Total pancreatic necrosis after organophosphate intoxication / 医学前沿

Cases of acute pancreatitis induced by organophosphate intoxication are encountered occasionally in clinics, but very few of them develop into severe pancreas necrosis and irreversible pancreatic function impairment. Here, we report a 47-year-old female organophosphate poisoning case after ingestion of massive insecticides; she was considered to have total necrosis and function failure of the pancreas via serum amylase test, glucose level test, and CT imaging. The patient exhibited no relief under the regular medicine treatment, which included sandostatin, antibiotics, intravenous atropine, and pralidoxime methiodide. She received percutaneous catheterization and drainage of pancreatic zone to expel hazardous necrotic waste, also by which the pathogenic evidence was obtained and the antibiotics were adjusted subsequently. The patient recovered gradually, was discharged after 2 weeks, and was prescribed with oral pancreatin capsules before meals and hypodermic insulin at meals and bedtime to compensate the impaired pancreatic function.

The effect of continuous veno venous hemofiltration on neutrophil gelatinase-associated lipocalin plasma levels in critically ill patients with acute kidney injury / 中华内科杂志

Objective To evaluate the effect of continuous veno venous hemofiltration (CVVH) on neutrophil gelatinase associated lipocalin (NGAL) in critically ill patients with acute kidney injury (AKI).Methods Critically ill patients with AKI who needed CVVH and admitted to Department of Critical Care Medicine of Peking Union Medical College Hospital were enrolled prospectively from January 2015 to June 2015.AN69 membrane filters were used for CVVH.Prefilter,postfilter,and plasma NGAL measurements were taken at 10 mins,4 hours and 8 hours (T 10 min,T 4 h,T 8 h) after CVVH.The influence of membrane filter and volume management on NGAL level was analyzed.Results Forty patients were recruited.The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score was 22.9±7.0.The sequential organ failure score (SOFA) was 12.1±2.9,and ICU mortality was 27.5％.During CVVH,there were no significant differences in NGAL levels between prefilter [T 10 min:39.3 (24.8,62.4)μg/min;T 4 h:(45.1±23.2)μg/min;and T 8 h:(45.5±22.4)μg/min] and postfilter [T 10 min:33.5 (25.1,60.7)μg/min;T 4 h:(44.2±24.3)μg/min,and T 8 h:(45.9±22.4)μg/min] (P＞ 0.05 for all).Compared with the survival group[310.0(162.0,588.0) μg/L],plasma NGAL level in T 10 min [684.0(270.0,944.0) μg/L] was significantly higher in death group (P=0.033).After fluid balance correction,T 4 h [603.4(484.8,620.2) μg/L] and T 8 h [590.2(475.9,749.4) μg/L] plasma NGAL levels in death group were significantly higher than those in the survival group [T4 h:419.5 (227.5,552.4)μg/L;T 8 h:400.7(196.1,517.4) μg/L] with statistical significance (P＜0.01 for both).Conclusions During CVVH,AN69 membrane filter does not have significant effect on plasma NGAL level in critically ill patients with AKI.After volume balance correction,plasma NGAL level could be used as an effective indicator in these patients.