Nebulized salbutamol for asthma: effects on serum potassium and phosphate levels at the 60 min.

OBJECTIVE: We conducted this prospective study to expand available information in relation to serum phosphate levels in treatment of acute asthma. A ß-adrenergic agonist, salbutamol, was used for this purpose. MATERIAL AND METHODS: Twenty-six patients who met the inclusion criteria as; age over 16 years, asthma history, and an acute exacerbation were included. Serum blood urea nitrogen, creatinine, glucose were within normal limits in all the patients. None of the patients were on chronic theophylline therapy. Baseline serum phosphate and potassium levels were measured. Nebulized salbutamol (2.5mg) was used three times at every hour. After 60 min, serum phosphate and potassium levels were measured. RESULTS: Serum phosphate levels decreased from 3.7±0.9 mg/dL (baseline) to 3.6±0.9 mg/dL at 60 min. This decrease was not statistically significant (p=0.373). Serum potassium levels decreased significantly (p<0.001) from 4.6±0.7 mmol/L (baseline) to 4.3±0.7 mmol/L (60 min). CONCLUSION: Administration of nebulized salbutamol during the emergency treatment of acute exacerbation of asthma is not associated with a statistical decrease in serum phosphate. There was significant hypokalemia. This study indicates that a further study is needed to elucidate the clinical significance of nebulized salbutamol on serum phosphate.

Gastric lavage with normal saline: effects on serum electrolytes.

OBJECTIVE: The aim of this study is to determine the intensity of changes in serum calcium, ionized calcium, and magnesium levels after gastric lavage with normal saline in patients with amitriptyline intoxication. MATERIAL AND METHODS: In this study, thirty patients older than 16 years with the history of intoxication with amitriptyline were included. After the baseline serum calcium, ionized calcium, and magnesium levels had been measured, gastric lavage with normal saline was performed. Serum levels of calcium, ionized calcium, and magnesium were monitored at 15 minutes, 6 hours, and 12 hours. RESULTS: Serum calcium levels decreased significantly from 9.32 +/- 0.47 mg/dL to 8.40 +/- 0.61 mg/dL (15 minutes, p < 0.001), 8.92 +/- 0.54 mg/dL (6 hours, p < 0.001), and 8.93 +/- 0.54 mg/dL (12 hours, p < 0.001). Serum ionized calcium levels decreased significantly from 1.26 +/- 0.10 mmol/L to 1.20 +/- 0.07 mmol/L (15 minutes, p = 0.004), 1.21 +/- 0.08 mmol/L (6 hours, p = 0.024), and 1.21 +/- 0.08 mmol/L (12 hours, p = 0.034). Serum magnesium levels decreased from 2.41 +/- 0.43 mg/dL to 2.04 +/- 0.25 mg/dL (15 minutes, p < 0.001), 2.14 +/- 0.26 mg/dL (6 hours, p < 0.001), and 2.16 +/- 0.25 mg/dL (12 hours, p < 0.001). CONCLUSION: Our study demonstrated that gastric lavage with normal saline can cause a statistically significant decrease in serum calcium, ionized calcium, and magnesium (Fig. 4, Ref. 8).

Etiological and demographical characteristics of acute adult poisoning in Adana, Turkey.

The objective of this study is to define the etiological and demographical characteristics of the patients applying to the emergency department in Faculty of Medicine, Cukurova University because of poisoning. This retrospective study was carried out by examining the records of 491 people who applied to the main emergency department in Faculty of Medicine, Cukurova University, with the complaint of poisoning between January 1, 2004 and December 31, 2004. It was determined that the reason why 491 of 20 817 persons (2.4%) applied during this term was because of poisoning: 159 (32.4%) of such patients were male and 332 of them (67.6%) were female. It was found that the average age of men was 27.1 +/- 10.5 years and that of women was 24.4 +/- 9.5 years (P = 0.005); 427 of poisoning cases (87.0%) happened intentionally as suicide attempts and 64 of them (13.0%) were accidental. The rate of suicide-purposed poisoning was higher in women and the rate of unintentional poisoning was higher in men (P +/- 0.001). The drugs were accountable for 71.1% of all poisoning cases and the pesticides were accountable for 18.9% of such cases. Poisonings increase during summers. The mortality rate in poisonings was found as 0.8%. The drugs and pesticides in Ckurova region constitute 90.0% of all poisoning cases. The mortality rate in poisoning will be decreased by training the physicians employed in the emergency department about poisoning by drugs and pesticides.

Ruptured hydatid cyst following minimal trauma and few signs on presentation.

Hydatid disease is a parasitic infection caused by Echinococcus granulosus characterised by cyst formation in any organ, although the liver is the most commonly involved. Hydatid cysts can rupture either spontaneously or following trauma. Surgical treatment can be life-saving. This paper reports the atypical presentation of a young girl admitted to the emergency department. She presented with pain on her palms due to falling down a few steps. Because of the rebound tenderness on the right upper quadrant of her abdomen on physical examination, bedside ultrasonography was performed to identify the underlying cause, and promptly revealed a 62 x 72 mm lobular cyst on the right lobe of the liver with free fluid in the subcapsular area. Shortly afterwards, urticaria developed. Fluid resuscitation, methylprednisolone and diphenylhydramine were administered intravenously. Afterwards she was taken to the operation room for unroofing, drainage and capitonage. In conclusion, primary care and emergency physicians should perform a complete physical examination on all admitted patients with vague symptoms and a high index of suspicion for a ruptured hydatid cyst, even following trivial trauma, especially in endemic regions.

Different renal pathologies associated with hypothyroidism.

Hypothyroidism may coexist with different renal pathologies. This article describes three cases with hypothyroidism and different renal pathologies. The first patient had hypothyroidism and nephrotic syndrome due to renal amyloidosis and Muckle-Wells Syndrome (MWS). The second patient had hypothyroidism and associated membranoproliferative glomerulonephritis (MPGN). The third patient with hypothyroidism had obstructive acute renal failure caused by retroperitoneal fibrosis.

Intoxication with 100 grams of mercury: a case report and importance of supportive therapy.

Nearly everyone is at risk of acute and chronic toxic exposure to hazardous substances in the ambient environment. Morbidity and mortality following an overdose are reduced by intensive appropriate supportive therapy. A well-trained medical team is required for the administration of intensive clinical care, which includes enough equipment for monitoring the patient's status. In this paper we present a student who, after attending a dentist faculty, ingested 100 grams of pure inorganic mercury in order to commit suicide and was treated with forced diuresis, whole bowel irrigation, and D-penicillamine. The latter was found following 48 hours of therapy and only used for 4 days because of lack of availability of other antidotes for mercury in our city.

A case of child abuse: haloperidol poisoning of a child caused by his mother.

This presentation focused on a hyperactive child admitted to the emergency department because of ataxia and imbalance. It was later discovered that the child had been abused by his mother. In cases where there is conflict between the clinical findings, the patient and the family's history in a clinical state which cannot be explained satisfactorily by the medical staff, the need for taking the history again from other relatives whilst taking into account the parents' physiological well-being, is time well spent.

Life-threatening uvular angioedema caused by Ecbalium elaterium.

Ecbalium elaterium, known as the wild or squirting cucumber, is a hairy perennial herbaceous vine of the Cucurbitaceae family, endemic to the Mediterranean region. All parts of the plant are toxic, particularly the gherkin-like fruits. It is frequently used in the treatment of sinusitis by nasal aspiration in some parts of the Mediterranean. The studies regarding to Ecbalium elaterium, argue that it has an anti-inflammatory characteristic. Two cases of uvular oedema have been ascribed to the undiluted use of this substance. Since they can threaten life, similar cases arising with the improper use of herbals should not be ignored in the emergency department. In this paper we present a life-threatening uvular angioedema caused by nasal aspiration of undiluted juice of squirting cucumber.

Comparison of blood gas and acid-base measurements in arterial and venous blood samples in patients with uremic acidosis and diabetic ketoacidosis in the emergency room.

BACKGROUND/AIMS: The aim of this study was to examine a plausible correlation between venous and arterial blood gas values in acidotic patients with chronic uremia or diabetic ketoacidosis (DKA). METHODS: A total of 152 arterial and 152 venous blood samples from uremic patients (n = 100), DKA patients (n = 21) and healthy controls (n = 31) were analyzed for measurements of blood gas and acid-base status. RESULTS: The means of arterial and venous pH, and arterial and venous HCO(-)(3) values for the uremic patients were 7. 17 +/- 0.14, 7.13 +/- 0.14, 10.13 +/- 4.26 and 11.86 +/- 4.23 mmol/l, respectively. The respective mean differences between arterial and venous pH values and arterial and venous HCO(-)(3) values were 0.04 +/- 0.02 and -1.72 +/- 0.42 mmol/l, respectively, for these patients. The means of the laboratory findings of DKA patients were arterial pH, 7.15 +/- 0.15; venous pH, 7.10 +/- 0.15; arterial HCO(-)(3), 8. 57 +/- 5.71 mmol/l and venous HCO(-)(3), 10.46 +/- 5.73 mmol/l. The respective mean differences between arterial and venous pH and arterial and venous HCO(-)(3) for this group were calculated to be 0. 05 +/- 0.01 and -1.88 +/- 0.41 mmol/l. In the healthy controls, the means of arterial and venous pH, and arterial and venous HCO(-)(3) values were 7.39 +/- 0.02, 7.34 +/- 0.02, 24.91 +/- 0.82 and 26.57 +/- 0.83 mmol/l, respectively. For the healthy controls the mean differences between the respective values in arterial and venous pH, and arterial and venous HCO(-)(3) were 0.05 +/- 0.01 and -1.66 +/- 0. 58 mmol/l. Although in healthy controls the correlation between arterial and venous pH values (r(2): 0.595) and arterial and venous HCO(-)(3) values (r(2): 0.552) were moderate, these correlations were significantly increased in both the acidotic patient group (r(2): 0.979 and 0.990) and the DKA group (r(2): 0.989 and 0.995) CONCLUSION: A venous blood sample can be used to evaluate the acid-base status in uremic and DKA patients.