[CME: Ethylene Glycol Intoxication]. / CME: Ethylenglykol-Intoxikation.

CME: Ethylene Glycol Intoxication Abstract. Ethylene glycol is a sweet-tasting alcohol used in common antifreeze and other industrial solutions. Without appropriate therapy, intoxication with ethylene glycol can result in severe metabolic acidosis, acute renal failure, and in death. After gastrointestinal resorption, hepatic metabolism starts with oxidation by alcohol dehydrogenase and results in severe anion gap metabolic acidosis. Other metabolic products are calcium oxalate crystals, which can deposit in several tissues like the kidneys and lead to acute tubular necrosis with reversible renal failure. The crucial therapeutic step is rapid inhibition of alcohol dehydrogenase with fomepizole or ethanol to avoid the formation of toxic metabolites. Additionally, haemodialysis is the most effective way to eliminate ethylene glycol as well as its toxic metabolites. If therapy is initiated rapidly, prognosis is favorable.

Growth of arachnoid cysts in patients with autosomal dominant polycystic kidney disease: serial imaging and clinical relevance.

BACKGROUND: Autosomal dominant polycystic kidney disease (ADPKD) is an inherited disorder that results in the growth of cysts in the kidneys and other organs. Multisystemic involvement is common including affection of the central nervous system with cerebral aneurysms and arachnoid cysts. METHODS: This is a prospective cohort study to investigate the prevalence and growth rate of arachnoid cysts in ADPKD patients. Participants enrolled in the SUISSE ADPKD cohort were offered cranial imaging for the detection of intracranial alterations. In the case of identified arachnoid cysts, patients were suggested to undergo follow-up imaging to assess the growth rate of the cysts. Volume of arachnoid cysts at the baseline and at follow-up visits was assessed by manual segmentation on a dedicated workstation. RESULTS: A total of 109 ADPKD patients agreed to undergo cranial imaging. In 14 (12.8%) patients (9 males and 5 females), 18 singular arachnoid cysts were identified. The baseline volumes of individual cysts ranged from 1.8 to 337.6 cm(3). During a mean follow-up period of 24 months, the volume changes of 12 individual arachnoid cysts of nine patients ranged from -3.1 to 3.7 cm(3). Cystic lesions were mostly localized in the middle fossa. All affected patients were clinically asymptomatic. CONCLUSIONS: We found a higher prevalence of arachnoid cysts in ADPKD patients with more advanced disease. There was a large variability in size and growth. These arachnoid cysts were clinically silent and their growth pattern was subtle and unpredictable, in contrast to the much more foreseeable growth of the renal cysts.

Predicting outcomes in critically ill patients with acute kidney injury undergoing intermittent hemodialysis--a retrospective cohort analysis.

PURPOSE: Despite advances in the management of critically ill patients with acute kidney injury (AKI), the prognosis is poor. The evidence base on risk factors for poor outcomes in these patients is scarce. Our aim was to identify predictors of outcome in AKI patients undergoing intermittent hemodialysis (IHD). METHODS: We retrospectively analyzed patient records from consecutive, critically ill patients with AKI treated with IHD in one teaching secondary care hospital from 2002 to 2006. We used multivariate Cox proportional hazard regression analysis to identify predictors of mortality, hemodynamical instability during hemodialysis and failing renal recovery. RESULTS: Totally, we included 39 patients with a mean APACHE II score of 20.1 (SD 7.5) who had an average of 5.1 +/- 4.8 hemodialysis sessions. All-cause mortality was 35.9% (14/39 patients). In multivariate analysis, pre-existing cardiac co-morbidity (HR 1.92 [0.58-6.47]), metabolic acidosis (2.40 [0-74-7.74]) and presence of ARDS (1.83 [0.52-6.46]) were the strongest predictors. 7 patients (18%) sustained new hemodynamic instability during hemodialysis, for which ARDS (6.42 [0.64-64.03]) was a strong predictor. Among survivors, 20 patients (80%) had partial or complete renal recovery. Preexisting renal insufficiency (3.13 [0.34-29.13]) and high net ultrafiltration quantities (3.30 [0.40-26.90]) were the strongest predictors for failing renal recovery. As a consequence of the small samples size none of the associations was statistically significant. CONCLUSIONS: Presence of ARDS and high net ultrafiltration rates seem to represent key factors affecting prognosis in patients with AKI undergoing IHD. Targeting these risk factors may improve the poor prognosis of these patients.