Analysis of clinical characteristics of 294 acute poisoning patients with gastric lavage / 中华急诊医学杂志

Objective:To describe the current situation of gastric lavage operation and put forward measures for improvement by analyzing the clinical characteristics of 294 patients with gastric lavage in Poisoning Treatment Center of The First Affiliated Hospital of Nanjing Medical University.Methods:The clinical data of 294 patients with acute poisoning and gastric lavage from 2019 to 2021 were collected and analyzed retrospectively, and the related parameters (poison type, gastric lavage volume, poisoning to gastric lavage time, etc.) of each year were compared.Results:A total of 653 poisoning patients underwent gastric lavage from 2019 to 2021, with an average age of (44.2 ±20.1) years, and 134 (45.6%) were male. The main causes of gastric lavage were pesticide poisoning (52.72%) and drug poisoning (42.86%). The volume of gastric lavage was less than 10 L for 43.8% of patients and 10-20 L for 32.7% of patients. Patients with gastric lavage within 60 min after ingestion of poison accounted for 45.3%, followed by 25.8% within 61-120 min. The in-hospital mortality rate was 17.7%. The common complications of gastric lavage were: the incidence of gastrointestinal bleeding (55/121, 45.5%), the incidence of aspiration pneumonia (54/140, 38.6%), and the incidences of electrolyte disorder (21% of low potassium, 29% low calcium, and 10.0% low sodium). Compared with the groups in different years, the proportion of gastric lavage in poisoning was 58.85% vs. 46.60% vs. 32.41%, which decreased year by year, with statistical difference ( P <0.05). And there was no difference in the period from ingestion to gastric lavage and gastric lavage fluid volume. There was an increasing trend in poison types between diquat and other insecticides, but there was no statistical difference. Conclusions:From 2019 to 2021, the most common causes of acute gastric lavage were pesticide poisoning and drug poisoning, and the proportion of diquat and other pesticides showed an overall upward trend. A majority of the patients (71.1%) had gastric lavage within 2 h, and 76.5% of the patients had less than 20 L gastric lavage fluid. In the future, we will further control the amount of gastric lavage fluid and pay attention to the gastric lavage operation of new insecticide poisoning.

Refractory hypokalemia: a case report

Hypokalemia is a common electrolyte disturbance in hospitalized patients, which prompts appropriate identification of hypokalemia symptoms and signs. As many as 20% of hospitalized patients are found to have hypokalemia. Many hypokalemia patients could also have systemic disease.A 55-year-old woman was presented with weakness, nausea, and vomiting for 2 days before admission. Vomit consisted of water; there was no bloodin the vomit. Defecation was normal; consistency and odor of feces were normal. Patient had diabetes and was already on insulin regiment. Insulin was discontinued during hospitalization since blood sugar was close to lower limit. Electrocardiography (ECG)was within normal limit.Symptoms and signs of hypokalemia may not be readily apparent, as seen in this case. Treatment of hypokalemia should intend not to only replenish potassium, but also to identify underlying cause. Causes include gastrointestinal losses, intracellular shift, renal potassium losses, and inadequate intake.

McKittrick-Wheelock syndrome secondary to rectal adenocarcinoma

Introduction: McKittrick-Wheelock syndrome is a rare condition that arises from a hypersecretory state secondary to large colorectal tumors, mainly villous adenomas, leading to an electrolytic disorder associated with chronic diarrhea that usually persists for years. It is a relatively unknown disease that can lead to severe complications such as acute kidney injury, severe hyponatremia, and hypokalemia. In fact, it causes death in most untreated cases. Surgical removal of the tumor is the most successful treatment, and symptoms tend to disappear after proper management. Case Report: A 62-year-old man with a 2-year history of mucoid diarrhea preceded by abdominal pain presented with acute kidney injury, hyponatremia, and hypokalemia. A digital rectal examination and sigmoidoscopy were performed, and revealed a large laterally-spreading tumor in the rectum. Further investigation showed a rectal tubulovillous adenoma with secondary McKittrick-Wheelock syndrome. An anterior resection of the rectum with a colonic J-pouch and a diverting ileostomy were performed, and the patient improved with the resolution of the renal failure and electrolyte disturbances. The histopathological analysis revealed an invasive rectal adenocarcinoma. Discussion: McKittrick-Wheelock syndrome is a condition with a low incidence that needs early intervention and proper diagnosis. It is of extreme importance that this disease is included in the differential diagnoses for chronic diarrhea associated with an electrolytic disorder. (AU)

Medication Analysis of Electrolyte Disturbance with Suspected Deteriorated Demyelination Post PCI / 医药导报

Objective A case would be discussed on suspected demyelination due to electrolyte disturbance to provide references for clinical pharmacists to carry out pharmaceutical care. Methods A pharmaceutical care case on PCI postoperative acute heart failure and contrast induced nephropathy with suspected demyelization due to electrolyte disturbance was introduced through a combination of analysis on clinical symptoms,renal function,electrolyte,blood glucose level and further discussion on consciousness change reason, diuretic use, electrolyte management, and other related issues. Results Clinical pharmacist should provide more care to patients with abnormal blood sodium and osmotic pressure,pay more attention to the calculation and evaluation of rehydration sodium/filling quantity and speed, accumulate more knowledge of contrast induced nephropathy, and raise their awareness on the identification of high risk population. Conclusion Arrhythmia,heart failure,renal failure,infection can beincentives to one another,and thus doctors and pharmacists must pay more attention to the comprehensive situations.

Study design of Real World Evidence for Treatment of Hyperkalemia in the Emergency Department (REVEAL-ED): a multicenter, prospective, observational study

OBJECTIVE: Hyperkalemia affects up to 10% of hospitalized patients and, if left untreated, can lead to serious cardiac arrhythmias or death. Although hyperkalemia is frequently encountered in the emergency department (ED), and is potentially life-threatening, standard of care for the treatment is poorly defined, with little supporting evidence. The main objectives of this observational study are to define the overall burden of hyperkalemia in the ED setting, describe its causes, the variability in treatment patterns and characterize the effectiveness and safety of ED standard of care therapies used in the United States. METHODS: This is an observational study evaluating the management of hyperkalemia in the ED. Two hundred and three patients who presented to the ED with a potassium value ≥5.5 mmol/L were enrolled in the study at 14 sites across the United States. Patients were treated per standard of care practices at the discretion of the patient’s physician. In patients who received a treatment for hyperkalemia, blood samples were drawn at pre-specified time points and serum potassium values were recorded. The change in potassium over 4 hours and the adverse events after standard of care treatment were analyzed. RESULTS AND CONCLUSION: This article describes the background, rationale, study design, and methodology of the REVEAL-ED (Real World Evidence for Treatment of Hyperkalemia in the Emergency Department) trial, a multicenter, prospective, observational study evaluating contemporary management of patients admitted to the ED with hyperkalemia.

Changes in blood gas parameters of heatstroke rats in dry-heat environment of desert / 中华危重病急救医学

ObjectiveTo investigate the changes in characteristics of blood gas analysis of heatstroke rats residing in dry-heat environment of desert, and to provide a theoretical reference for its treatment in clinic.Methods Forty-eight male Sprague-Dawley (SD) adult rats under anesthesia were divided into six groups by random number table, with 8 rats in each group: namely mild, moderate, severe heatstroke groups and their corresponding control groups. The rats were placed in an artificial chamber with simulated desert dry-heat environment (temperature 41℃, humidity 10%) for about 70, 110, 145 minutes, respectively, to reproduce mild, moderate, severe heatstroke models. The rats in control groups were placed in a normothermic environment for corresponding duration. Abdominal aorta blood of each group was collected for blood gas analysis, and electrolytes were determined by a portable blood gas analyzer.Results① Arterial partial pressure of carbon dioxide (PaCO2) in mild heatstroke group was increased to (45.64±8.19) mmHg (1 mmHg = 0.133 kPa), arterial oxygen saturation (SaO2) was decreased to 0.84±0.08, pH value was lowered to 7.36±0.11, showing that respiratory acid-base imbalance was resulted. Base excess of extracellular fluid (BEecf) in moderate heatstroke group was decreased to (-3.00±0.76) mmol/L, HCO3- was decreased to (19.39±1.89) mmol/L, and pH value was lowered to 7.21±0.07, indicating that metabolic acid-base imbalance was aggravated gradually. The changes in parameters in severe heatstroke group gradually became more serious, and a significant difference was found as compared with those of mild and moderate heatstroke groups (PaCO2:F = 6.537,P = 0.006; SaO2:F = 5.174,P = 0.015; pH value:F = 10.736,P = 0.001;BEecf:F = 67.136,P = 0.000; HCO3-:F = 5.612,P = 0.011), manifesting an obvious combination of respiratory acidosis and metabolic acidosis, and a serious mixed acid-base disturbance was produced.② Compared with corresponding control groups, hemoglobin (Hb) was significantly increased in moderate heatstroke group (g/L: 15.31±1.84 vs. 13.28±0.94,t = 2.791,P = 0.014), Hb and hematocrit (HCT) in severe heatstroke group were significantly increased [Hb (g/L): 16.59±2.52 vs. 13.42±1.15,t = 3.224,P = 0.006; HCT: (53.50±6.63)% vs. (45.50±4.47)%,t = 2.828, P = 0.013], showing that the degree of dehydration was aggravated gradually from mild to serious degree.③ Serum sodium content in mild heatstroke group was normal (t = 0.665,P = 0.517), serum potassium content was lowered significantly (t = -2.526,P = 0.024); serum sodium content in moderate heatstroke group was increased significantly (t = 2.162,P = 0.048), serum potassium content was lowered significantly (t = -5.458,P = 0.000); and serum sodium content in severe heatstroke group rose obviously (U = 12.500,P = 0.038), and most of the rats showed hypokalemia, with a small proportion of rats showed obvious hyperkalemia (U = 19.500,P = 0.195).ConclusionsAcidosis, electrolyte disturbance, respiratory failure and dehydration in heatstroke occurred in dry-heat environment of desert. It indicates that resuscitation should focus on correction of respiratory acidosis, with simultaneous correction of metabolic acidosis, and one should be alert to correct dehydration and electrolyte disturbance. During the moderate phase and the serious phase, correction of aggravated metabolic acidosis should be reinforced, and the prevention and treatment of the severe dehydration and electrolyte disturbance should be undertaken actively.

Evaluation of Bartter-like Syndrome Associated with Aminoglycoside Micronomocin Sulfate Administration During Acute Pyelonephritis Treatment / 대한신장학회잡지

The aminoglycoside antibiotics is widely used in the treatment of infectious caused by gram-negative bacteria and for synergistic effect with(beta-lactam antibiotics. However, its therapeutic usefulness is limited by this potential nephrotoxicity and by disturbance of electrolyte homeostasis resulting in hypomagnesemia, hypokalemia, hypocalcemia such as Bartter-like syndrome. Many case repots have been reported on development of Bartter-like syndrome after aminoglycosides administration. But these reports had the many differences of such as types of aminoglycosides, age of patients, duration and total dose of treatment, combined antibiotics and baseline diseases. Therefore, the purpose of this study is to assess the effects of micronomocin sulfate on magnesium, calcium and potassium status of patients in acute pyelonephritis. Twenty one patients in acute pyelonephritis(18 female/3 male, ages 20-75) was treated with single or combined antibiotics. Eleven of twenty one patients as study group were treated with both micronomicin sulfate(aminoglycoside, 4mg/kg/day, during 5-8days) and flomoxef sodium (3rd cephalosporine, 2g/day, during 5-8days), and ten of twenty one patients as control group were treated only with flomoxef sodium(3rd cephalosporine. 2g/day. during 5-8days). Renal values, plasma and urinary electrolytes were measured before and at the end of IV antibiotic therapy. After micronomicin sulfate administrated for 6.4+/-1.5days, serum Mg, Ca, K, FEMg (fractional excretion of Mg), TTKG(transtubular K concentration gradient) and FECa(fractional excretion of Ca) did not significantly change(p>0.05). Therefore, those results suggest that micromonicin sulfate therapy within dose of 240mg/day(4mg/kg/day) for 6.4+/-1.5days may not cause disturbance of electrolyte homeostasis such as Bartter-like syndrome in acute pyelonephritis. Howerever, electrolyte disturbance is an important complication when aminoglycosides is given in larges doses over extended periods. Therefore, monitoring of blood concentration and urinary losses of electrolyte should be carried out along with careful observation of Bartter-like syndrome.