Use of continuous renal replacement therapy in salicylate toxicity: A case report and review of the literature.

OBJECTIVE: To report a case of salicylate toxicity treated with continuous venovenous hemodiafiltration (CVVHDF) and review the literature regarding the use of continuous renal replacement therapy (CRRT) for salicylate toxicity. CASE: A 16-year-old male presented after ingesting 1901 mg/kg of enteric coated aspirin. Salicylate level was 92 mg/dl 4 h after ingestion. Sequele included seizure, acute kidney injury, pulmonary edema, and prolonged QTc. He received 5.5 h of hemodialysis followed by CVVHDF to continue to augment clearance. His aspirin level fell to 37.4 mg/dl after HD and then to 11.3 mg/dl after nearly 10 h of CVVHDF. DISCUSSION: Cited reasons for the use of CRRT for salicylate toxicity primarily have been hypotension or desire for ongoing augmentation of salicylate clearance in the setting of multiorgan toxicity. CVVHDF may have a role in severe salicylate toxicity to enhance ongoing clearance after an initial round of HD in order to prevent significant rebound.

Paragonimus kellicotti flukes in Missouri, USA.

Paragonimiasis is an infection caused by lung flukes of the genus Paragonimus. In Asia, P. westermani infections are relatively common because of dietary practices. However, in North America, cases of paragonimiasis, which are caused by P. kellicotti flukes, are rare. Only 7 autochthonous cases of paragonimiasis were reported during 1968-2008. In 2009, we reported 3 new case-patients with paragonimiasis who had been seen at our medical center over an 18-month period. Six additional case-patients were identified in St. Louis, Missouri, USA, and treated at Washington University-affiliated health centers in 2009-2010. We report detailed descriptions of these case-patients, which includes unusual clinical manifestations. We also describe public health interventions that were undertaken to inform the general public and physicians about the disease and its mode of transmission.