[Diagnosis and therapy of ethylene glycol poisoning--analysis of 20 patients]. / Diagnostika a liecba otravy etylénglykolom--rozbor 20 chorých.

The paper presents a retrospective analysis of 20 patients with acute ethylene glycol intoxication who were treated from 1972 to 2001 in the Dialysis Centre of the IVth Medical Clinic and from 1997 at the L. Pasteur Nephrological Clinic of the Faculty Hospital and Safarík Medical Faculty in Kosice. The ethylene glycol intoxication was manifested by neurological symptoms, extreme metabolic acidosis, acute toxic hepatitis and acute renal failure. Laboratory examination revealed oxaluria in 17 patients and leukocytosis in all patients. Percutaneous renal biopsy was made for differential diagnostic or forensic reasons in the convalescent stage of acute renal failure in 6 patients. In the treatment of ethylene glycol intoxication the authors used ethyl alcohol as an antidote: in the first four patients administered by the i.v. route, in the remaining patients in dialyzation solution. Extreme metabolic acidosis improved in 15 patients after bicarbonate haemodialysis. Concomitant application of haemoperfusion over active charcoal during the first haemodialysis in four patients led to a potentiated effect on the uraemic syndrome. Conservative and extracorporeal elimination treatment of ethylene glycol intoxication succeeded in 16 patients (80%). According to the authors' experience early and fractionated application of bicarbonate haemodialysis with 100 mg% concentration of ethylalcohol in the dialysis solution is the method of choice in the treatment of ethylene glycol intoxication.

[Hemoperfusion in mushroom poisoning. Clinical analysis of 58 patients]. / Pouzitie hemoperfúzie pri otrave hubami. Klinický rozbor 58 chorých.

Fifty-eight patients with acute mushroom poisoning--Amanita phalloides were treated. Among them were 28 children and 2 adolescents. From all the patients mean age was 30.5 years, 31 patients were in hepatic coma. All patients undergone conservative treatment and haemoperfusion. The mean time from beginning of acute poisoning to the first haemoperfusion was 61 hours. Ninety-eight haemoperfusions were performed, from this number 26 using Amberlite XAD-2. Seventeen simultaneous or subsequent haemodialyses and 12 plasmaphereses were performed. Mortality occurred in 20 patients (34.5%). Survival of patients depended on the amount of ingested mushroom, on the early admission of patients to dialysis centre and on the beginning of extracorporeal treatment until the period of 24 hours after acute poisoning.

[Use of hemoperfusion and cholinesterase in acute poisoning with organophosphate cholinesterase inhibitors--clinical analysis of 50 patients]. / Pouzitie hemoperfúzie a cholínesterázy pri akútnej otrave orgánofosforovými inhibítormi cholínesteráz--klinický rozbor 50 chorých.

The authors present a retrospective analysis of 50 patients with acute intoxication with various organophosphate cholinesterase inhibitors who were treated in the course of 8 years by comprehensive conservative and extracorporeal elimination treatment. The mean age of the patients was 38 years. During therapy conservative treatment was used (gastric lavage, repeated lavage of the large intestine, forced diuresis, TMB-4 fusion through activated carbon, amberlite XAD-2 and XAD-4, haemodialysis). A total of 63 haemoperfusions and 15 simultaneous haemoperfusions with haemodialysis were performed. Treatment was successful in 92%. The results of treatment depended on early attendance of the patient in the dialyzation centre, on the onset of intense comprehensive treatment and the concurrent presence of other diseases.

[Use of a computer for obtaining optimal serum sodium values at the end of hemodialysis]. / Pouzitie pocítaca na dosiahnutie optimálnej hodnoty sodíka v sére na konci hemodialýzy.

The authors made 41 haemodialyses in 21 patients in the course of a long-term dialyzation programme, using a dialyzation monitor connected with a computer. The aim of the investigation was to achieve at the end of the six-hour haemodialysis the optimal serum sodium value of 142 mmol/l, using different ultrafiltrations (1000, 2000 and 3000 ml/6 hours). It was revealed that to obtain the optimal serum sodium level it was necessary to use in the dialyzation solution a sodium concentration of 144.9 +/- 0.2 mmol/l. The water transport from the intracellular to the extracellular fluid was typical for the distribution of total body water, regardless of the volume of ultrafiltration. The amount of removed sodium during haemodialysis depended on the sodium concentration in the dialyzation fluid and on the ultrafiltration volume. The values of the volume and clearance of sodium-free water depended on the amount of sodium eliminated into the dialyzation solution.

[The effect of sodium levels in dialysis solutions on the distribution of total body water during hemodialysis]. / Vplyv koncentrácie sodíka v dialyzacnom roztoku na distribúciu celkovej telovej vody pocas hemodialýzy.

Thirty-seven haemodialyses with ultrafiltration were performed (3000 ml/6 hours). using three sodium concentrations (140, 145 and 150 mmol/l) in the dialysate solution in 16 hyperhydrated patients during a long-term dialysis program. The amount of eliminated sodium during haemodialysis depended on the sodium concentration in the dialysate solution. The reduction of the volume of total body water corresponded to ultrafiltration. When a sodium concentration of 150 mmol/l in the dialysate solution was used, the smallest diminution of extracellular fluid and greatest diminution of intracellular fluid was observed. At the same time the greatest transport of water from the intracellular into the extracellular fluid was recorded. A sodium concentration of 145 and 150 mmol/l in the dialysate solution gave rise to positive values of sodium-free water and of sodium-free water clearance. Sodium-free water and of sodium-free water clearance correlated directly with the sodium concentration in the dialysate solution and inversely with the amount of eliminated sodium. The patients were free from complaints during haemodialyses and no significant blood pressure changes were found. The dialysate solution with the sodium concentrations used is suitable for a long-term dialysis programme; the authors recommend, however, to use individual sodium concentrations, depending on the patient's clinical condition.