The Comparison of Blood Acid-Base Changes in Severe Burn Patients Resuscitation with Hartmann Solution and Plasma Solution-A

PURPOSE: Intravenous infusion of crystalloid solution is very important in the treatment of severe burn patients. But variable blood acid-base differences can be induced due to crystalloids. The aim of this study was to compare, in severe burn patients, the effects of two balanced fluids (Hartmann solution and plasma solution-A) on blood chemical differences. METHODS: A retrospective review was performed on 21 patients from January 2010 to December 2012 who admitted as severe burn patients to KEPCO Medical Center burn care unit. One group was resuscitated with Hartmann solution according to Parkland formula. The other one was resuscitated with plasma solution-A. RESULTS: 21 patients were enrolled. 14 patients belonged to plasma solution-A group and 7 patients belonged to Hartmann solution group. Bicarbonate, pH, serum lactate and serum electrolytes showed no statistic differences between plasma solution-A and Hartmann solution group (P>0.05). As time went by, pH and bicarbonate increased and serum lactate level decreased in both group. CONCLUSION: In this study, plasma solution-A had equally alkalinizing effect as Hartmann solution in severe burn patient resuscitation.

The Usefulness of Plasma Neutrophil Gelatinase-Associated Lipocalin in Acute Pyelonephritis

PURPOSE: Plasma neutrophil gelatinase-associated lipocalin (NGAL) is a biomarker that shows correlation with the severity of acute infection and acute kidney injury (AKI). This study was conducted in order to determine the predictive value of NGAL in the emergency department for predicting the severity of acute pyelonephritis. METHODS: A retrospective study was conducted between October 2012 and May 2013. A total of 46 patients diagnosed with acute pyelonephritis were enrolled in this study. Plasma NGAL was measured upon admission to the hospital and clinical and laboratory data, CT were collected. Based on these data, we classified our patients according to two groups (high NGAL group: NGAL > or =400 ng/mL vs low NGAL group: NGAL <400 ng/mL) and we evaluated the correlation between clinical data, laboratory data, and CT. RESULTS: Among the 46 patients, there were 45 female patients and the mean age was 59.0+/-20.4 years. Statistically significant differences in CT grades, hospital stay, SIRS, and shock were observed between the NGAL groups. The area under the ROC curve for CT severity by NGAL was 0.890(95% CI, 0.796-0.985), which was better than CRP and MDRD GFR. NGAL levels showed correlation with CRP (r=0.508; p<0.001) and MDRD GFR (r=-0.766, p<0.001). CONCLUSION: NGAL is a useful specific biomarker predicting severity of acute pyelonephritis.

Plasma Lactate and Base Deficit: Early Predictors of Morbidity in Burn Patients

PURPOSE: Plasma lactate and base deficit has been used as a marker to determine the status of tissue perfusion in trauma and clinically ill patients and also to predict the outcome of these patients. This study was performed to investigate the effect of plasma lactate and base deficit in predicting burn patients outcome. METHODS: A retrospective review was performed on 102 patients from January 2012 to December 2013 who were admitted as severe burn patients to our burn care unit. Plasma lactate and base deficit were measured upon admission to the hospital and SIRS score, hospital day, ABSI and TBSA were collected after admission. RESULTS: 102 patients were enrolled. Initial base deficit, hospital day, burn surface area and ABSI score showed statistical differences between low SIRS group and high SIRS group. The SIRS score, hospital day and ABSI score showed statistical differences between high base deficit group and low base deficit group (P0.05). CONCLUSION: In this study, initial base deficit but not plasma lactate, was predictor of morbidity following burn injury.

Delayed Spinal Accessory Neuropathy Diagnosed after Local Operative Surgical Procedures in The Posterior Cervical Triangle

The spinal accessory nerve is well known to be injured by surgical procedures in the posterior cervical triangle. The trapezius muscle innervated by the spinal accessory nerve is a major scapular stabilizer, so the paralysis of this muscle results in shoulder droop, limited range of motion, and displacement of scapula as well as shoulder pain. Spinal accessory neuropathy from a local surgical procedure may begin immediately. We experienced three spinal accessory neuropathy cases with delayed onset after local surgical procedures.