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Volume 23 (2); December 2008
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Review
Evaluating and Managing Hyponatremia
Minwook Yoo, Ozan Akca, Evelyn Bediako
Korean J Crit Care Med. 2008;23(2):67-74.
DOI: https://doi.org/10.4266/kjccm.2008.23.2.67
  • 2,212 View
  • 43 Download
  • 2 Citations
AbstractAbstract PDF
Although hyponatremia is a common electrolyte disorder, its evaluation and management are not well defined. When diagnosed, hyponatremia should be categorized based on four criteria: volume status, urinary Na+, serum K+, and acid-base balance. This approach helps to determine what the cause of hyponatremia is and how it should be treated. Initially, hypovolemic hyponatremia, including cerebral salt wasting syndrome (CSWS), is treated by volume resuscitation and salt supplementation. Euvolemic hyponatremia, including the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), is treated by fluid restriction and salt supplementation, and hypervolemic hyponatremia is treated by fluid restriction and salt restriction. Hyponatremia can be managed well using these primary treatments and medications.

Citations

Citations to this article as recorded by  
  • Cerebral salt wasting syndrome in craniopharyngioma
    Sankari Santra, Jayanta Chakraborty, Bibhukalyani Das
    Indian Journal of Anaesthesia.2013; 57(4): 404.     CrossRef
  • Dilutional Hyponatremia during Hysteroscopic Myomectomy - A Case Report -
    Si Young Ok, Seung Hwa Ryoo, Young Hee Baek, Sang Ho Kim
    The Korean Journal of Critical Care Medicine.2009; 24(2): 102.     CrossRef
Original Articles
Does Adding Somatostatin to Proton Pump Inhibitor Improve the Outcome of Peptic Ulcer Bleeding?
Insung Kim, Yoon Seon Lee, Byuk Sung Koh, Won Kim, Kyoung Soo Lim
Korean J Crit Care Med. 2008;23(2):75-78.
DOI: https://doi.org/10.4266/kjccm.2008.23.2.75
  • 2,736 View
  • 23 Download
  • 2 Citations
AbstractAbstract PDF
BACKGROUND
Somatostatin has been shown to offer a distinct advantage over antisecretory drugs in the management of peptic ulcer bleeding (PUB). However, rebleeding rates are still high in spite of endoscopic and medical treatment. In this study, we intended to determine whether combined therapy of a proton pump inhibitor (PPI) plus somatostatin is more beneficial than a PPI alone in patients with PUB.
METHODS
We enrolled 90 consecutive patients who presented with PUB between January 2006 and October 2007. All the patients were managed with endoscopic hemostasis and divided into two treatment groups: 1) PPI alone (group A) and 2) PPI plus somatostatin (group B). The primary outcome was rebleeding within 72 hours. The secondary outcomes were rebleeding in 30 days, packed red blood cells (pRBC) transfused, length of hospital stay, need for surgery, and in-hospital mortality.
RESULTS
Forty-five patients in the PPI group (A) and 45 patients in the PPI plus somatostatin group (B) were studied. There was no difference between the two groups with respect to clinical and endoscopic features at admission. After medical treatment, there was no difference between groups A and B in rebleeding at 72 hours (11% vs. 13%, p = NS), rebleeding in 30 days (13% vs. 16%, p = NS), pRBC transfused (mean, 3.2 vs. 4.5 units, p = NS), length of hospital stay (mean, 7.4 vs. 8.4 days, p = NS), and in-hospital mortality (2% vs. 7%, p = NS).
CONCLUSIONS
Combined therapy with PPI and somatostatin did not result in better outcomes than PPI alone.

Citations

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  • The effect of octreotide in acute nonvariceal upper gastrointestinal bleeding: A randomized, double-blind, placebo-controlled trial
    Masoud Abrishami, Payam Peymani, Marziyeh Zare, KamranB Lankarani
    Journal of Research in Pharmacy Practice.2020; 9(2): 94.     CrossRef
  • Octreotide Added to a Proton Pump Inhibitor Versus a Proton Pump Inhibitor Alone in Nonvariceal Upper-Gastrointestinal Bleeds
    Heidi M. Riha, Rachel Wilkinson, Jennifer Twilla, L. Jeff Harris, Lauren A. Kimmons, Mehmet Kocak, Megan A. Van Berkel
    Annals of Pharmacotherapy.2019; 53(8): 794.     CrossRef
Effect of 6% Hydroxyethyl Starch Solution on Coagulation Function in Patients with Major Burns
In Suk Kwak, Ji Yeong Bae, Kwang Min Kim
Korean J Crit Care Med. 2008;23(2):79-83.
DOI: https://doi.org/10.4266/kjccm.2008.23.2.79
  • 1,815 View
  • 16 Download
AbstractAbstract PDF
BACKGROUND
Patients with major burns require replacement of intravascular volume. Hydroxyethyl starch (HES) solutions are widely used to replace intravascular volume. Dilution with crystalloids or colloids and corresponding platelet dysfunction are known causes of perioperative bleeding tendencies. The aim of the current study was to evaluate the effect of crystalloid and colloid solutions on platelet function in patients with major burns.
METHODS
Forty patients scheduled for burn surgery were divided into 4 groups. The infusion was started with a Hartman solution infusion (group 1) from 7 A.M. until surgery. HES (6%, Voluven(R)) was infused in the following concentrations: 7 ml/kg (group 2), 10 ml/kg (group 3), and 15 ml/kg (group 4). The bleeding time (BT), prothrombin time (PT), prothrombin time international ratio (PT INR), activated partial thromboplastin time (aPTT), hemoglobin (Hb), platelet function analyzer-100 closing time (PFA CT), and platelet count (Plt) were measured.
RESULTS
Hartmann solution and HES had no significant effect on the BT, PT, PT INR, a PTT, Hb, and Plt. The post-operative PFA CT was significantly higher in group 4 than in group 3. In group 4, the PFA CT was significantly higher post-operatively compared to pre-operatively.
CONCLUSIONS
The use of high dose HES may increase the risk of bleeding tendencies in burn patients.
Do-not-resuscitate Order in Patients, Who Were Deceased in a Medical Intensive Care Unit of an University Hospital in Korea
Kwangha Lee, Hang Jea Jang, Sang Bum Hong, Chae Man Lim, Younsuck Koh
Korean J Crit Care Med. 2008;23(2):84-89.
DOI: https://doi.org/10.4266/kjccm.2008.23.2.84
  • 2,969 View
  • 54 Download
  • 16 Citations
AbstractAbstract PDF
BACKGROUND
Do-not-resuscitate (DNR) in the event of a cardiac arrest is the most common and important discussion between a patient's family and physicians among the end-of-life decision-making process. To observe the performance of a DNR order in critically ill patients, we analyzed the incidence of DNR orders, the changes in therapeutic levels after DNR orders, and the cases of violated DNR codes in patients who had died in a Korean medical intensive care unit (ICU) between 1 January 2006 and 30 June 2006.
METHODS
The charts of patients who had died in the medical ICU were retrospectively reviewed.
RESULTS
One hundred two patients were enrolled. The ICU and hospital lengths of stay of the patients were 12.4 +/- 14.0 and 23.2 +/- 21.1 days, respectively. Hematologic malignancy (24.5%) accounted for the most common premorbid diagnosis before ICU admission. Seventy-five patients (73.5%) had DNR orders. The DNR order was suggested by the physician in 96% of the patients. There was no significant difference in the clinical parameters and the performance of a DNR order. Eighty-four percent of the patients with a DNR order had received the order within 3 days death. The withholding of additional therapy or withdrawing of current therapy occurred in 57.3% of the patients. The DNR order was violated in 9 cases (12%).
CONCLUSIONS
DNR orders are well-accepted by the patient's family in the ICU. However, DNR orders are initiated when patient death is imminent.

Citations

Citations to this article as recorded by  
  • Act on Decisions on Life-Sustaining Treatment and Timing of Referral to Hospice
    Han-na Ju, Seung Hun Lee, Yun-Jin Kim, Sang-Yeoup Lee, Jeong-Gyu Lee, Yu-Hyeon Yi, Young-Hye Cho, Young-Jin Tak, Hye-Rim Hwang, Eun-Ju Park, Young-In Lee
    Korean Journal of Family Practice.2021; 11(5): 331.     CrossRef
  • Reversals in Decisions about Life-Sustaining Treatment and Associated Factors among Older Patients with Terminal Stage of Cardiopulmonary Disease
    Jung-Ja Choi, Su Hyun Kim, Shin-Woo Kim
    Journal of Korean Academy of Nursing.2019; 49(3): 329.     CrossRef
  • End-of-Life Care Practice in Dying Patients with Do-Not-Resuscitate Order: A Single Center Experience
    Sang Eun Yoon, Eun Mi Nam, Soon Nam Lee
    The Korean Journal of Hospice and Palliative Care.2018; 21(2): 51.     CrossRef
  • Intensive Care Nurses’ Experiences of Death of Patients with DNR Orders
    Ji Yun Lee, Yong Mi Lee, Jae In Jang
    The Korean Journal of Hospice and Palliative Care.2017; 20(2): 122.     CrossRef
  • Trends in the Use of Intensive Care by Very Elderly Patients and Their Clinical Course in a Single Tertiary Hospital in Korea
    Junghyun Kim, Jungkyu Lee, Sunmi Choi, Jinwoo Lee, Young Sik Park, Chang-Hoon Lee, Jae-Joon Yim, Chul-Gyu Yoo, Young Whan Kim, Sung Koo Han, Sang-Min Lee
    Korean Journal of Critical Care Medicine.2016; 31(1): 25.     CrossRef
  • Clinical Characteristics of Oncologic Patients with DNR Decision at a Tertiary Hospital
    Na Young Kang, Jeong Yun Park
    The Korean Journal of Hospice and Palliative Care.2016; 19(1): 26.     CrossRef
  • Evaluation of Informed Consent for Withholding and Withdrawal of Life Support in Korean Intensive Care Units
    Jin Ha Park, Shin Ok Koh, Jin Sun Cho, Sungwon Na
    The Korean Journal of Critical Care Medicine.2015; 30(2): 73.     CrossRef
  • Do-not-resuscitation in Terminal Cancer Patient
    Jung Hye Kwon
    The Korean Journal of Hospice and Palliative Care.2015; 18(3): 179.     CrossRef
  • Research Trend Analysis of Do-Not-Resuscitate Decision: Based on Text Network Analysis
    Miji Kim, Sangmi Noh, Eunjung Ryu, Sangmoon Shin
    Asian Oncology Nursing.2014; 14(4): 254.     CrossRef
  • The Current Status of Medical Decision-Making for Dying Patients in a Medical Intensive Care Unit: A Single-Center Study
    Kyunghwa Shin, Jeong Ha Mok, Sang Hee Lee, Eun Jung Kim, Na Ri Seok, Sun Suk Ryu, Myoung Nam Ha, Kwangha Lee
    Korean Journal of Critical Care Medicine.2014; 29(3): 160.     CrossRef
  • The End-of-Life Care in the Intensive Care Unit
    Jae Young Moon, Yong Sup Shin
    Korean Journal of Critical Care Medicine.2013; 28(3): 163.     CrossRef
  • Medical Residents' Perception and Emotional Stress on Withdrawing Life-Sustaining Therapy
    Jae Young Moon, Hee Young Lee, Chae-Man Lim, Younsuck Koh
    Korean Journal of Critical Care Medicine.2012; 27(1): 16.     CrossRef
  • Current status of end-of-life care in Korean hospitals
    Younsuck Koh
    Journal of the Korean Medical Association.2012; 55(12): 1171.     CrossRef
  • Changes in how ICU nurses perceive the DNR decision and their nursing activity after implementing it
    Young-Rye Park, Jin-A Kim, Kisook Kim
    Nursing Ethics.2011; 18(6): 802.     CrossRef
  • The Preference for Care Near the End of Life of Korean Nurses
    Hyun Sook Kim, Shinmi Kim, Su Jeong Yu, Moungok Kim
    The Korean Journal of Hospice and Palliative Care.2010; 13(1): 41.     CrossRef
  • Physician's Role and Obligation in the Withdrawal of Life-sustaining Management
    Younsuck Koh
    Journal of the Korean Medical Association.2009; 52(9): 871.     CrossRef
Comparing the Usefulness of the Initial Acute Physiologic and Chronic Health Evaluation (APACHE) II Score in the Emergency Department (ED) and the Mortality in Emergency Department Sepsis (MEDS) Score for Predicting the Prognosis of Septic Patients Admitt
Chan Young Koh, Young Sik Kim, Tae Yong Shin, Young Rock Ha
Korean J Crit Care Med. 2008;23(2):90-95.
DOI: https://doi.org/10.4266/kjccm.2008.23.2.90
  • 2,112 View
  • 15 Download
  • 3 Citations
AbstractAbstract PDF
BACKGROUND
To determine the prognostic value of the initial APACHE II score in the ED compared with the classic APACHE II score in the ICU and to check the usefulness of the MEDS score together for more rapid risk stratification of septic patients admitted to the ICU via the ED.
METHODS
We prospectively checked the initial APACHE II and MEDS scores of all the patients who had systemic inflammatory response syndrome in the ED and the classic APACHE II scores after admission to the ICU, as well 6 months later. We enrolled the only sepsis cases in the final diagnosis after reviewing the medical records. We evaluated the predictive abilities of the initial APACHE II and MEDS scores compared with the classic APACHE II score.
RESULTS
During 6 months, 58 patients diagnosed with sepsis were enrolled. Twenty-four (41.4%) patients died within 28 days of admission and 34 patients survived. The mortality group had a significantly higher mean classic APACHE II score (19 +/- 6.7 vs. 15 +/- 5.0, p < 0.01) and a higher mean MEDS score (16.67 +/- 2.70 vs. 8.91 +/- 3.11, p < 0.01) than the survivor group. The initial APACHE II score at the ED was not significantly different between the two groups. ROC analysis showed the discriminative power of the MEDS score in predicting mortality was much better than the APACHE II score (areas under the curves of the APACHE II score in the ED and ICU, and the MEDS scores were 0.668, 0.807, and 0.967, respectively; p < 0.01).
CONCLUSIONS
The initial APACHE II score in the ED did not predict mortality better than the classic APACHE II score. However, the MEDS score predicted the poor prognosis of septic patients more rapidly and accurately in the ED than the APACHE II model.

Citations

Citations to this article as recorded by  
  • Thrombomodulin is a Strong Predictor of Multiorgan Dysfunction Syndrome in Patients With Sepsis
    Dunja M. Mihajlovic, Dajana F. Lendak, Biljana G. Draskovic, Aleksandra S. Novakov Mikic, Gorana P. Mitic, Tatjana N. Cebovic, Snezana V. Brkic
    Clinical and Applied Thrombosis/Hemostasis.2015; 21(5): 469.     CrossRef
  • Endocan is useful biomarker of survival and severity in sepsis
    Dunja M. Mihajlovic, Dajana F. Lendak, Snezana V. Brkic, Biljana G. Draskovic, Gorana P. Mitic, Aleksandra S. Novakov Mikic, Tatjana N. Cebovic
    Microvascular Research.2014; 93: 92.     CrossRef
  • A Case Study of Metastatic Cholangiocarcinoma with Sepsis who Showed Symptomatic Improvement after Treated with Handayeolso-tang, Fel Tauri, and Antibiotics
    Soo-Min Lee, Seong-Heon Choi, An-Na Song, Ji-Young Lee, Jin Chae, Eu-Hong Jung, Soo-Kyung Lee
    Journal of Sasang Constitutional Medicine.2013; 25(4): 432.     CrossRef
The Clinical Features of Patients with Deep Neck Infections Who Were Admitted to the Intensive Care Unit in a Single Emergency Center
Jin Joo Kim, Sung Youl Hyun, Jung Kwon Kim, Yong Su Lim, Jong Hwan Shin, Jin Seong Cho, Ji Ho Ryu, Gun Lee
Korean J Crit Care Med. 2008;23(2):96-101.
DOI: https://doi.org/10.4266/kjccm.2008.23.2.96
  • 2,073 View
  • 15 Download
  • 1 Citations
AbstractAbstract PDF
BACKGROUND
Deep neck infections are a life-threatening disease that spread to the neck spaces and the mediastinum via neck fascial planes. In spite of using antibiotics, the mortality of deep neck infections is still high. The aim of our study was to analyze the factors related to mortality and morbidity of patients with deep neck infection who were admitted to the intensive care unit.
METHODS
This is a retrospective study of patients with deep neck infections who were admitted to the intensive care unit over a 2 year period between June 2006 and May 2008. The various factors related to mortality and morbidity were analyzed.
RESULTS
Twenty-four patients were included over 2 years. The median age was 58 years. Eighteen patients (75%) were males and six patients were females. Ten patients (41.7%) had underlying diabetes mellitus. The median white blood cell count and C-reactive protein (CRP) were 14,000/mm3 and 24.1 mg/dl, respectively. The most common cause of deep neck infection was of dental origin (62.5%) and the most common complication was mediastinitis (37.5%). The factors related to mortality were underlying diabetes mellitus, pO2, CRP, sequential organ failure assessment (SOFA) score, gas-forming score (GAS), and complications due to mediastinitis.
CONCLUSIONS
It is useful to measure several factors in patients with deep neck infections. The patients with underlying diabetes mellitus, increased CRP, a GAS score of 2, and complications to mediastinitis have a high mortality rate, so active surgical and medical management should be performed.

Citations

Citations to this article as recorded by  
  • Retrospective investigation of anesthetic management and outcome in patients with deep neck infections
    Tae Kwane Kim, Hye Jin Yoon, Yuri Ko, Yuna Choi, Ui Jin Park, Jun Rho Yoon
    Anesthesia and Pain Medicine.2019; 14(3): 347.     CrossRef
Case Reports
Mental Change, Cardiovascular Depression and QT Prolongation Caused by Severe Hypermagnesemia: A Case Report
Hyung Oh Choi, Seung Geun Lee, Pil Hyung Lee, Sung Nam Lim, Byeong Seok Sohn, Yun Hee Chung, Gi Byoung Nam
Korean J Crit Care Med. 2008;23(2):102-105.
DOI: https://doi.org/10.4266/kjccm.2008.23.2.102
  • 2,938 View
  • 16 Download
  • 1 Citations
AbstractAbstract PDF
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.

Citations

Citations to this article as recorded by  
  • Symptomatic Hypermagnesemia in Normal Kidney Function with a Colonic Cleansing Agent
    Taehong Kim, Tae Hyung Kim, Won Hyuk Lee, Yoo Jin Lee, Sihyung Park, Bong Soo Park, Yang Wook Kim
    The Korean Journal of Medicine.2016; 91(3): 306.     CrossRef
A Case of Wernicke's Encephalopathy Occurring in a Patient with Aspiration Pneumonia: A Case Report
So Mi Kim, Ji Hyun Suh, Ran Noh, Young Kwang Choo, Sung Soo La, Jae Seuk Park, Doh Hyung Kim
Korean J Crit Care Med. 2008;23(2):106-110.
DOI: https://doi.org/10.4266/kjccm.2008.23.2.106
  • 2,290 View
  • 27 Download
  • 1 Citations
AbstractAbstract PDF
Wernicke's encephalopathy is a neurologic complication of thiamine deficiency, presenting with acute confusion, oculomotor dysfunction, and gait ataxia. While most often associated with chronic alcoholism, Wernicke's encephalopathy occasionally occurs in the setting of poor nutritional status, such as malabsorption, increased metabolic requirements, or increased loss of the water-soluble vitamins. Patients with critical illnesses can present with excessive catabolic status because of activation of the sympathetic nervous system and the pituitary-adrenal axis. In addition, inappropriate nutritional evaluation and lack of concerns for adequate nutrient support can increase the morbidity and mortality in such patients. However, the importance of adequate nutritional support is often disregarded during treatment of the patient's primary illness. We have recently managed a patient with Wernicke's encephalopathy and pneumonia who did not receive adequate nutritional support during hospitalization. We report this case to call attention to the importance of nutritional support in critically ill patients.

Citations

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  • A Case of Wernicke's Encephalopathy in a Postoperative Patient with Parenteral Nutrition and Temporary Oral Feeding - A Case Report -
    Hannah Lee, Eun Hye Lee, Sang Chul Lee, Hee Pyoung Park
    The Korean Journal of Critical Care Medicine.2010; 25(3): 186.     CrossRef
Management of Pulmonary Thromboembolism with Inferior Vena Cava Filter: A Case Report
Yeon Jang, Yun Sun Chin, Hyun Suk Jung, Ho Kyung Song
Korean J Crit Care Med. 2008;23(2):111-114.
DOI: https://doi.org/10.4266/kjccm.2008.23.2.111
  • 1,794 View
  • 10 Download
AbstractAbstract PDF
We managed a case in which an inferior vena cava filter was inserted for a pulmonary thromboembolism that occurred during general anesthesia. A 71-year-old woman was prepped for reduction of a distal femur fracture and arthroplastic surgery. Her initial vital signs were stable, but the end-tidal CO2 and SaO2 were decreased gradually after application of the tourniquet for surgery. Because of impaired ventricular wall motion and a dilated inferior vena cava on echocardiogram, we suspected a pulmonary thromboembolism. Thus, we inserted an inferior vena cava filter percutaneously under propofol sedation in the Radiology Department. In addition to ventilatory support and hemodynamic management, heparin was administered as anticoagulant therapy postoperatively in the intensive care unit. Multiple thrombi in the pulmonary artery were confirmed on chest CT. On the 4th postoperative day, she was transferred to the general ward without any complications.
Perioperative Management for the Patient with May-Thurner Syndrome: A Case Report
Soo Kyung Lee, Eun Joo Choi, Kun Il Kim, Young Mi Kim, Hyun Choi, Hyun Soo Moon
Korean J Crit Care Med. 2008;23(2):115-119.
DOI: https://doi.org/10.4266/kjccm.2008.23.2.115
  • 3,204 View
  • 47 Download
AbstractAbstract PDF
May-Thurner syndrome is an anatomic variant in which the left common iliac vein is compressed by the right common iliac artery. The most frequent clinical presentation is deep vein thrombosis of the left lower extremity. We report the perioperative management in a patient with May-Thurner syndrome undergoing an open reduction of a tibia fracture. The patient developed deep vein thrombosis of the left lower extremity and had an endovascular stent placed approximately 1 year earlier. An important aspect of the perioperative management in a patient with May-Thurner syndrome is to prevent deep vein thrombosis. We monitored the activated clotting time during the intraoperative period.

ACC : Acute and Critical Care