A Case of Salicylate-Intoxication-Induced Pseudohyperchloremia / 대한내과학회지

Despite the increasing use of alternative analgesic agents, salicylate overdose remains a not-uncommon problem. Severe poisoning is life threatening, so prompt treatment and supportive measures are required to reduce mortality. Generally, salicylate intoxication results in the development of high-anion-gap metabolic acidosis. However, outside of Korea, normal-anion-gap or negative-anion-gap metabolic acidosis with hyperchloremia is rarely reported. We report herein the case of an 83-year-old female patient with chronic aspirin intake who presented with hyperchloremia and a negative anion gap. The patient's symptoms improved with conservative treatment and hemodialysis; notably, her chloride levels decreased as her blood salicylate concentrations decreased. Salicylate may cause hyperchloremia, demonstrating the importance of careful documentation of patient medication histories.

Clinical Manifestations of Elderly Patients Admitted Because of Severe Hyponatremia / 대한신장학회지

PURPOSE: Recently the incidence of severe hyponatremia is increasing in old patients but there is no report about clinical findings of old patients with hyponatremia. We evaluated the cause and clinical manifestations of severe hyponatremia in old patients who had been admitted via emergency room. METHODS: We retrospectively reviewed clinical records of the hyponatremic patients who had been admitted from 2000 to 2007. We enrolled 53 patients (Age >60 years, Na <125 mEq/L) without severe liver cirrhosis, heart failure or chronic kidney disease. We analyzed data to evaluate the differences of clinical manifestations according to the presence of symptoms, taking diuretics, urine sodium concentrations and the degree of hyponatremia. RESULTS: Mean serum sodium concentration was 111.4+/-6.9 mEq/L and urine sodium concentration was 68.7+/-43.8 mEq/L. There was no difference in serum sodium concentration according to age. Twenty-nine (54.7%) patients had nausea and vomiting and 19 patients (35.8%) had neurologic symptoms. Patients with neurologic symptoms showed lower serum and urine sodium concentration than patients without neurologic symptoms. The main causes of severe hyponatremia were poor oral intake (79.2%), diuretics use (37.7%) and recent operation (15.1%). The mean sodium concentration of the fluid administered to achieve 125 mEq/L of serum sodium level was 336.5+/-160.6 mEq/L. CONCLUSION: The urinary sodium loss, e.g., diuretics abuse, may be the main cause of severe hyponatremia in elderly patients over 60 years. In elderly patients, diuretics should be carefully administered with frequent electrolyte monitoring.

Comparison of Vascular Calcification Scores on Plain Radiographs as Predictors of Coronary Artery Disease in Hemodialysis Patients / 대한신장학회지

PURPOSE: Vascular calcification (VC) scores on simple plain radiographic films are known to be associated with coronary artery disease (CAD) and mortality. The present study was designed to demonstrate a correlation between VC scores of the hands and pelvis, and feet and lateral lumbar spine on plain radiographs. In addition, we analyzed the usefulness of checking all the plain radiographs for assessment of pre-existing CAD. METHODS: We recruited 61 hemodialysis (HD) patients from OO Dialysis Center. We checked the plain radiographic films of the feet, hands, pelvis, and lateral lumbar spine and evaluated VC scores with previously reported methods. We defined CAD based on myocardial scans, echocardiography, or coronary angiography. RESULTS: Positive associations were found between the VC scores of the feet, VC scores of the hands and pelvis, scores of abdominal aortic calcifications (AACs), and CAD. Approximately 30% of patients who had CAD could be missed based on a single VC scoring method. Patients who showed any one finding among the AAC scores >5, VC scores of the pelvis and hands >3 or arterial media calcifications of the feet on plain radiographs had a high sensitivity (93.8%) and a high negative predictive value (96.3%) for the presence of CAD. CONCLUSION: Each VC score was highly inter-correlated. All three VC scoring methods on plain radiographic films are useful screening tests for the presence of CAD in HD patients.

Abciximab (ReoPro)-Induced Thrombocytopenia Diagnosed Through Measurement of Heparin-Dependent Antibody

Abciximab (ReoPro) is an extremely potent inhibitor of the glycoprotein IIb/IIIa receptor. Its main application is in the maintenance of coronary flow after suboptimal coronary intervention. Complications associated with this drug include bleeding and severe thrombocytopenia. We report a case of severe thrombocytopenia secondary to abciximab therapy for percutaneous coronary intervention in a 65-year-old woman suffering from an acute myocardial infarction. Her platelet count dropped to 1,000/mm3 7 hours after abciximab administration and improved with transfusion of 12 units of platelet concentrate the following day. The patient was diagnosed through measurement of heparin-dependent antibodies and readministration of heparin.

Two cases of toxic hepatitis after Polygonum multiflorum Thunb. ingestion / 대한내과학회지

The desire to maintain youth and beauty has led to an increase in the use of health foods and herbs. Because Polygonum multiflorum Thunb. is thought to prevent hair loss and maintain black hair, this herb in particular has captured public interest in Korea and China. Although there have been many reports regarding the toxic effects of herbs and health foods, the potential toxicity of this herb has not yet been reported. Here, we discuss two cases of toxic hepatitis due to Polygonum multiflorum ingestion and present a review of the relevant literature.

Diagnostic validity of weighted diagnostic index scores for tuberculous meningitis in adults / 대한내과학회지

BACKGROUND/AIMS: Tuberculous meningitis is a common, occasionally fatal infectious disease of the central nervous system. We evaluated the diagnostic validity of weighted diagnostic index scores (WDIS), which have been suggested to aid in the diagnosis of adult patients with tuberculous meningitis, on the basis of simple clinical and laboratory findings. METHODS: The microbiological and clinical data of adult patients with either tuberculous or bacterial meningitis were reviewed retrospectively. Diagnostic validity and WDIS cut-off values were evaluated by receiver operating characteristic (ROC) curve analysis. RESULTS: A total of 77 cases were included: 47 with tuberculous meningitis and 30 with bacterial meningitis. For the diagnosis of tuberculous meningitis, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of WDIS suggested by Thwaites (cut-off value of < or =4) were 100, 90, 94 and 100%, respectively. Based on ROC curve analysis (area under ROC curve=0.993), a cut-off value of < or =3 was most appropriate for the diagnosis of tuberculous meningitis. The sensitivity and specificity of WDIS with a cut-off value of < or =3 were 100 and 93.3%, respectively. CONCLUSIONS: Our study demonstrated that WDIS are highly predictable and acceptable for the early diagnosis of tuberculous meningitis in Korea, based on our analysis of clinical and laboratory findings. A cut-off value of < or =3 showed the best diagnostic validity.