Acute and Critical Care

Volume 23 (2); December 2008

Review Article

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

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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.

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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

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Abstract 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

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Abstract 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

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Abstract 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

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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

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Abstract 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

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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

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Abstract 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.

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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

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Abstract 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.

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An unusual presentation of severe preeclampsia presenting with maternal collapse in the post-cesarean section secondary to drug toxicity associated with pituitary hemorrhage: a case report
Krishna Mylavarapu Kumar, Shyam Madabushi, Amit Lall, Pranjali D. Dwivedi
Ain-Shams Journal of Anesthesiology.2023;[Epub] CrossRef
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

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Abstract 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.

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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

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Abstract 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

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Abstract 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.

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