ABSTRACT
We report the case of a male patient with severe metabolic acidosis and heart failure caused by thiamine deficiency. He was admitted in August 1998 to the Tokai University Oiso Hospital because of severe dyspnea. The patient was diagnosed with heart failure and metabolic acidosis of unknown causes based on arterial blood gas analysis, chest x ray, and ultrasonic echocardiographic examinations. Our previous experience in treating a patient with thiamine deficiency caused by total parenteral nutrition without thiamine supplementation suggested that this patient was deficient in thiamine. The serum thiamine level was low and the lactate level was high. After intravenous administration of thiamine, the acidosis and heart failure disappeared. Dietary analysis showed that thiamine intake was low (0.32 mg/1000 kcal/d). Thiamine deficiency should be included in the differential diagnosis when encountering cases of heart failure with severe metabolic acidosis, even in developed countries.
Subject(s)
Acidosis, Lactic/etiology , Heart Failure/etiology , Parenteral Nutrition, Total/adverse effects , Thiamine Deficiency/complications , Acidosis , Acidosis, Lactic/metabolism , Aged , Diagnosis, Differential , Heart Failure/metabolism , Humans , Male , Thiamine/administration & dosage , Thiamine Deficiency/diagnosisSubject(s)
Graft Rejection/epidemiology , Graft Survival/physiology , Kidney Transplantation/physiology , Postoperative Complications/epidemiology , Acute Disease , Adolescent , Adult , Aged , Cadaver , Child , Female , Heart Arrest , Humans , Kidney Failure, Chronic/etiology , Kidney Failure, Chronic/surgery , Kidney Transplantation/mortality , Kidney Transplantation/pathology , Kidney Tubular Necrosis, Acute/epidemiology , Male , Middle Aged , Prognosis , Retrospective Studies , Survival Rate , Tissue DonorsSubject(s)
Antilymphocyte Serum/therapeutic use , Graft Survival , Immunosuppression Therapy/methods , Kidney Neoplasms/immunology , Muromonab-CD3/therapeutic use , Azathioprine/therapeutic use , Chi-Square Distribution , Cyclosporine/therapeutic use , Cytomegalovirus Infections/epidemiology , Humans , Immunization , Immunosuppressive Agents/therapeutic use , Kidney Neoplasms/mortality , Methylprednisolone/therapeutic use , Postoperative Complications , Prednisolone/therapeutic use , Retrospective Studies , Survival Rate , Time FactorsSubject(s)
Cytomegalovirus Infections/epidemiology , Diabetes Mellitus, Type 1/surgery , Diabetic Nephropathies/surgery , Kidney Failure, Chronic/surgery , Kidney Transplantation/methods , Pancreas Transplantation/methods , Postoperative Complications/epidemiology , Humans , Pancreas Transplantation/physiology , Time Factors , Urinary Bladder/surgeryABSTRACT
A case of a 73-year-old woman with acute renal failure due to toxic shock syndrome (TSS) is reported. The patient was admitted to our hospital with the complaints of high fever, disturbance of consciousness and shock. Laboratory findings on admission were; CRP 25.11 mg/dl, WBC 35000/ microl, Plt 1.6 x 10(4)/ microl, GOT 155 U/l, GPT 65 U/l, CPK 4202 U/l (CPK-MM 96%), BUN 123 mg/dl and SCr 7.0 mg/dl. Because of anuria, hemodialysis was performed. This patient was treated with dopamine, methyl prednisolone (MP), frozen fresh plasma, AT III, antibiotics, and platelet transfusion. The bacterial cultures of blood and cerebrospinal fluid were negative, but MRSA was isolated subsequently from the pharynx and vagina. We investigated the production of toxic shock syndrome toxin 1 (TSST-1) and staphylococcal enterotoxins (SE). The isolated MRSA produced TSST-1, SEB and SEC. Accordingly, we made the diagnosis of TSS. After improvement of acute renal failure and the patient's general condition, MRSA persisted and TSST-1 was still found in the patient's blood. Finally we eradicated the MRSA and TSST-1 after administration of ciprofloxacin hydrochloride (CPFX) and Rifampicin (RFP).
