The Clinical Use of the Plasma Acetaminophen Halflife in NAC-treated Acetaminophen Overdose

PURPOSE: A plasma acetaminophen halflife of more than 4 hours has been correlated with hepatotoxicity in acetaminophen overdosing not treated with an antidote. However, the acetaminophen halflife has not been studied in patients receiving the antidote N-acetylcysteine (NAC). METHODS: Ninety-eight (98) patients with acetaminophen overdoses, all of whom were treated with N-acetylcysteine were studied. A minimum of 2 plasma acetaminophen valu e s > 2.0 microgram/ml were available for calculating the acetaminophen halflife, assuming first-order kinetics. RESULTS: Overall, the median acetaminophen halflife was 6.2 hours (range, 1.15~103.9 hours). Sixty-two (62) patients with no hepatotoxicity (AST 1,000 U/L) without acute hepatic failure, and 6 patients with hepatotoxicity (AST > 1,000 U/L) with hepatic failure had acetaminophen halflives of 3.7 hours (range, 1.15~23.2 hours), 5.9 hours (range, 1.96~26.2 hours), 6.3 hours (range, 2.19~15.38 hours), and 32.8 hours (range, 5.48~103.9 hours), respectively (p<0.05). A receiver operating characteristic curve analysis showed that an acetaminophen halflife of 5.19 hours provided better discrimination (sensitivity=69.6%, specificity=84.0%, accuracy=80.6%). CONCLUSION: The acetaminophen halflife correlates well with the degree of liver damage in patients treated with N-acetylcysteine. Longer halflives reflect a greater toxic effect on the liver.

Clinical Manifestations of Vivax Malaria Diagnosed Patients

PURPOSE: In this study, we analyzed clinical manifestations of and ways to manage malaria. METHODS: The medical records of the patients confirmed as malaria by using peripheral blood smear at Ui jungbu St. Mary's hospital from April 1997 to November 2001 were reviewed retrospectively. RESULTS: Of the 170 patients, there were 111 males and 59 females, and their mean ages were 32.3+/-14.5, 34.9+/-18.1 years, respectively. Malaria occurred throughout the year and peaked during the sixth to ninth months (84.1%). All cases were vivax malaria. All 170 patients had fever, but tertian fever was seen in only 81 (48%) patients. Laboratory abnormalities were hemoglobin below 12 g/dL in 70 (41.2%) patients, WBC below 4000/mm3 in 49 (28.9%), platelet count below 120,000/mm3 in 142(83.5%). Of the 92 patients who underwent ultrasonography of the abdomen, splenomegaly was seen in 81 (89%)patients. The time from onset of symptoms to admission ranged from 2 to 30 days with a mean 8.1+/-5.5 days. All patients responded promptly to drug therapy. One patient developed recurrent malaria 120 days after the first attack. Another patient experienced multifocal splenic infarction. CONCLUSION: All patients with malaria had fever and chills. The most common laboratory findings were thrombocytopenia and anemia. All patients responded promptly to drug therapy. As cases of malaria in Korea are increasing, early diagnosis and treatment, as well as prevention, are important.

Effect of Pentoxifylline on Ischemia-Reperfusion Injury of Brain Following Cardiac Arrest in Rats

BACKGROUND: Two major events occurring in the cerebral hemodynamics after successful resuscitation from cardiac arrest are reactive hyperemia and postischemic hypoperfusion. In this study, we examined the effect of Pentoxifylline(PTX) on the rat brain following cardiac arrest. METHODS: Fourteen rats were anesthetized and artificially ventilated. Cardiac angst was produced by chest compression and clamping of tracheal tube far 3 minutes in ketamine anesthetized rats. Circulation was restored by standard cardiopulmonary resuscitation methods. In 7 rats, PTX 10mg/kg was infused at 10min after cardiac angst(PTX group). In the other 7 rats, same amount of normal saline was infused(control group). RESULTS: In both groups, hemodynamic variables, neurologic deficit(ND) score and histopathologic findings of hippocampal CA1 neurons were observed. Hemodynamic variables and ND score were not significandy different between two groups. Delayed ischemic neurons of hippocampal CA1 were decreased in PTX group(2.2+/-2.4%) compared with control group(9.1+/-1.2%). CONCLUSIONS : We conclude that PTX prevented development of delayed ischemic neurons in hippocampal CA1 after cardiac arrest. PTX may be useful in emergency situations following cardiac arrest.

Utilization of the Short-Stay Unit in Emergency Department

Overcrowding of emergency department is a serious and growing problem at St. Mary's Hospital. This has motivated the development of short-stay unit(SSU) as an alternative ward to routine hospital admission and ED discharge. In our hospital a SSU begun to admit patients in January 6, 1997. the SSU received 247 patients from the ED during the eight month interval(January 6, 1997 to August 31, 1997). To examine the utilization of the SSU in ED, we retrospectively analyzed 247 patients admired in SSU from the ED, and compared the average hours per patient with acute gastroenteritis spent in the ED doing the 2-month intervals before(July-August 1996) and after(July-August 1997) the establishment of the SSU. The following results were obtained; 1. The total patients consist of EM 92(37.2%), GS 48(19.4%), IM 24(9.7%), PS 21(8.5%), OS 20(8.1%), OBGY 14(5.7%) and others 28(11.3%). 2. The results of EM patients admitted in SSU from ED 1) Sex ratio of male to female was 1:1.1 and the mean age was 37.3+/-16 years. 2) In diagnosis, acute gastroenteritis was 29 cases(31.5%), multiple contusion 14 cases(15.2%), drug intoxication 12 cases(13%), limb laceration 6 cases(6.5%), tendon rupture offhand 6 cases(6.5%), and others 19 cases(20.6%). 3) Mean length of stay in ED was 9.18 hours. 4) Among 92 patients to the SSU, 79 patients(85.9%) were discharged, 11 patients(11.9%) formally admired to hospital and 2 patients(2.2%) transferred to otherhospital. The mean hospital stay time of the patients admitted to SSU was 2.6 days. 3. There was a significant reduction in the average stay time spent in the ED by treat-and-releasing patients with acute gastroenteritis after the establishment of the SSU(from 14.65+/-9.6 to 7.52+/-5.4 hr/patient, p<0.001). Conclusively, the establishment of the SSU can shorten the average stay time that treat-and-releasing patients spend in the ED, and reduce the number of admixed patients waiting in the ED.

A Case of Recurrent Seizure following Overdose of Isoniazid

Isoniazid(Isonicotinic acid hydrazide) is an antimicrobial drug used since 1952 as a fast line agent for the prophylaxis and treatment of tuberculosis. Isoniazid is well known for problems in population having a high prevalence of isoniazid use for prophylaxis or treatment of tuberculosis. But intentional or accidental isoniazid overdose is uncommon. The ingestion of toxic amounts of isoniazid causes recurrent seizures, profound metabolic acidosis, coma and even death. In adults, toxicity can occur with the acute ingestion of as little as 1.5g of isoniazid. Doses larder than 30mg per kg often produce seizures. When ingested in amounts of 80-150mg per kg or more, isoniazid can be rapid fatal. 40-year-old woman having previous pulmonary tuberculosis ingested 7 gram of isoniazid(140mg/kg) to attempt suicide approximately 30 minutes prior to visit to our emergency medical center. She had recurrent generalized tonicclonic seizures and metabolic acidosis. We report one patient treated with pyridoxine, which was equivalent to the amount of isoniazid ingested and administered as a intravenous dose and oral dose.

A Patient with Pulmonary Edema and Cardiac Arrest after Phenobarbital Overdose

Phenobarbital is a long-acting barbiturate causing generalized depression of neuronal activity in the brain. Its effect is primarily achieved through enhanced GABA-mediated synaptic inhibition. Its use as an antiepileptic agent was first described in 1912. Before the introduction of phenytoin, phenobarbital is used as sedative-hypnotics. It is used for the treatment of epilepsy and status epilepticus. All barbiturates, including phenobarbital, have a high potential far abuse. They were frequently used for suicide attempts in the past, but they have in large part been replaced by benzodiazepines. the onset of symptoms depends on the drug and the route of administration. Mild to moderate barbiturate intoxication resembles ethanol inebriation with slurred speech, ataxia, and lethargy. Severe acute barbiturate intoxication is life threatening. Early deaths are generally cardiovascular-related. Hypotension, shock, pulmonary edema, and cardiac arrest that occurs with large doses are caused by depression of central sympathetic tone and as well as by direct depression of cardiac contractility. The potentially fatal oral dose of phenobarbital is 6-l0g. We describe an 23-year-old woman with pulmonary edema and cardiac arrest after ingestion of 18 grams of phenobarbital. She was completely recovered by successful cardiopulmonary resuscitation and hemoperfusion. We report a case with literature review.

A Clinical Analysis of Hospitalized Patients During the Period of Flood in Ujungbu

BACKGROUND: Flood is the most common natural disaster in our country. Lots of victims occurred during the period of flood in the northern territory of Kyoungkido on August 5, 1998. We tried to describe the characteristics of the flood-related injury and illness, management and medical requirements. METHODS: We interviewed the patients admitted to 8 hospitals in Ujungbu and reviewed medical records from aug 5 to Aug 14, 1998. RESULTS: There were total 102 patients, male were 52%and women were 48% Most of patients were between 30's and 60's. Most of them were minor, and less than 3%of them needed critical care. The diagnosis were laceration(39.2%, contusion(22.5%, fracture(13.7%, infectious disease(7.8%, ligament rupture(7.8%, aggravation of chronic illness(5.9%, dermatitis(2.0% and traumatic hyphema(1.0%. The laceration occurred in the foot(37.9%, lower leg(27.0%, thigh(16.2%, hand(10.8% and head(8.1%. The location of ligament injury were achilless tendon(62.5%, hand(25% and knee(12.5%. The 67.5%of flood-related laceration patients progressed cellulitis, especially in sutured wound and a typical tetanic patient was developed. Of hospitalized patients, 2 patients showed evidence of post-traumatic stress disorder(PTSD). CONCLUSION: During flood, civils have better to be educated about prevention of injury, such as wearing of shoes and clothes. Although laceration was minor, lacerated wounds should be thoroughly irrigated, debrided the margin and considered delayed closure, tetanus immunization. Reportedly, there is an increased prevalance of PTSD and depression after disasters. Therefore mental health care will be required in the future.

Correlation Analysis between END-tidal CO2 Tension and Arterial CO2 Tension in Nonintubated Emergency Department Patients with Respiratory Distress

BACKGROUND: The end-tidal carbon dioxide tension(ETCO2) is defied as a partial pressure of carbon dioxide at the end of an exhaled breath.)he purpose of this study is to determine the correlation between ETCO2 and arterial carbon dioxide tension(PaO2) in nonintubated abated patients with respiratory distress in emergency department(ED). METHODS: A prospective non-blind study was performed in ED of our university hospitals. Participants included all nonintubated adult patients with respiratory distress requiring arterial blood gas analysis. ETCO2 was measured with a capnography monitor during tidal volume breathing. ETCO2 were recoreded at the time of arterial blood gas sampling. The correlation between ETCO2 and PaCO2 was analysed in all patients and in subgroups by simple linear regression. RESULTS: Sixty patients were enrolled. In all patients, ETCO2 was 5.72mmHg lower than PaCO2 and correlated well with PaCO 2(r2=0.716). ETCO2 correlated best with PaCO2) in patients who were either acidotic or non-smoking. CONCLUSION: ETCO2 correlate well with PaCO2 in nonintubated patients with respiratory distress in ED. ETCO2 may be sufficient to reflect PaCO2 in selected patients and obviate the need far repeat arterial blood gas determination.

Recovery of Acute Renal Failure Secondaruy to Ethylene Glycol Intoxicity

Ethylene glycol is a sweet-tasting liquid with industrial use as a solvent or as a starting reagent in chemical processes. Physicians are familiar with ethylene glycol because it is the major component of many antifreeze solutions and is taken in suicide attempts or, more often inadvertency. its metabolites may cause severe intoxication. Unfortunately, its metabolites are highly toxic and require rapid treatment Treatment involves correction of metabolic acidosis, ethanol administration and enhancement of elimination. The most commonly used elimination technique is hemodialysis We describe an 21-year-old man with acute renal failure due to ingestion of antifreeze that contained ethylene glycol. He was transferred to our hospital because of aggressive management The recovery of our patient with severe ethylene glycol intoxication illustrates that aggressive and early treatment can prevent mortality and morbidity.