Disturbance of consciousness associated with hypophosphatemia in a chronically alcoholic patient.

A 69-year-old man with chronic alcoholism was admitted to our hospital due to disturbance of consciousness and oliguria. Emergency laboratory examination revealed metabolic acidosis, hypoglycemia, hyponatremia, mild liver dysfunction, acute renal failure and rhabdomyolysis. After administration of fluids and nutrients and continuous hemodiafiltration, he recovered from all signs and symptoms except for disturbance of consciousness after 7 days. Since severe hypophosphatemia persisted, we administered adequate phosphates, and then his level of consciousness normalized. We discuss the relationships among alcohol abuse, hypophosphatemia and disturbance of consciousness, and recommend that hypophosphatemia be considered a potential cause of disturbance of consciousness in alcoholic patients.

Acute electrolyte disturbances in coronary sinus during left coronary arteriography in man.

Electrolyte disturbances, particularly reduction of ionized calcium, induced by iodinated contrast media (CM) are important considerations in coronary arteriography. A study was conducted in 24 patients to evaluate the acute electrolyte alterations in the coronary sinus during left coronary arteriography. During left coronary arteriography, coronary sinus blood was withdrawn for measurement of electrolytes. The CM used were diatrizoate, ioxaglate, iohexol, and iopamidol. The hematocrit was decreased moderately by all 4 CM used at 5 s and returned to the control level at 15 s. The level of ionized calcium was decreased by all CM at 5 s. Prolonged reduction of ionic calcium was observed with diatrizoate and ioxaglate at 15 s. The level of potassium was almost unchanged by diatrizoate and ioxaglate in spite of hemodilution, which may lead us to a hypothesis that potassium can be released from the intracellular spaces such as red blood cells and vascular endothelial cells. Thus the depression of left ventricular function might be caused not only by reduction of ionized calcium, but also by a relative increase in the level of serum potassium.

Ionized calcium levels in coronary sinus blood during coronary angiography: effects of four contrast media.

The changes in ionized calcium level in the coronary sinus during coronary angiography were compared for four contrast media (meglumine sodium diatrizoate, iohexol, iopamidol, and meglumine sodium ioxaglate) in 44 subjects. Blood samples were collected before and 5, 15, and 30 seconds after injection of contrast medium into the left coronary artery. The hematocrit and ionized calcium level of each specimen were measured. Meglumine sodium diatrizoate produced the largest changes in hematocrit and ionized calcium level. The time-concentration curve of the hematocrit was similar for all four contrast media, but diatrizoate and ioxaglate produced a prolonged decrease of ionized calcium. The cause of this is not clear, but the phenomenon may be related to differences of ionic status among the contrast media. With respect to maintenance of the ionized calcium level, nonionic low-osmolality contrast medium with added calcium may be preferable for coronary angiography.

Anomalous origin of the left main coronary artery from the right aortic sinus of Valsalva with vasospastic angina.

A case of anomalous origin of the left main trunk of the coronary artery from the right aortic sinus of Valsalva with vasospastic angina is described. Vasospasm was induced in the left main coronary artery by intracoronary administration of ergonovine. To our knowledge, this is the first reported case of vasospastic angina occurring in the presence of the anomalous origin of the left main coronary artery from the right aortic sinus.

Counter measures against death from arrhythmias in acute myocardial infarction: mortality of the disease in a hospital at different periods with changing care systems. Factors of delay in the pre-hospital phase.

The results of treatment of 400 patients with established acute myocardial infarction in a hospital at different periods with changing care systems are described. Significant reduction of death from arrhythmias could be obtained only when an organization with immediate availability of well-trained medical personnel and reliable actual continuous monitoring of electrocardiograms had been established. Components of delay in the pre-hospital phase of acute myocardial infarction were also studied. There were two significant factors in delay: one was delay due to ignorance of patients about the disease, second was the delay after consultation of family doctors until arrival at the CCU. Time is consumed in the latter factor mainly in making of definite diagnosis. The implication of these data in the management of patients with a diagnosis of acute myocardial infarction are discussed.

Unusual mechanism in the initiation of the paroxysmal supraventricular tachycardia in a patient with WPW syndrome.

A heretofore unreported unusual mechanism in the initiation of the paroxysmal supraventricular tachycardia (PSVT) in a patient with WPW (Wolff-Parkinson-White) syndrome was observed using His bundle recordings. The patient initially had some degree of AV conduction disturbance at the level of the AV node. A premature atrial impulse initially activated the ventricle exclusively through the accessory pathway and the same impulse re-excited the ventricle via the AV nodal-His axis after finishing the pure pre-excitation with marked prolongation of the AH and the HV intervals. After finishing this double ventricular response it traversed to the atrium to produce the PSVT.