A case of acute kidney injury caused by dapsone-induced methemoglobinemia in a patient with chronic kidney disease

Methemoglobinemia (MetHb), which is characterized by an increased methemoglobin level, is a rare but potentially fatal disorder caused by congenital enzyme deficiencies or exposure to oxidizing agents, including dapsone. Elevation in the methemoglobin level impairs the oxygen-carrying capacity of hemoglobin, produces functional anemia, and induces tissue hypoxia. Such hypoxia results in microcirculation injury and hypoperfusion in the tissue and organs, including the kidney, and is a risk factor for acute kidney injury (AKI). This paper reports a case of AKI caused by dapsone-induced MetHb in a patient with chronic kidney disease, in which the patient ingested approximately 1,500 mg of dapsone in a suicide attempt, which was treated with aggressive management, including methylene blue, ascorbic acid, and transfusion.

Clinical Analysis of Acute Endosulfan Poisoning: Single Center Experience

PURPOSE: Acute endosulfan poisoning is rare but causes significant morbidity and mortality. The aim of our study is to describe complications and features of seizure and determine factors associated with mortality in acute endosulfan poisoning. METHODS: Twenty-eight adult patients with acute endosulfan poisoning admitted to our emergency department during a 15-year period were studied retrospectively. The clinical features of seizure, use of antiepileptic drugs during seizure, and hospital courses were evaluated. Clinical factors between survived group and non-survived group were compared for identification of factors associated with mortality. RESULTS: Of the 28 patients with endosulfan poisoning, 4 patients (14.3%) died and 15 (53.6%) patients developed generalized tonic-clonic seizure. Thirteen patients (46.4%) and 5 patients (17.9%) progressed to status epilepticus (SE) and refractory status epilepticus (RSE), respectively. SE and RSE were associated with mortality. Almost all significant complications including shock, acute renal failure, hepatic toxicity, rhabdomyolysis, and cardiac injury developed in SE and RSE patients. CONCLUSION: SE and RSE were important contributors to death in endosulfan poisoning. Emergency physicians treating endosulfan poisoning should make an effort not to progress seizure following endosulfan poisoning to SE and RSE using a rapid and aggressive antiepileptic drug.

Predictors of Cerebrovascular Causes in the Emergency Department Patients with Dizziness: Application of the ABCD2 Score / 대한평형의학회지

BACKGROUND AND OBJECTIVES: Dizziness is a common presenting complaint in the emergency department (ED) that had various pathologic causes. Most of dizziness can be caused by benign origin but identifying cerebrovascular causes among ED patients with dizziness is a diagnostic challenge. ABCD2 score is clinical prediction tool for assessing the risk of stroke after a transient ischemic attack. We evaluated predictors of cerebrovascular causes and whether ABCD2 score would identify cerebrovascular events among ED patients with dizziness. MATERIALS AND METHODS: We analyzed 180 patients (> or =20 years old) with dizziness in ED, Presbyterian Medical Center (single-center prospective observational study) for 2 months. Type of dizziness, associated symptoms, past medical history, ABCD2 score (0-7), neuro-otologic examination, diagnosis were recorded. RESULTS: The incidence of dizziness is 3.6% (192/5,374). After excluding 12 patients, 180 patients (56% female, mean 59 years) met our eligibility criteria and were included in the final analysis. Cerebrovascular causes of dizziness were found in 10% (18/180): 3 vertebrobasilar insufficiency, 9 cerebellar infarction, 1 right middle cerebral artery (MCA) infarction, 1 right MCA giant aneurysm, 1 lateral medullary infarction, 1 posterior limb of internal capsule infarction, 1 intracerebral hemorrhage of cerebellum. Patients with cerebrovascular cause were males and had more hypertension, diabetes mellitus, imbalance, abnormal neuro-otologic findings and ABCD2 score. CONCLUSION: Several clinical factors (hypertension, diabetes, abnormal neuro-otologic findings ABCD2 scores) favored a diagnosis of central neurological causes of dizziness. ABCD2 score is a simple and easily applied tool for distinguishing cerebrovascular from peripheral causes of dizziness in ED.

Measurement of Volume of a Swallow for Liquid Swallowing in Healthy Young Adults

PURPOSE: The aim of this study is to estimate one mouthful volume in a single swallow and average volume per swallow (AVS) in multiple swallows in the situation of toxic liquid poisoning. METHODS: Thirty five men and 35 women were included in this study. Each subject was asked to drink one swallow and three consecutive swallows from bottle containing water and a bottle containing saline separately. We calculated one mouthful volume in a single swallow and AVS in three swallows. One mouthful volume and AVS were compared according to sex and content, respectively. One mouthful volume of water and saline was then compared with AVS of each. RESULTS: Sixty seven adults(34 men; 26.9+/-3.2 years, 33 women; 25.6+/-2.4 years) completed the study. Men had larger one mouthful volume of water(49.1+/-19.9 ml vs 39.7+/-10.2 ml, p=0.02) and saline(20.7+/-10.9 ml vs 14.0+/-4.6 ml, p=0.004) and AVS of water(28.5+/-11.9 ml vs 21.5+/-5.9 ml, p=0.004) and saline(11.9+/-6.3 ml vs 7.9+/-2.0 ml, p=0.001) than women. One mouthful volume and AVS of saline swallow were lower than those of water swallow. AVS of three consecutive swallows was lower than one mouthful volume in water and saline swallow. CONCLUSION: We suggest that one mouthful volume in a single swallow is 21 ml in men and 14 ml in women and AVS in multiple swallows is 12 ml in men and 8 ml in women. AVS in multiple swallows is two-threefold lower than reference values(20~30 ml) commonly used in poisoning study.