Intoxicación por sales de hierro como gesto autolítico / Iron salts overdose as a suicide attempt

La intoxicación por hierro puede causar un fracaso multiorgánico que puede llevar a la muerte. Se presenta el caso de un paciente de 21 años que consultó en la unidad de urgencias tras ingerir, conánimo autolítico, 2.100 mg de hierro elemento. Refirió una sintomatología inicial compatible con gastritis. Se constató la presencia de comprimidos radio-opacos en una radiografía simple de abdomen. La concentración de hierro en la sangre se mantuvo aumentada durante las primeras 48 horas, por lo que precisó terapia con de feroxamina. Se revisa el mecanismo fisiopatológico, las manifestaciones clínicas y el tratamiento de la intoxicación por hierro (AU)

Taking an overdose of iron may cause multi-organ failure that can lead to death. We present a case of a 21-yerars old patient, who went to a hospital emergency department after a suicide attempt. He said he had swallowed 2100 mg of iron salts. He complained of some non-specific gastrointestinal symptoms such as stomach-ache. The presence of radio-opaque pills was observed in an abdominal X-ray. His serum iron concentration remained high for 48 hours, requiring deferoxamine treatment. After an observation period he was asymptomatic and is transferred to a hospital ward. We review the physiopathology, clinical manifestation and treatment of iron poisoning (AU)

[Age as predictive factor of mortality in an intensive and intermediate care unit]. / La edad biológica como factor predictor de mortalidad en una unidad de cuidados críticos e intermedios.

INTRODUCTION: Age by itself is not a criterion of biological prognosis. Scores for physiological variables on admission and multiorgan failure are better predictors of mortality. PATIENTS AND METHODS: We performed a retrospective/ prospective observational study from September, 2005 to May, 2007. The following variables were analyzed: age, sex, Acute Physiology and Chronic Health Classification System (APACHE) II, modified APACHE II score (without the variable of age), Sequential Organ Failure Assessment (SOFA) score, length of hospital stay, type of disease and mortality, limitation of therapeutic effort (LTE), Katz index on admission, intensive and intermediate care unit (IICU) mortality and in-hospital mortality. Student's t-test was used to analyze continuous variables. RESULTS: Of the 572 patients admitted to the IICU, we excluded 75 due to transfer to other hospitals, 142 due to direct admission to intermediate care, and 89 due to acute coronary syndrome. Of the 266 remaining patients with medical disease, mortality was higher when the APACHE II score was > 20 (OR = 9.4) and/or the SOFA score was >4 (OR = 15.41) but not when age was 3 76 years (OR = 2.04). Multivariate analysis of these parameters revealed higher mortality in the IICU (P=.01) in patients with a SOFA score > 4 and modified APACHE II score >16, independently of age or the Katz index. In addition to the SOFA and the APACHE II scores, in-hospital mortality was significantly influenced by the Katz index (P=.05). LTE was significantly greater in patients with a Katz index E-G. CONCLUSIONS: Higher SOFA and APACHE II scores predicted higher IICU mortality, regardless of age. LTE was more frequent in patients with a greater degree of dependence.

La edad biológica como factor predictor de mortalidad en una unidad de cuidados críticos e intermedios / Age as predictive factor of mortality in an intensive and intermediate care unit

Introducción: la edad no es por sí misma un criterio de pronóstico biológico. Puntuaciones asociadas a variables fisiológicas al ingreso y al fallo multiorgánico predicen mejor la mortalidad.Pacientes y métodos: estudio observacional, retrospectivo/ prospectivo, desde septiembre de 2005 a mayo/2007. Se analizaron la edad, el sexo, el APACHE II (Acute Physiology and Chronic Health Evaluation), el APACHE II modificado (sin el parámetro de la edad), SOFA (Sequential Organ Failure Assesment), estancia, tipo de afección y mortalidad por patologías, limitacióndel esfuerzo terapéutico (LET), índice de Katz basal, mortalidad en la unidad de cuidados críticos e intermedios (UCCI) e intrahospitalaria. Se realizó la prueba de la t de Student para variables continuas.Resultados: ingresamos a 572 pacientes en la UCCI, de los que excluimos a 75 por traslado a otros hospitales, 142 fueron ingresados directamente en cuidados intermedios y 89 con síndrome coronario agudo. De los 266 pacientes restantes con afección médica, encontramos mayor mortalidad cuando presentaban una puntuación en le APACHE II > 20 (odds ratio [OR] = 9,4) y SOFA > 4 (OR = 15,41), pero no cuando la edad era ≥ 76 años(OR = 2,04). Si realizamos un análisis multivariante de estos parámetros, encontramos mayor mortalidad en la UCCI (p ≤ 0,01) en pacientes con SOFA > 4 y APACHE II modificado > 16, independientemente de la edad o del índice de Katz. Mientras que en la mortalidad intrahospitalaria, además del SOFA y el APACHE II,influía significativamente también el índice de Katz (p < 0,05). La LET fue significativamente mayor en pacientes con índices de Katz E-G.Conclusiones: la mortalidad en la UCCI fue significa-tivamente mayor conforme aumentaban el SOFA y el APACHE II, independientemente de la edad. Encontramos mayor LET en pacientes con mayor grado de dependencia

Introduction: age by itself is not a criterion of biological prognosis. Scores for physiological variables on admission and multiorgan failure are better predictors of mortality.Patients and methods: We performed a retrospective/ prospective observational study from September, 2005 to May, 2007. The following variables were analyzed: age, sex, Acute Physiology and Chronic Health Classification System (APACHE) II, modified APACHE II score (without the variable of age), Sequential Organ Failure Assessment (SOFA) score, length of hospital stay, type ofdisease and mortality, limitation of therapeutic effort (LTE), Katz index on admission, intensive and intermediate care unit (IICU) mortality and in-hospital mortality. Student’s t-test was used to analyze continuous variables.Results: of the 572 patients admitted to the IICU, we excluded 75 due to transfer to other hospitals, 142 due to direct admission to intermediate care, and 89 due to acute coronary syndrome. Of the 266 remaining patients with medical disease, mortality was higher when the APACHE II score was > 20 (OR = 9.4) and/or theSOFA score was >4 (OR = 15.41) but not when age was ≥ 76years (OR = 2.04). Multivariate analysis of these parameters revealed higher mortality in the IICU (P=.01) in patients with a SOFA score > 4 and modified APACHE II score >16, independently of age or the Katz index. In addition to the SOFA and the APACHE II scores, in-hospital mortality was significantly influenced by theKatz index (P=.05). LTE was significantly greater in patients with a Katz index E-G.Conclusions: higher SOFA and APACHE II scores predictedhigher IICU mortality, regardless of age. LTE was more frequent in patients with a greater degree of dependence (AU)

Hipoglucemia en Urgencias / Hypoglycaemia in the ER

La acidosis láctica es un trastorno ácido-básico consecutivo a la acumulación de ácido láctico. Entre los fármacos que se asocian a acidosis láctica están descritos en la literatura las biguanidas, y dentro de éstas la metformina. Se presenta el caso de una mujer de 71 años, derivada al Servicio de Urgencias del Hospital de Hellín por el 112 a consecuencia de pérdida de conciencia en su domicilio de minutos de duración, objetivándose una glucemia capilar de 28 mg/dl y una fi brilación auricular a 120 latidos por minuto (AU)

Lactic acidosis is an acid-base disorder due to the build up of lactic acid. The biguanide class of drugs, especially meltformin, are amongst the drugs described in the literature with reference to lactic acidosis. We report the case of a 71 year old woman referred to the Hellín Hospital Casualty Department by the Emergency Health Services (911). The patient had lost consciousness at her home for a few minutes. She had a capillary glycaemia of 28 mg/dl and atrial fi brillation at 120 beats per minute