Consideration of Prognostic Factors in Hypoglycemic Encephalopathy / 대한구급학회지

BACKGROUND: Recently, there are many reports about the association of Diffusion Weighted Imaging (DWI) and the prognosis of hypoglycemic encephalopathy (HE), but those relationships have not yet been completely determined. As such, we researched for prognosis, according to a variety of clinical data, and the lesion's distribution on DWI. METHODS: We retrospectively reviewed 19 patients who were diagnosed as HE. In addition, those prognoses were analyzed by a variety of clinical data and characteristics of lesion's distribution, which were evaluated on DWI and Apparent Diffusion Coefficient (ADC) maps. Three months later, those prognoses were determined by each Modified Rankin Scale. Further, the time-dependent average Glasgow Coma Scale (GCS), among the groups according to the characteristics of lesion's distributions in the initial DWI, was estimated. RESULTS: In this study, the difference of prognosis was not shown, according to all the clinical data, such as the severity or duration of the hypoglycemic state, but the group that did not have any pathologic lesion on the initial DWI demonstrated a better prognosis, in comparison with the groups-that exhibited any positive lesion on the initial DWI (p = 0.006). The group that had a focal pathologic lesion on the initial DWI showed a better prognosis than the diffuse lesion's group (p = 0.045). The groups with no lesion or focal lesion showed a faster recovery of GCS than the other groups with a positive lesion or diffuse lesion within the initial 1 week. CONCLUSIONS: We can identify that the characteristics of the lesion's distribution of DWI can be more helpful to predict of prognosis in HE than a variety of clinical data, such as the severity or duration of the hypoglycemic state.

A Case of Successful Management of Inhalation Injury Caused by Hydrofluoric Acid Poisoning

Hydrofluoric acid (HFA) is an extremely corrosive fluid and should be handled very carefully. It penetrates tissue more quickly than typical acids, and has the systemic toxicity that can occur via dermal, ocular, inhalation, and oral routes. Furthermore, it interferes with nerve function, thus burns may not initially be painful but may become gradually painful. If the treatment is delayed, the extent and seriousness of injury and toxicity will be much more severe; HFA will be absorbed into the blood stream, react with serum calcium, and may cause arrhythmia or cardiac arrest. As the chemical industry grows, the frequency of HFA use is increasing, leading to increased incidences of HFA dermal burn. Yet, reports of HFA inhalation injury are rare. Presently, we treated one patient with HFA inhalation injury sustained during work at a cosmetic factory. The male presented an acutely ill appearance, shortness of breath, and cold sweating. At once, oxygen, IV antibiotics, and IV 20% calcium gluconate were administered, and the patient was closely monitored. The patient was admitted to the intensive care unit. Successful management led to discharge without any significant complications.

A Case of Successful Management of Inhalation Injury Caused by Hydrofluoric Acid Poisoning

Hydrofluoric acid (HFA) is an extremely corrosive fluid and should be handled very carefully. It penetrates tissue more quickly than typical acids, and has the systemic toxicity that can occur via dermal, ocular, inhalation, and oral routes. Furthermore, it interferes with nerve function, thus burns may not initially be painful but may become gradually painful. If the treatment is delayed, the extent and seriousness of injury and toxicity will be much more severe; HFA will be absorbed into the blood stream, react with serum calcium, and may cause arrhythmia or cardiac arrest. As the chemical industry grows, the frequency of HFA use is increasing, leading to increased incidences of HFA dermal burn. Yet, reports of HFA inhalation injury are rare. Presently, we treated one patient with HFA inhalation injury sustained during work at a cosmetic factory. The male presented an acutely ill appearance, shortness of breath, and cold sweating. At once, oxygen, IV antibiotics, and IV 20% calcium gluconate were administered, and the patient was closely monitored. The patient was admitted to the intensive care unit. Successful management led to discharge without any significant complications.