Sodium hypochlorite (NaOCl) is commonly used as a disinfectant or bleaching agent. The ingestion of household bleach is often benign, with minimal irritating effect on the mucosa. Occasionally, however, it can be life-threatening. Here, we report an unusual case of acute poisoning involving household bleach with a near-fatal outcome that was treated with intense hemodialysis. A 42-year-old woman presented to the emergency room after ingesting 1 liter of 5% household bleach. Ten hours later, her metabolic acidosis, hypernatremia, hyperchloremia, and renal failure deteriorated gradually, despite aggressive medical treatment. Rapid, effective correction of the metabolic acidosis and electrolytes imbalance was needed and hemodialysis was performed immediately. After 3 days of dialysis, the laboratory imbalance was completely corrected.
Acidosis ; Adult ; Dialysis ; Eating ; Electrolytes ; Emergencies ; Family Characteristics ; Female ; Humans ; Hypernatremia ; Mucous Membrane ; Renal Dialysis ; Renal Insufficiency ; Sodium ; Sodium Hypochlorite

BACKGROUND/AIMS: We assessed changes in hemodynamic and arterial stiffness parameters following reductions of dialysate calcium concentrations in patients undergoing hemodialysis. METHODS: In this prospective study, 20 patients on maintenance hemodialysis (10 females, 10 males) with dialysate calcium concentrations of 1.75 mmol/L were enrolled. At the start of the study, the dialysate calcium level was lowered to 1.50 mmol/L. Serial changes in biochemical, hemodynamic, and arterial stiffness parameters, including pulse wave velocity (PWV) and augmentation index (AIx), were assessed every 2 months for 6 months. We also examined changes in the calcification-inhibitory protein, serum fetuin-A. RESULTS: During the 6-month study period, serum total calcium and ionized calcium decreased consistently (9.5 +/- 1.0 to 9.0 +/- 0.7, p = 0.002 vs. 1.3 +/- 0.1 to 1.1 +/- 0.1, p = 0.035). Although no apparent changes in blood pressure were observed, heart-femoral PWW (hf-PWV) and AIx showed significant improvement (p = 0.012, 0.043, respectively). Repeated-measures ANOVA indicated a significant effect of lowering dialysate calcium on hf-PWV (F = 4.58, p = 0.004) and AIx (F = 2.55, p = 0.049). Accompanying the change in serum calcium, serum fetuin-A levels significantly increased (95.8 +/- 45.8 pmol/mL at baseline to 124.9 +/- 82.2 pmol/mL at 6 months, p = 0.043). CONCLUSIONS: Lowering dialysate calcium concentration significantly improved arterial stiffness parameters, which may have been associated with upregulation of serum fetuin-A.
Aged ; Analysis of Variance ; Ankle Brachial Index ; Arteries/*drug effects/physiopathology ; Biological Markers/blood ; Blood Pressure/drug effects ; Calcium/*administration & dosage/adverse effects ; Compliance ; Female ; Hemodialysis Solutions/*administration & dosage/adverse effects/chemistry ; Humans ; Male ; Middle Aged ; Prospective Studies ; Pulsatile Flow/*drug effects ; *Renal Dialysis ; Republic of Korea ; Time Factors ; Treatment Outcome ; alpha-2-HS-Glycoprotein/metabolism

Hafnia alvei is a gram-negative bacillus that is rarely isolated from human clinical specimens and is rarely pathogenic. This organism is an extremely uncommon cause of spontaneous bacterial peritonitis (SBP). We report a case of an 83-year-old male with hepatitis C-associated liver cirrhosis and hepatocellular carcinoma who was diagnosed with SBP caused by H. alvei. He was admitted to an university-affiliated hospital with fever and abdominal pain. There were 2 episodes of SBP during 2 months. Although isolates of H. alvei from ascitic fluid were shown to be susceptible to cefotaxime, responses for cefotaxime treatment were inadequate in both episodes. Therefore, cefotaxime was switched to imipenem in the first episode and to ciprofloxacin in the second, according to the results of antimicrobial susceptibility. After the antibiotics was changed, SBP was resolved.
Abdominal Pain ; Aged, 80 and over ; Anti-Bacterial Agents ; Ascitic Fluid ; Bacillus ; Carcinoma, Hepatocellular ; Cefotaxime ; Ciprofloxacin ; Fever ; Hafnia ; Hafnia alvei ; Hepatitis ; Humans ; Imipenem ; Liver ; Liver Cirrhosis ; Male ; Peritonitis

PURPOSE: AST-120 is known to delay progression of chronic kidney disease (CKD) when combined with other proven therapy. AST-120 is an oral adsorbent for uremic toxin, such as indoxyl sulfate from the gastrointestinal tract. There have been a lot of studies to show its effect in other countries, but there are few studies done in Korea yet. METHODS: 195 patients were included in the study (mean age, 64+/-14 years; diabetes mellitus (DM), 104 patients; male, 130 patients). The patients with CKD who started AST-120 and maintained the medication for at least 6 months were enrolled. The patients' laboratory results for 6 months before and after administrating AST-120 was surveyed. Then the rate of patients' renal functional deterioration was compared before and after AST-120. In addition, adverse effects during the medication were surveyed. RESULTS: There were no statistically significant differences in laboratory data between before and after AST-120 administration. But, after administrating AST-120, the renal deterioration slope has blunted significantly from -0.0123+/-0.0318 to -0.0013+/-0.0184 dL/mg/month (p<0.01) in 1/sCr and from -1.1423+/-2.3906 to 0.0639+/-1.3825 ml/min/1.73m2/month (p<0.01) in estimated glomerular filtration rate (eGFR). There were no differences between DM and non-DM patients in the effect of AST-120, as well as ages over 70 and below 70. There were no serious adverse effects during medication. CONCLUSION: This study showed that AST-120 had additive effect on retarding the CKD progression when combined with established therapy regardless of DM and ages without serious adverse effects.
Carbon ; Diabetes Mellitus ; Gastrointestinal Tract ; Glomerular Filtration Rate ; Humans ; Indican ; Indoles ; Kidney Failure, Chronic ; Korea ; Male ; Oxides ; Renal Insufficiency, Chronic

BACKGROUND AND PURPOSE: Chronic kidney disease (CKD) is an established risk factor for numerous cardiovascular diseases including stroke. The relationship between the baseline estimated glomerular filtration rate (eGFR) and clinical 3-month outcomes in patients with acute ischemic stroke were evaluated in this study. METHODS: This was a prospective cohort study involving a hospital-based stroke registry; 1373 patients with acute ischemic stroke were enrolled. Patients were divided into the following four groups according their eGFR (calculated using the CKD Epidemiology Collaboration equations): > or =60, 45-59, 30-44, and <30 mL/min/1.73 m2. The primary endpoint of poor functional outcome was defined as 3-month death or dependency (modified Rankin Scale score > or =3); secondary endpoints were neurological deterioration (increase in National Institutes of Health Stroke Severity score of > or =4 at discharge compared to baseline) during hospitalization and in-hospital mortality. RESULTS: The overall eGFR was 84.5+/-20.8 mL/min/1.73 m2 (mean+/-SD). The distribution of baseline renal impairment was as follows: 1,218, 82, 40, and 33 patients had eGFRs of > or =60, 45-59, 30-44, and <30 mL/min/1.73 m2, respectively. At 3 months after the stroke, 476 (34.7%) patients exhibited poor functional outcome. Furthermore, a poor functional outcome occurred more frequently with increasingly advanced stages of CKD (rates of 31.9%, 53.7%, 55.0%, and 63.6% for CKD stages 1/2, 3a, 3b, and 4/5, respectively; p<0.001). Multivariate analysis revealed that a baseline eGFR of <30 mL/min/1.73m2 increased the risk of a poor functional outcome by 2.37-fold (p=0.047). In addition, baseline renal dysfunction was closely associated with neurological deterioration during hospitalization and with in-hospital mortality. CONCLUSIONS: A low baseline eGFR was strongly predictive of both poor functional outcome at 3 months after ischemic stroke and neurological deterioration/mortality during hospitalization.
Cardiovascular Diseases ; Cohort Studies ; Cooperative Behavior ; Epidemiology ; Glomerular Filtration Rate* ; Hospital Mortality ; Hospitalization ; Humans ; Mortality ; Multivariate Analysis ; National Institutes of Health (U.S.) ; Prospective Studies ; Renal Insufficiency, Chronic ; Risk Factors ; Stroke*

PURPOSE: Adiponectin (ADPN) has been known to protect against cardiovascular disease (CVD) in metabolic syndrome with normal renal function for its anti-inflammatory and anti-atherogenic property. However, it is still unclear whether ADPN is associated with cardiovascular outcomes in end-stage renal disease (ESRD) patients. METHODS: This study included 80 non-diabetic ESRD patients [mean age, 52.8+/-13.7 years; dialysis duration, 67.1+/-52.0 months; hemodialysis (HD), 35 pts; peritoneal dialysis (PD), 45 pts] who survived for more than 3 months after the start of dialysis, and serum ADPN levels were measured at the beginning of the study. We conducted a longitudinal follow-up to evaluate the association of serum ADPN level with cardiovascular outcomes for 29.3+/-6.7 months. RESULTS: ADPN was inversely correlated with fasting serum insulin (r=-0.309, p=0.006) and HOMA-IR (r=-0.321, p=0.004) in ESRD patients. In a multiple linear regression analysis adjusted for age, gender, waist to hip ratio (WHR), and HDL-cholesterol, HOMA-IR (beta=-0.880, p=0.041) was an independent factor associated with serum ADPN level. Kaplan-Meier analysis revealed that patients with higher ADPN levels (> or =15.8 microgram/mL) had a significantly higher survival rate compared with lowers (<15.8 microgram/mL) (p=0.032). Cox proportional hazard model adjusted for age, WHR, creatinine, CRP, and previous CVD history revealed that serum ADPN level (HR, 0.899; 95% CI, 0.818-0.987; p=0.026) was an independent determinant of cardiovascular outcomes. CONCLUSION: These findings suggest that lower ADPN levels independently predict cardiovascular events in non-diabetic ESRD patients.
Adiponectin ; Cardiovascular Diseases ; Creatinine ; Dialysis ; Fasting ; Follow-Up Studies ; Humans ; Insulin ; Kaplan-Meier Estimate ; Kidney Failure, Chronic ; Linear Models ; Peritoneal Dialysis ; Proportional Hazards Models ; Renal Dialysis ; Survival Rate ; Waist-Hip Ratio

BACKGROUND/AIMS: Osteoprotegerin (OPG) and fetuin-A are vascular calcification regulators that may be related to high cardiovascular (CV) mortality in hemodialysis (HD) patients. We evaluated the relationship between OPG, fetuin-A, and pulse wave velocity (PWV), a marker of vascular stiffness, and determined whether OPG and fetuin-A were independent predictors of CV events in HD patients. METHODS: We conducted a prospective observational study in 97 HD patients. OPG and fetuin-A were measured at baseline and arterial stiffness was evaluated by PWV. All patients were stratified into tertiles according to serum OPG levels. RESULTS: A significant trend was observed across increasing serum OPG concentration tertiles for age, HD duration, systolic blood pressure, cholesterol, triglycerides, and PWV. Multiple linear regression analysis revealed that diabetes (beta = 0.430, p = 0.000) and OPG levels (beta = 0.308, p = 0.003) were independently associated with PWV. The frequency of new CV events was significantly higher in the upper OPG tertiles compared with those in the lower OPG tertiles. In Cox proportional hazards analysis, upper tertiles of OPG levels were significantly associated with CV events (hazard ratio = 4.536, p = 0.011). CONCLUSIONS: Serum OPG, but not fetuin-A, levels were closely associated with increased vascular stiffness, and higher OPG levels may be independent predictors of new CV events in HD patients.
Adult ; Aged ; Biological Markers/blood ; Cardiovascular Diseases/blood/diagnosis/*etiology/mortality/physiopathology ; Female ; Humans ; Kaplan-Meier Estimate ; Linear Models ; Male ; Middle Aged ; Multivariate Analysis ; Osteoprotegerin/*blood ; Predictive Value of Tests ; Prognosis ; Proportional Hazards Models ; Prospective Studies ; Pulse Wave Analysis ; *Renal Dialysis/adverse effects/mortality ; Renal Insufficiency, Chronic/complications/diagnosis/mortality/*therapy ; Risk Factors ; Up-Regulation ; *Vascular Stiffness ; alpha-2-HS-Glycoprotein/analysis

A 62-year-old male developed a solitary asymptomatic nodule on the lateral aspect of the distal interphalangeal joint of the right great toe. Histopathologic findings demonstrated a myxoid cyst with a concomitant epidermal inclusion cyst. To the best of our knowledge, this is the first case of concurrent occurrence of digital myxoid cyst and epidermal inclusion cyst. Although the exact mechanism for developing a digital myxoid cyst and an epidermal inclusion cyst simultaneously at the same site is not explained, trauma might be a possible cause.
Ganglion Cysts ; Humans ; Joints ; Male ; Middle Aged ; Toes

A 52-year old woman, who had hypothyroidism associated with autoimmune thyroiditis for 5 years, was hospitalized for tingling sensation and muscle weakness of both lower extremities. Her initial laboratory findings showed severe hypokalemia, metabolic acidosis, and high titer of thyroid autoimmune antibodies. She was diagnosed of distal renal tubular acidosis by bicarbonate loading test (FEHCO(3)(-) <3.0 %) and renal calcifications on pre-enhanced CT scan. Since she had other symptoms of xerostomia and xerophthalmia, primary Sjogren's syndrome was diagnosed by Schirmer test, salivary scan, and serologic findings. She was treated with potassium citrate, potassium chloride, and hydroxychlorquine. Four months later, she has remained well with those treatments. There were only a few case reports about distal renal tubular acidosis associated with Sjogren's syndrome and autoimmune thyroiditis. In Korea, there has not been any report of such cases. Therefore, we report a case of distal renal tubular acidosis and Sjogren's syndrome in a patient with autoimmune thyroiditis.
Acidosis ; Acidosis, Renal Tubular ; Antibodies ; Female ; Humans ; Hypokalemia ; Hypothyroidism ; Korea ; Lower Extremity ; Muscle Weakness ; Potassium Chloride ; Potassium Citrate ; Sensation ; Sjogren's Syndrome ; Thyroid Gland ; Thyroiditis, Autoimmune ; Xerophthalmia ; Xerostomia

Infliximab, the monoclonal antibody to tumor necrosis factor, is indicated for refractory luminal and fistulizing Crohn's disease and rheumatoid arthritis. Infliximab treatment has adverse events including infusion reactions, opportunistic infections, and the potential for the event such as reactivation of latent tuberculosis. Cutaneous adverse reactions of TNF-alpha agents include skin rash, urticaria, pruritus, lupus-like eruption, and injection site reactions. Most of all, psoriasis or psoriasiform dermatitis induced by infliximab treatment for Crohn's disease is rarely reported in Korea. We report a case of psoriasis induced by infliximab treatment for Crohn's disease with a review of world literature.
Anti-Inflammatory Agents/*adverse effects/therapeutic use ; Antibodies, Monoclonal/*adverse effects/therapeutic use ; Colonoscopy ; Crohn Disease/diagnosis/*drug therapy ; Female ; Humans ; Psoriasis/*chemically induced/pathology/therapy ; Ultraviolet Rays ; Young Adult