cardiac event were age and Goldman index. CONCLUSION: The plasma NT-proBNP level may be a useful parameter for the prediction of postoperative cardiac complications.

A case of thyrotoxic periodic paralysis associated with rhabdomyolysis / 대한내과학회지

Hyperthyroidism has been associated with changes in muscle function such as thyrotoxic myopathy, thyrotoxic periodic paralysis and thyroid opthalomopathy, but rarely rhabdomyolysis. Usually serum creatinine kinase is either normal or low in hyperthyroidism. Only 3 reports described association between rhabdomyolysis and hyperthyroidism, no previous literatures have thyrotoxic periodic paralysis associated rhabdomyolysis. Patients with hypokalemic periodic paralysis sometimes elevated serum muscle protein during recovery from paralytic attack, but the mechanism was not well known. We report a patient who presented with clinical feature of thyrotoxic periodic paralysis and increasing serum CK, myoglobin during recovery from paralysis.

Weight Gain Associated with Atypical Antipsychotic Drugs / 대한정신약물학회지

The purpose of this study is to compare weight gain by risperidone, clozapine and olanzapine which are atypical antipsychotic drugs with that by haloperidol which is typical antipsychotic drug. METHODS: We performed a retrospective chart review of 278 schizophrenic patients who were treated longer than 12 weeks with 4 different drugs. We measure weight gain weekly until 12th week and weight change curve over 12 weeks was drawn. Additionally, we examined any correlations of weight change with some factors. RESULTS: 1) The highest weight gains were observed in the olanzapine and clozapine groups, followed by the risperidone and haloperidol groups. 2) The haloperidol group showed a main weight gain within first 3 weeks, and patients ingested 3 atypical drugs gained weight steadily during 12 weeks. 3) The initial underweight group showed the largest weight gain. CONCLUSION: This study shows that the atypical antipsychotic drugs induced more weight gain than haloperidol. And we can expect that long-term treatment with clozapine and olanzapine would induce more severe weight gain, particularly in underweight patients.