Predictive Factor of Blood Pressure Lowering in Patients with Fever Using Propacetamol

PURPOSE: This study aimed to identify predictive factors for decreased blood pressure in patients prescribed with propacetamol in the emergency room using clinical and laboratory indicators of sepsis. METHODS: Among patients aged 18 years or older with a fever, who visited Chungbuk National University hospital's emergency room between July and December of 2014, 246 patients underwent intravenous infusion of propacetamol to control body temperature. Of these, 112 patients fulfilled all study requirements. Patients whose systolic or diastolic blood pressure dropped below 90 mmHg or 60 mmHg, respectively, were included in the blood pressure decline group. Additional inclusion criteria were a decline in systolic blood pressure of more than 30-mmHg and thereby treated with fluids or inotropics after intravenous infusion of propacetamol. Remaining patients were included in the blood pressure maintenance group. The relationship of each factor between the two groups was then investigated. RESULTS: Twenty-nine patients (25.9%) showed a significant decrease in blood pressure, and among many factors, high-sensitivity C-reactive protein (hs-CRP) (cut off value, 11.86; sensitivity, 72.4%; specificity, 69.9%; area under curve [AUC], 0.698) and procalcitonin (cut off value, 0.67; sensitivity, 75.9%; specificity, 60.2%; AUC, 0.667) levels showed a statistically significant effect. Of the 29 patients with a decrease in blood pressure, 10 patients received fluids and inotropics; procalcitonin in particular showed a significant effect. CONCLUSION: When propacetamol is administered to patients at the emergency room, and if hs-CRP or procalcitonin levels are high, there is an increased risk of a decrease in blood pressure. In particular, if procalcitonin levels are high, aggressive treatment is required, such as administration of inotropics in addition to fluids.

The Correlation between Stool Exams and Abdominal Computed Tomography (CT) Findings in the Patients with Acute Diarrhea Visiting Emergency Department (ED)

PURPOSE: Stool exams are a useful tool for the early presumptive diagnosis of infectious bacterial diarrhea in the Emergency Department (ED). CT scans are often used to increase the physician's level of certainty and to facilitate patient triage by identifying the source of pain in most patients with an acute abdomen in the ED. This study was designed to investigate the correlation between stool exams and abdominal CT in patients with acute diarrhea visiting the ED. METHODS: We conducted a retrospective study in the emergency department of a national university hospital from January 1, 2012 to June 30, 2013. The subjects consisted of 156 patients with acute diarrhea and abdominal pain who had stool exam results and abdominal CT findings. We divided the patients into three groups according to the stool exam results. Simultaneously, we evaluated their CT findings of the bowel and adjacent structures. RESULTS: A total of 156 patients were enrolled. Frequency of abnormal CT findings showed statistically significant correlation with stool exams (p-value <0.001). Abnormal CT findings increased as WBCs and RBCs in stool increased (p-value <0.001). CONCLUSION: The stool exam was a statistically significant predictive variable in indirectly determining the severity of acute diarrhea and it showed correlation with the frequency of abnormal CT findings. It is suggested that stool exams can be used as a susceptible marker for predicting the probability of severe infectious colitis, and for making an early decision regarding close medical attention.

Usefulness of Immediate W-plasty in the Emergency Department for Minimizing Scar Formation: Results from a Short-term Follow-up

PURPOSE: Facial scars are a main complaint of patients who had undergone suture in the emergency department. Therefore, effective techniques for minimizing scar formation are required. W-plasty, a widely used method of scar correction, has been performed to change the scar direction or divide it into multiple segmented scars. This method can be applied in the initial stage of wound repair in the emergency department. The aim of this study was to investigate the effectiveness of direct application of W-plasty to the wound in simultaneously accomplishing the aforementioned objectives. METHODS: This was a prospective study, from June 2012 to June 2014. Either simple debridement or W-plasty for facial laceration was performed in 31 patients. In patients in the simple debridement group, the excision was made along the laceration margin. In patients in the W-plasty group, the excision was made within the W-form predesigned margin of the laceration. The prognosis was evaluated using the Stony Brook scar evaluation scale (SBSES). RESULTS: Among 31 patients, 15 underwent simple debridement and 16 underwent W-plasty. In procedure time, there was no significant difference between the two groups. No complications were observed in either group. The median SBSES score was 4 (IQR, 3-4) in the simple debridement group and 5 (IQR, 5-5) in the W-plasty group, indicating a significant difference between the two groups (p<0.001). CONCLUSION: We achieved good results of direct W-plasty application to wound lacerations in terms of minimal scar formation. Thus, for patients with facial lacerations, we suggest that application of W-plasty to the wound debridement is more effective than the classic simple debridement.

Outcome and Current Status of Therapeutic Hypothermia Following Out-of-hospital Cardiac Arrest in Korea from the Korea Hypothermia Network Registry

PURPOSE: Therapeutic hypothermia (TH) has become a standard strategy for reducing brain damage in the postresuscitation period. The aim of this study is to investigate the outcomes and current performance of TH with out-of-hospital cardiac arrest (OHCA) survivors through the Korean hypothermia network (KORHN) registry. METHODS: We used the KORHN registry, a web-based, multicenter registry that includes 24 participating hospitals throughout the Republic of Korea. Adult comatose OHCA survivors treated with TH from 2007 to 2012 were included. The primary outcomes were neurologic outcome at hospital discharge and in-hospital mortality. The secondary outcomes were TH performance and adverse events during TH. RESULTS: A total of 930 patients were included; of these, 556 (59.8%) patients survived to discharge and 249 (26.8%) were discharged with good neurologic outcomes. The median time from return of spontaneous circulation (ROSC) to the start of TH was 101 (interquartile range (IQR): 46-200) minutes. The induction, maintenance, and rewarming durations were 150 (IQR: 80-267) minutes, 1440 (IQR: 1290-1440) minutes, and 708 (IQR: 420-900) minutes, respectively. The time from the ROSC to coronary angiography was 1,045 (IQR: 121-12,051) hours. Hyperglycemia (46.3%) was the most frequent adverse event. CONCLUSION: Over one quarter of OHCA survivors (26.8%) were discharged with good neurologic outcome. TH performance was managed appropriately in terms of the factors related to the timing of TH, which were the start time for cooling and the rewarming duration.

Could One-Hand Compression for a Small Child Cause Intra-abdominal Injuries?

PURPOSE: We examined the question of whether one-hand chest compression for a small child could compress intraabdominal organs. METHODS: We retrospectively examined medical charts and multidirectional computed tomography (MDCT) images obtained from children aged 1 to 18 years who presented to the hospital from March 2002 to March 2012. We measured the length of the sternum (Stotal) and the length of the lower half of the sternum (Stotal/2~X). We also measured the distance from the diaphragm to the midpoint of the sternum (Stotal/2~D) and half the width of an adult hand (Wtotal/2). Finally, we counted the number of instances at each age in which Stotal/2~X and Stotal/2~D were less than Wtotal/2. RESULTS: This study included records and MDCT images for 301 children with a mean age of 12.05+/-5.59 years. We also enrolled 47 adult rescuers (25 men, 53.2%) with a mean age of 23.20+/-2.13 years. The mean Wtotal/2 was 4.62+/-0.46 cm. All 1-year-old children had Stotal/2~X and Stotal/2~D less than Wtotal/2. Among children aged 2 years, six (60.0%) had Stotal/2~X and Stotal/2~D less than Wtotal/2. Among children aged 3 years, four (26.7%) had Stotal/2~X and Stotal/2~D less than Wtotal/2, and among those aged 4 years, two (13.3%) had Stotal/2~X and Stotal/2~D less than Wtotal/2. However, Stotal/2~X and Stotal/2~D were greater than Wtotal/2 in children aged 5 years or more. CONCLUSION: Our measurements indicate that one-hand chest compression for a small child could cause intraabdominal organ injury.

A Comparative Study of Tissue Injury Grades, with Clinical Factors, in Patients with Hydrofluoric Acid Burns who Received Intra-arterial Infusion of Calcium Gluconate

PURPOSE: Hydrofluoric acid (HFA) causes injury via tissue penetration by the free fluoride ion. Methods for treatment of HFA burns include continuous intra-arterial infusion of calcium gluconate, which is especially useful for patients with dermal burns of the digits caused by HFA. However, no comparative study of tissue injury grade with clinical factors among patients with HFA burns treated with continuous intra-arterial infusion of calcium gluconate has been conducted in Korea. METHODS: We conducted a prospective study at the emergency department of a university teaching hospital between January 2011 and June 2013. The subjects enrolled in this study consisted of 33 patients with HFA burns. After completion of treatment, we divided the patients into three groups according to the type of skin lesions. Patients requiring a skin graft or surgical flap were included in the poor outcome group, those who had to undergo incision and drainage in the moderate outcome group, and those who did not require further treatment in the good outcome group. RESULTS: After completion of all treatments, 22 of the 33 patients were included in the good outcome group and seven in the moderate outcome group; the remaining four patients were included in the poor outcome group, as they met the above-mentioned criteria, experienced longer-lasting pain, and were more frequently treated with injection in comparison with the other patients. CONCLUSION: Patients with HFA burns with long-term pain who need frequent arterial injections despite undergoing intra-arterial calcium gluconate treatment are likely to have poor outcome; therefore, they require more proactive interventions.

A Case of Chemical Pneumonitis with Gastrointestinal Disturbance Caused by Nitric Acid Inhalation

Nitric acid is a typical strong acid that is colorless, corrosive, and flammable. It is often used for industrial purposes, such as refining, metal cleaning, and electroplating. In Korea, some cases of chemical pneumonitis from nitric acid poisoning have been reported, but to our knowledge, there have been no reports of diarrhea caused by nitric acid poisoning. A 42-year-old man visited a nearby hospital because of continuous diarrhea, coughing, and dyspnea after inhaling nitric acid fumes at his workplace the previous day. He was transferred to our hospital and admitted to the intensive care unit. He showed tachypnea and hypoxemia in our emergency department. Initial chest radiographs showed diffuse interstitial infiltrates and ground glass opacity in both lungs. The patient showed improvements in clinical symptoms and on chest radiographs after receiving oxygen and mechanical ventilation, antibiotics, and systemic glucocorticoid therapy. After 20 days he was discharged and showed no symptoms and sequelae on his 1-year follow-up.

Two New Species of Cryptococcus sp. and Candida sp. from Wild Flowers in Korea

Among 80 types of yeast isolated from wild flowers in Daejeon, Korea, two species that have not yet been identified by phylogenetic analysis of the internal transcribed spacer-2 (ITS2) genes and 26S rDNA sequences were identified as Candida sp. 44-C-1 and Cryptococcus sp. 9-D-1. Neither of the newly identified species formed ascospores, while Candida sp. 44-C-1 formed pseudomycelium and Cryptococcus sp. 9-D-1 did not.

Comparison of Microbial Diversity of Korean Commercial Makgeolli Showing High beta-Glucan Content and High Antihypertensive Activity, Respectively

We measured physiological functionalities, including antihypertensive angiotensin I-converting enzyme inhibitory activity and immun-stimulating beta-glucan content for sixty kinds of Makgeolli that is commercially available from the market. As a result, we selected R-12 commercial raw Makgeolli, with a high content of immuno-stimulating beta-glucan, and R-14 commercial raw Makgeolli, exhibiting high antihypertensive activity. Due to the similarities in their overall physicochemical properties and raw materials used for fermentation, we compared the microbial flora in order to investigate the reason for the differences in their functionalities. Nested PCR and denaturing gradient gel electrophoresis for yeasts and bacteria were performed for analysis of microbial diversity of two different kinds of Makgeolli (i.e., R-12, R-14), which showed immuno-stimulating beta-glucan content and exhibited a very high level of antihypertensive activity, respectively. Analysis of the 18S rDNA amplicon revealed a major presence of the yeast strain Pichia burtonii in every Makgeolli sample. Analysis of the 16S rDNA amplicon revealed a predominance of lactic acid bacteria, and the most frequent lactic acid bacteria were Lactobacillus ingluviei, L. fermentum, and L. harbinensis, and Lactobacillus sp. Among these, L. harbinensis was detected only in R-12 and L. ingluviei was found only in R-14. Different functionalities from the individual commercially available Makgeolli may be attributed to actions of different microbial flora during fermentation.

The Influence of Antioxidant Resveratrol on Paraquat-induced Oxidative Stress in Cultured Lung Cells

PURPOSE: Paraquat (1,1'-dimethy-4,4'-bipyridinium dichloride, PQ) is an effective and widely used herbicide, which was introduced commercially in 1962. It is reduced by an electron donor, such as NADPH, and then transfers the electron to molecular oxygen. As a result, the reactive oxygen species (ROS) produced are related to its cellular toxicity. Resveratrol (trans-3,4',5-trihydroxystilbene), a naturally occurring hydroxystilbene, is considered an essential antioxidative constituent of red wine, possessing chemopreventive properties. However, the influence of resveratrol on PQ-induced oxidative cell damage has not fully been investigated. METHODS: This experiment was conducted in vitro using cultured lung cells from SD rats. The MTT and LDH methods were used for assessment of cytotoxicity. The 2',7'-dichlorofluorescein diacetate (DCF-DA) assay was used for measurement of intracellular ROS levels. The 2,2-diphenyl-1-picrylhydrazyl (DPPH) assay was used for measurement of pro-oxidant capacity of resveratrol. The Thiobarbituric acid reactive substances (TBARS) assay, which reflects lipid peroxidation, was used for estimation of oxidative stress. RESULTS: According to results of the MTT and LDH assays, incubation of cultured lung cells with resveratrol did not protect lung cells from PQ-induced cytotoxicity, and no decrease in ROS production was observed, according to results of the DCF-DA assay. On the other hand, incubation of lung cells with non-lethal resveratrol resulted in aggravation of PQ-induced oxidative stress. CONCLUSION: Results of this study showed that incubation of cells with resveratol did not result in reduction of PQ toxicity, but lead to elevation of PQ-induced oxidative stress in cultured lung cells.

A Case of Methanol Intoxication from Windshield Washer Fluid Ingestion Misidentified as an Alcoholic Beverage

Almost all cases of acute methanol intoxication result from ingestion. Absorption of methanol following oral administration is rapid and peak concentration occurs within 30-60 min. Foromic acid converted metabolites of methanol are responsible for its toxic effect. Methanol poisoning typically induces nausea, vomiting, abdominal pain, and mild central nervous system depression. Then there is a latent period lasting, followed by an uncompensated metabolic acidosis and visual dysfunction, depending on the dose of methanol ingested. Here we report on three patients who were victims of methanol intoxication due to ingestion of windshield washer fluid, which was misidentified as an alcoholic beverage. One patient had a mild form, which included abdominal discomfort, another patient had a moderate case, which included nausea, vomiting, and acidosis, and the other patient had severe acidosis and altered mentality and visual dysfunction. Except one case of visual dysfunction, all three patients recovered successfully following medical treatment and hemodialysis.

Clinical Predictors of Cervical Abscess in Adult Emergency Department Patients Presenting a Sore Throat

PURPOSE: To evaluate clinical predictors of cervical abscess in adult patients who present a sore throat. METHODS: We prospectively studied adult patients (18 years of age or older) who presented with a sore throat at one of three hospitals (Chungnam national university hospital, Chungbuk national university hospital, and Konyang university hospital) from June 2010 to June 2011. The enrolled patients received a neck computed tomography scan, and their clinical manifestations were investigated. We evaluated several clinical variables in order to predict the existence of cervical abscess by use of multiple logistic regression analysis, and assessed the ability of the results of these variables to accurately diagnose cervical abscess using a receiver operating characteristic curve. RESULTS: A total of 109 patients were enrolled in this study. We identified two clinical variables (swelling and voice change) useful in predicting the existence of cervical abscess, and the AUC acquired by adding the scores of the two clinical factors was 0.89 (p<0.01). The sensitivity and specificity of these clinical factors to predict cervical abscess were 0.96 and 0.69 when the cut off value was determined to be 2. CONCLUSION: Two clinical factors (swelling and voice change) were useful in predicting the appearance of cervical abscesses. Consideration should be made for the need for incision and drainage of a cervical abscess if a patient presents swelling, or swelling and voice change.

Clinical Predictors of Cervical Abscess in Adult Emergency Department Patients Presenting a Sore Throat

PURPOSE: To evaluate clinical predictors of cervical abscess in adult patients who present a sore throat. METHODS: We prospectively studied adult patients (18 years of age or older) who presented with a sore throat at one of three hospitals (Chungnam national university hospital, Chungbuk national university hospital, and Konyang university hospital) from June 2010 to June 2011. The enrolled patients received a neck computed tomography scan, and their clinical manifestations were investigated. We evaluated several clinical variables in order to predict the existence of cervical abscess by use of multiple logistic regression analysis, and assessed the ability of the results of these variables to accurately diagnose cervical abscess using a receiver operating characteristic curve. RESULTS: A total of 109 patients were enrolled in this study. We identified two clinical variables (swelling and voice change) useful in predicting the existence of cervical abscess, and the AUC acquired by adding the scores of the two clinical factors was 0.89 (p<0.01). The sensitivity and specificity of these clinical factors to predict cervical abscess were 0.96 and 0.69 when the cut off value was determined to be 2. CONCLUSION: Two clinical factors (swelling and voice change) were useful in predicting the appearance of cervical abscesses. Consideration should be made for the need for incision and drainage of a cervical abscess if a patient presents swelling, or swelling and voice change.

The Neuroprotective Effect of delta-opioid Receptor Stimulation with D-Ala2, D-Leu5 Enkephalin Against Ischemic Neuronal Injury

PURPOSE: Oxygen is indispensable for survival and aerobic metabolism in all mammalian cells. Inadequate oxygen triggers a multifaceted cellular response negatively impacting important physiological functions which are observed in clinical diseases such as stroke, drowning, cardiac arrest, hazardous gas poisoning, myocardial infarction and vascular dementia. In this study, we investigated the neuroprotective effect of a synthetic delta-opioid agonist, [D-Ala2, D-Leu5] enkephalin (DADLE), and its role in ischemic neuronal injury. METHODS: This experiment was conducted in vitro using a primary culture of rat cortical neurons. Ischemia induction was performed using a hypoxic chamber. To test the degree of neuronal viability, as protected by delta-opioid stimulation with DADLE under ischemia, we used three independent approaches including a lactate dehydrogenase assay, MTT assay, and an immunofluorescent staining assay for viable cells. In addition, the gene expressions of caspase-3 and heat shock protein 70 were analyzed using real-time PCR. RESULTS: Incubation of the cortical neurons with DADLE protected them from ischemia-induced cytotoxicity, as observed by all three independent viability assays. Also, we found that its neuroprotective effect might be related with suppression of the caspase-3 gene. CONCLUSION: The results of this study suggested that DADLE exhibits a neuroprotective effect against ischemia-induced neuronal cell death.

The Neuroprotective Effect of delta-opioid Receptor Stimulation with D-Ala2, D-Leu5 Enkephalin Against Ischemic Neuronal Injury

PURPOSE: Oxygen is indispensable for survival and aerobic metabolism in all mammalian cells. Inadequate oxygen triggers a multifaceted cellular response negatively impacting important physiological functions which are observed in clinical diseases such as stroke, drowning, cardiac arrest, hazardous gas poisoning, myocardial infarction and vascular dementia. In this study, we investigated the neuroprotective effect of a synthetic delta-opioid agonist, [D-Ala2, D-Leu5] enkephalin (DADLE), and its role in ischemic neuronal injury. METHODS: This experiment was conducted in vitro using a primary culture of rat cortical neurons. Ischemia induction was performed using a hypoxic chamber. To test the degree of neuronal viability, as protected by delta-opioid stimulation with DADLE under ischemia, we used three independent approaches including a lactate dehydrogenase assay, MTT assay, and an immunofluorescent staining assay for viable cells. In addition, the gene expressions of caspase-3 and heat shock protein 70 were analyzed using real-time PCR. RESULTS: Incubation of the cortical neurons with DADLE protected them from ischemia-induced cytotoxicity, as observed by all three independent viability assays. Also, we found that its neuroprotective effect might be related with suppression of the caspase-3 gene. CONCLUSION: The results of this study suggested that DADLE exhibits a neuroprotective effect against ischemia-induced neuronal cell death.

Acute Respiratory Failure and Hypotension with Acute Imidacloprid Poisoning

Imidacloprid belongs to a relatively new class of insecticides, chloronicotinyl neonicotinoid compounds that are agonists of insect postsynaptic nicotinic acetylcholine receptors (nAChrs). Imidacloprid insecticides have been believed to be of low toxicity to humans causing only mild symptoms such as vomiting, abdominal pain and headache in the majority of cases due to nicotinic receptor resistance. Despite the original belief that imidacloprid has low mammalian toxicity, evidence is increasing evidence that imidacloprid may cause heart, kidney and other organ damages and even death, besides gastrointestinal irritation and neurological symptoms. We report a case of acute ingestion of an imidacloprid-containing insecticide. Clinical manifestrations included hypotension and respiratory failure. A literature review is included.

Spinal Schwannoma in a Patient with Chronic Right Flank Pain Presenting at an Emergency Department

Many patients with flank pain present to an emergency department (ED). The differential diagnosis of flank pain is difficult, especially in the case of women. Spinal schwannoma (SS) is one of the most common intraduralextramedullary spinal tumors. SS can present as symmetrical pain in the back or pain that radiates to both the lower extremities, which is commonly observed in clinical practice. We report the case of a 47-year-old woman with pain in her right flank area that began 2 months before she presented to our ED. Abdominal contrast computed tomography was performed to identify an intra-abdominal cause for the pain. Incidentally, we found a schwannoma, a spinal cord tumor, at the 10th thoracic vertebrae level. The pain disappeared after the tumor was surgically resected. On the basis of our findings, we conclude that the pain in her right flank pain area was caused by the SS.

Continuous hypoxia attenuates paraquat-induced cytotoxicity in the human A549 lung carcinoma cell line

Paraquat (1,1'-dimethyl-4,4'-bipyridinium dichloride; PQ), an effective and widely used herbicide, was commercially introduced in 1962. It is reduced by the electron donor NADPH, and then reduced PQ transfers the electrons to molecular oxygen, resulting in the production of reactive oxygen species (ROS), which are related to cellular toxicity. However, the influence of continuous hypoxia on PQ-induced ROS production has not fully been investigated. We evaluated in vitro the protective effect of continuous hypoxia on PQ-induced cytotoxicity in the human carcinogenic alveolar basal epithelial cell line (A549 cells) by using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assay and live and dead assay, and by measuring lactate dehydrogenase (LDH) release. To elucidate the mechanism underlying this effect, we monitored the immunofluorescence of intracellular ROS and measured malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione peroxidase (GPx) activities. Continuous hypoxia protected the A549 cells from PQ-induced cytotoxicity. Continuous hypoxia for a period of 24 h significantly reduced intracellular ROS, decreased MDA concentration in the supernatant, and normalized SOD and GPx activities. Continuous hypoxia attenuated PQ-induced cell toxicity in A549 cells. This protective effect might be attributable to the suppression of PQ-induced ROS generation.

Clinical Manifestations of Persistent Smear Positive and Culture Negative Sputum Tests 5 Months after First-line Anti-Tuberculous Chemotherapy / 결핵및호흡기질환

BACKGROUND: It is not known with certainty whether patients with persistently positive sputum smear results who have also had negative sputum culture results require prolongation of treatment for tuberculosis in order to avoid an increased risk of eventual relapse. The purpose of the present study was to retrospectively describe the treatment characteristics and evaluate the appropriate duration of treatment in these patients. METHODS: Sixty of 69 patients with sputum smear positive and culture negative tests at 5 months after first line anti-tuberculous chemotherapy from 2002 to 2003 were retrospectively analyzed. Exclusion criteria included incomplete treatment or resistance to rifampicin or two additional antibiotics, as determined by a drug susceptibility test (DST). RESULTS: Smear conversion of the study subjects was observed after 8.3+/-2.3 months treatment, and the patients were culture negative after 2.0+/-0.8 months. The relapse rates of the study subjects were 3.8, 10.0, and 25.8% after 1, 2, and 5 years of anti-tuberculosis chemotherapy, respectively. The relapse rates were not significantly affected by a series of risk factors such as age, sex, presence of diabetes, a sputum culture examination after 2 months treatment, previous treatment history, chest radiograph, and duration of the treatment (p>0.05). CONCLUSION: Regimen change is not required for patients with persistent smear positive but culture negative tests in the fifth month for first line antituberculous treatment. However, a further study will be needed to clarify the high relapse rate in this specific group of patients.

Effect of Treatment in Patient with Rhabdomyolysis: Comparison between Single Hydration and Hydration with Urine Alkalinization

PURPOSE: Urine alkalinization is commonly used to treat rhabdomyolysis and to prevent the rapid progression of rhabdomyolysis into acute renal failure. However, there are no prospective studies on the beneficial effect of urine alkalinization on rhabdomyolysis. We prospectively examined whether fluid hydration with urine alkalinization treatment would be more effective than single hydration treatment in treating rhabdomyolysis and preventing acute renal failure in the emergency department. METHODS: We performed a prospective randomized trial with fifty-eight patients who were diagnosed with rhabdomyolysis. Thirty-five patients were treated with crystalloid alone, while the others were treated with crystalloid mixed with sodium bicarbonates. Creatine phosphokinase (CPK) and creatinine levels were checked every 4 hours for the first 24 hours and then checked every 8 hours thereafter. Data collected included "peak CPK time"(time from the start of treatment to achievement of the maximal CPK value), increasing and decreasing rate of CPK, and whether acute renal failure developed. RESULTS: Patient's age, sex, initial CPK concentrations, and initial creatinine concentrations were not statistically different between the single hydration treatment group and the hydration with urine alkalinization group. Mean time to peak CPK was 10.2+/-13.7 hours in the single hydration group and 8.1+/-10.2 hours in the hydration with urine alkalinization group. Neither the time to peak CPK nor the CPK change rates was statistically different between the two groups (p=0.547, p=0.176, p=0.696). CONCLUSION: Hydration with urine alkalinization as a treatment for rhabdomyolysis and prevention of acute renal failure did not improve patient results over single hydration treatment.