No abstract available.
Calcinosis ; Calcium ; Calcium Gluconate ; Gluconates ; Humans ; Infant, Newborn

As the elderly population continues to grow, the number of geriatric patients reported to poison centers continues to increase. Older poisoned patients are at an increased risk of death compared to younger adult patients. The purpose of this paper is to report a case of hydrofluoric acid poisoning along with a discussion of poisoning characteristics. A 79 year-old male with dementia visited emergency department presenting epigastic discomfort after ingestion of 50% hydrofluoric acid solution. At admission, he presented with a stable vital sign but progressed to pulseless electrical activity. In spite of advanced resuscitation efforts and administration of calcium gluconate, he rapidly detoriated and died 3 hours after the ingestion.
Adult ; Aged ; Calcium Gluconate ; Dementia ; Eating ; Emergencies ; Gluconates ; Humans ; Hydrofluoric Acid ; Male ; Resuscitation ; Vital Signs

BACKGROUND: Although therapeutic plasmapheresis (TP) is a useful procedure in removing pathogenic antibodies and toxic substances from the patient, adverse reactions could arise from the use of replacement fluids and anticoagulants. Comprehensive analysis on those adverse effects had been rarely reported in Korea. METHODS: We retrospectively investigated the clinical records and the TP records from 3,962 TP sessions for 581 patients between January 1995 and October 2008 at Asan Medical Center, and we analyzed the adverse reactions related to TP. RESULTS: Adverse reactions were seen in 142 patients (24.4%) in 348 TP procedures (8.8%). Citrate toxicity was most frequently seen in 83 procedures (23.9%) followed by chills in 72 procedures (20.7%), allergic reactions in 69 procedures (19.8%) and hypotension in 60 procedures (17.2%). Citrate toxicity, chills and allergic reactions were seen more frequently in the TP procedures using FFP than in the TP procedures using albumin (P=0.001). The prevalence of citrate toxicity was significantly lower in the cases where calcium gluconate was administered (P<0.001), while it was significantly higher in the patients whose hematocrit was below 28.5% (P<0.001). In terms of severity, the mild, moderate and severe adverse reactions were 36.8%, 56.3% and 6.9%, respectively. CONCLUSION: TP is a relatively safe method of treatment, but it is important to predict and prevent adverse reactions and to respond appropriately to these adverse reactions.
Antibodies ; Anticoagulants ; Calcium Gluconate ; Chills ; Citric Acid ; Gluconates ; Hematocrit ; Humans ; Hypersensitivity ; Hypotension ; Plasmapheresis ; Prevalence ; Retrospective Studies

PURPOSE: Although Hydrofluoric acid(HF) is not a strong acid compared to other hydrogen halides, it is a feared corrosive and is particularly dangerous in higher concentrations. HF burns are characterized by symptoms, often delayed and localized with diluted HF solutions, to include erythema, edema and severe pain. Pain, a well known symptom, is followed by exposure to calcium binding. And, EMLA(R) cream is a topical formulation based upon the eutectic mixture of lidocaine and prilocaine and is used in clinical settings to relieve pain undergoing superficial surgical procedures. The aim of this study is to evaluate effects of EMLA(R) cream, pain-control dressing on the treatment for HF injury wound. METHODS: From June 2007 to June 2008, this study was carried out with 10 patients who had HF partial thickness burns. We were applied topically EMLA(R) cream to injured wound with vaseline gauze and 10% calcium gluconate wet gauze dressings. As a principle, in the emergency treatment, partial or complete removal of the bullae along with copious washing with normal saline was done, depending on the degree of HF invasion of the distal digital extremities. The effect of dressing was investigated by visual analogue pain scale. RESULTS: We therefore reviewed 10 cases of HF- induced pain and pain relief treatment principle. The 10 cases who came to the hospital nearly immediately after the injury healed completely without sequelae and EMLA(R) related complications. CONCLUSION: Proper initial treatment of HF burn is important. If not promptly recognized or properly treated, it produces serious injury. Topical EMLA(R) cream remains a powerful, new advancement for minimizing HF-related pain during dressing procedures. When used appropriately, topical EMLA(R) cream can be a safe and effective alternative to other forms of HF-pain control treatment.
Bandages ; Blister ; Burns ; Burns, Chemical ; Calcium ; Calcium Gluconate ; Edema ; Emergency Treatment ; Erythema ; Extremities ; Gluconates ; Humans ; Hydrofluoric Acid ; Hydrogen ; Lidocaine ; Petrolatum ; Porphyrins ; Prilocaine

A 7-day-old female neonate who visited emergency depar tment due to generalized tonic seizure. Laboratory test results showed hypocalcemia (5.7 mg/dL), hypomagnesemia (0.55 mmol/L), low parathyroid hormone (7.5 pg/mL), and normal 25(OH) vitamin D3. Symptom and metabolic abnormalities were normalized with intravenous calcium gluconate and magnesium sulfate. Discharged with supplement of oral calcium, vitamin D, phenobarbital, and lansoprazol, she was re-admitted with hypocalcemia (4.8 mg/dL) with normal level of parathyroid hormone (12.3 pg/mL). Hypocalcemia was resolved with discontinuation of proton pump inhibitor. We report a case of recurrent hypocalcemia and hypomagnesemia due to proton-pump inhibitor.
2-Pyridinylmethylsulfinylbenzimidazoles ; Calcium ; Calcium Gluconate ; Cholecalciferol ; Emergencies ; Female ; Gluconates ; Humans ; Hypocalcemia ; Hypoparathyroidism ; Infant, Newborn ; Magnesium Sulfate ; Parathyroid Hormone ; Phenobarbital ; Proton Pumps ; Seizures ; Vitamin D

Bisphosphonate generally seems to be safe, but hypocalcemia may occasionally develop in the course of bisphosphonate treatment. Hypocalcemia induced by bisphosphonate is usually mild and asymptomatic, but unrecognized or poorly treated hypocalcemia can lead to life-threatening state. A 78-year-old woman who had a history of hip arthroplasty and intravenous zoledronate treatment for femur neck fracture was presented to emergency department with altered mental status. It turned out that her symptom was due to severe hypocalcemia which was caused by intravenous zoledronate treatment. She also had renal dysfunction. She was treated by intravenous calcium gluconate and calcitriol administration. This case supports the need for evaluation of renal dysfunction, vitamin D deficiency and parathyroid gland dysfunction before bisphosphonate treatment and accurate monitoring of plasma calcium and creatinine levels. In addition, vitamin D and calcium supply during treatment with bisphosphonate is mandatory.
Aged ; Arthroplasty ; Calcitriol ; Calcium ; Calcium Gluconate ; Creatinine ; Diphosphonates ; Emergencies ; Female ; Femoral Neck Fractures ; Gluconates ; Hip ; Humans ; Hypocalcemia ; Imidazoles ; Osteoporosis ; Parathyroid Glands ; Plasma ; Vitamin D ; Vitamin D Deficiency

PURPOSE: We investigated the clinical characteristics and demographics of patients who suffered from hydrofluoric acid chemical injury and the mechanism of damage. METHODS: We retrospectively reviewed the medical records of patients who were exposed to hydrofluoric acid from March 2004 to March 2009 and who were seen at the emergency centers in two university teaching hospitals. RESULTS: Forty four patients out of 47 patients suffered from chemical burn, while the injuries of the remaining 3 could not be identified by the medical records. A total of 17 hydrofluoric acid chemical injury patients were enrolled during the study period, and their mean age was 29.6+/-7.0. All the patients were accidentally injured by contact with the material and none of them inhaled or ingested the material. Only 6 patients wore appropriate protective equipments and 5 underwent the water irrigation for more than 10 minutes. The most common exposure area was the hand and forearm (70.5%). Less than 1% of all of the patients had their total body surface (TBS) exposed to hydrofluoric acid (mean=0.35%). The mean time interval from calcium gluconate administration to pain relief was 33.6+/-8.8 hours. CONCLUSION: When exposed to hydrofluoric acid, it is important to wear protective equipment and undergo water irrigation for more than 10 minutes. Pain and skin damage were observed in all the patients. After treatment, we concluded that administration of calcium gluconate and pain killers was successful in relieving pain, and the prognosis was also positive for the admitted and followed up patients when less than 1% of the TBS was exposed.
Burns, Chemical ; Calcium Gluconate ; Demography ; Emergencies ; Forearm ; Gluconates ; Hand ; Hospitals, Teaching ; Humans ; Hydrofluoric Acid ; Medical Records ; Prognosis ; Retrospective Studies ; Skin ; Water

BACKGROUND: Hydrofluoric acid_(HF) is widely used in many industrial and domestic settings such as etching glass, and polishing metals. HF is one of the most corrosive inorganic acids and can produce progressive and serious tissue necrosis with severe pain. Since HF chemical burns can be asymptomatic for the first few hours, it is crucial to understand its toxicity and the early use of antidote. CASE: A 37-year-old man presented with erythematous lesion and pain on his face, anterior neck, both forearms, both thighs, and left ankle after injury resulting from a chemical burn caused by HF. He showed normal vital signs and dyspnea, but complained of a sore throat. Liquid form of HF had splashed on his face and anterior neck first and run down his forearms and thighs while working at HF supply tanks. Some of the HF was splashed into his mouth. He immediately removed his clothes and showered with abundant water. A 4.5% calcium gluconate jel was applied to the involved area. He was given subcutaneous injection of 10% calcium gluconate solution. During 17 days of admission he didn't show any signs of systemic intoxication or deep tissue defects. CONCLUSIONS: Immediate cleansing of the affected area with running cold water is the first critical treatment for a chemical burn due to HF. Applying calcium gluconate gel within one hour was very effective for preventing further damage to the injured area as well as systemic injury. In order to reduce the risk of accident and perform first-aid treatment quickly, it is imperative to provide workers with safety education and establish safety facilities.
Adult ; Animals ; Ankle ; Burns, Chemical ; Calcium Gluconate ; Cold Temperature ; Dyspnea ; Forearm ; Glass ; Gluconates ; Humans ; Hydrofluoric Acid ; Injections, Subcutaneous ; Metals ; Mouth ; Neck ; Necrosis ; Pharyngitis ; Running ; Thigh ; Vital Signs ; Water

PURPOSE: Hydrofluoric acid(HF) is one of the most dangerous mineral acids with the dissociated fluoride ions. The initial corrosive burn is caused by free hydrogen ion, and the second and more severe burn is caused by penetration of fluoride ions into subcutaneous tissues. Silver is a cation producing dressing, an effective antimicrobial agent, but older silver-containing formulations are rapidly inactivated by wound environment, requiring frequent replenishment. But, Acticoat(R) is a relatively new form of silver dressing which helps avoid the problems of earlier agents. The aim of this study is to evaluate effects of Acticoat(R), silver-containing dressing on the treatment for HF injury wound. METHODS: From september 2006 to september 2007, the study was carried out with 10 patients who had HF partial thickness burns. Acticoat(R) dressing and 10% calcium gluconate wet gauze dressings in 10 cases. As a principle, in the emergency treatment, partial or complete removal of the nail and early bullectomy along with copious washing with normal saline was done, depending on the degree of HF invasion of the wound. Wound was dressed with Acticoat(R) and 10% calcium gluconate solution. The effect of dressing was investgated by serial bacterial culture and wound exudates assessment. RESULTS: We therefore reviewed 10 cases of HF- induced chemical burns and treatment principle. The 10 cases who came to the hospital nearly immediately after the injury healed completely without sequelae. CONCLUSION: As the industrial sector develops, the use of HF is increasing more and more, leading to increased incidences of HF-induced chemical burns. The education of patients regarding this subject should be empathized accordingly. In conclusion, Acticoat(R) dressing is a better choice for HF partial thickness burn injuries because of shorter healing time, less pain and more comfortable dressing.
Bandages ; Burns ; Burns, Chemical ; Calcium Gluconate ; Emergency Treatment ; Exudates and Transudates ; Fluorides ; Gluconates ; Humans ; Hydrofluoric Acid ; Incidence ; Ions ; Nails ; Patient Education as Topic ; Polyesters ; Polyethylenes ; Porphyrins ; Protons ; Silver ; Subcutaneous Tissue

A 50-year-old woman was referred to our hospital for evaluation of mental change and general weakness accompanied by an irregular and weak pulse. She had previously been diagnosed with Bartter's syndrome and had taken potassium-sparing diuretics. She had developed constipation that had led to abdominal pain and had taken excessive magnesium oxide over a long time. On admission, she was lethargic. Her blood pressure (BP) was 130/74 mmHg, with a heart rate varying from 30 to 78 beats/min. An electrocardiogram (ECG) revealed several abnormalities, including first degree AV block, QT prolongation, sinus pause with a junctional rhythm, and paroxysmal tachycardia alternating with sinus pause. Her serum concentration of magnesium was markedly elevated to 16.19 mg/dl. Hemodialysis and a calcium gluconate infusion was attempted to reduce magnesium levels and to counteract the cardiovascular effect of magnesium. As magnesium levels declined, her general medical condition improved and her ECG changes were normalized. Severe hypermagnesemia should be suspected as the cause of mental change, cardiovascular dysfunction, and variable ECG changes.
Abdominal Pain ; Atrioventricular Block ; Bartter Syndrome ; Blood Pressure ; Calcium Gluconate ; Constipation ; Depression ; Diuretics ; Electrocardiography ; Female ; Gluconates ; Heart Rate ; Humans ; Magnesium ; Magnesium Oxide ; Middle Aged ; Renal Dialysis ; Tachycardia, Paroxysmal