Acute and Critical Care

Case Reports

Neurology
Malignant Neuroleptic Syndrome following Deep Brain Stimulation Surgery of Globus Pallidus Pars Internus in Cerebral Palsy: Jae Meen Lee, Sun Ha Paek, Hye Ran Park, Kang Hee Lee, Chae Won Shin, Hye Young Park, Hee Pyoung Park, Dong Gyu Kim, Beom Seok Jeon; Korean J Crit Care Med. 2016;31(1):34-38. Published online February 29, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.1.34

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Neuroleptic malignant syndrome (NMS) is a rare but potentially lethal outcome caused by sudden discontinuation or dose reduction of dopaminergic agents. We report an extremely rare case of NMS after deep brain stimulation (DBS) surgery in a cerebral palsy (CP) patient without the withdrawal of dopaminergic agents. A 19-year-old girl with CP was admitted for DBS due to medically refractory dystonia and rigidity. Dopaminergic agents were not stopped preoperatively. DBS was performed uneventfully under monitored anesthesia. Dopaminergic medication was continued during the postoperative period. She manifested spasticity and muscle rigidity, and was high fever resistant to anti-pyretic drugs at 2 h postoperative. At postoperative 20 h, she suffered cardiac arrest and expired, despite vigorous cardiopulmonary resuscitation. NMS should be considered for hyperthermia and severe spasticity in CP patients after DBS surgery, irrespective of continued dopaminergic medication.

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Metal-free carboxyl modified g-C3N4 for enhancing photocatalytic degradation activity of organic pollutants through peroxymonosulfate activation in wastewater under solar radiation
Xueting Mei, Shujun Chen, Gangqiang Wang, Wenxing Chen, Wangyang Lu, Bingying Zhang, Yu Fang, Chenxiao Qi
Journal of Solid State Chemistry.2022; 310: 123053. CrossRef

Propofol-Related Infusion Syndrome in an Adult Patient Using Propofol Coma Therapy to Control Intracranial Pressure: Sang Youn Park, Eu Gene Kim, Hee Pyoung Park; Korean J Crit Care Med. 2013;28(3):234-238.; DOI: https://doi.org/10.4266/kjccm.2013.28.3.234

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Abstract PDF

Propofol-related infusion syndrome (PRIS) is a rare but fatal complication. Unexplained metabolic acidosis, rhabdomyolysis, hyperkalemia, myocardial dysfunction, cardiovascular collapse and acute kidney injury are the main characteristics of PRIS. Herein, we report a case of PRIS in a neurosurgical adult patient, who had received high-dose propofol continuous infusion in order to control intracranial pressure in an intensive care unit. She manifested severe metabolic acidosis, rhabdomyolysis, acute kidney injury and myocardial dysfunction. As soon as PRIS was diagnosed, propofol infusion was stopped. Conservative treatments, such as vasopressors and inotropics, continuous renal replacement therapy and extracorporeal membrane oxygenation were used to treat PRIS. However, she finally expired. This case report suggests that a great caution to PRIS is needed in a situation with high-dose propofol continuous infusion.

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Successful treatment of propofol-related infusion syndrome in critically ill patient receiving low-dose propofol infusion: a case report
Nahyeon Park, Tae Sun Ha
Acute and Critical Care.2023; 38(1): 144. CrossRef

Original Article

Effect of Clinical Pharmacist Interventions on Prevention of Adverse Drug Events in Surgical Intensive Care Unit: Minkyong Kang, Ahjeong Kim, Yoonsook Cho, Hyangsook Kim, Hyesook Lee, Yong Jae Yu, Hannah Lee, Kyu Joo Park, Hee pyoung Park; Korean J Crit Care Med. 2013;28(1):17-24.; DOI: https://doi.org/10.4266/kjccm.2013.28.1.17

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Abstract PDF

BACKGROUND
A pharmacist's participation in medical rounds in intensive care unit (ICU) is becoming popular nowadays. In this study, we investigated the effect of pharmacologic intervention by a pharmacist's participation in medical round in ICU on prevention of adverse drug events (ADEs).
METHODS
From March 2011 to July 2011, the intervention data were obtained by participating in medical round two or three times a week, and by reviewing electronic medical records of patients admitted to surgical ICU. The incidence, cause, and type of ADEs were noted, respectively. Expected cost avoidance was calculated from interventions, which were considered to be preventive of ADEs. The acceptance rate of pharmacologic interventions was noted.
RESULTS
Among 2781 patients, a total of 159 intervention data were collected in 90 patients. Recommendation for drug dosage adjustment or monitoring in patients with potential overdose and sub-therapeutic dose made up 82% of the total interventions. In 8% of interventions, initiation of drug therapy was recommended. 83% of the interventions were accepted and the acceptance rate of interventions within 24 hrs was 58%. The rate of the interventions, which were considered to be preventive of ADEs was 62%. Expected cost reduction obtained by preventing ADEs was 25,867,083 Won during a 5-month period.
CONCLUSIONS
A pharmacist's participation in physician rounds in ICU was associated with prevention of ADEs and subsequent reduction of the cost in drug therapy.

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What is impacting clinical pharmacists’ participation in an interprofessional ward round: a thematic analysis of a national survey
Dona Babu, Sally Marotti, Debra Rowett, Renly Lim, Alice Wisdom, Lisa Kalisch Ellett
Journal of Interprofessional Care.2024; 38(3): 444. CrossRef
A Systematic Review of Outcomes Research in the Hospital Pharmacists’ Interventions in South Korea
So Young Lee, Eun Cho
Korean Journal of Clinical Pharmacy.2019; 29(3): 193. CrossRef
Effects of Medication Reconciliation and Cost Avoidance Analysis by Clinical Pharmacists in a Neurocritical Care Unit
Ui Sang Cho, Young Joo Song, Young Mi Jung, Kyung Suk Choi, Eunsook Lee, Euni Lee, Moon-Ku Han
Journal of Neurocritical Care.2018; 11(2): 110. CrossRef
Pharmacotherapeutic Problems and Pharmacist Interventions in a Medical Intensive Care Unit
Tae Yun Park, Sang-Min Lee, Sung Eun Kim, Ka-Eun Yoo, Go Wun Choi, Yun Hee Jo, Yoonsook Cho, Hyeon Joo Hahn, Jinwoo Lee, A Jeong Kim
The Korean Journal of Critical Care Medicine.2015; 30(2): 82. CrossRef

Case Reports

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; Korean J Crit Care Med. 2010;25(3):186-189.; DOI: https://doi.org/10.4266/kjccm.2010.25.3.186

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Abstract PDF

Wernicke's encephalopathy is an acute neurological disorder, caused by thiamine deficiency, which is clinically characterized by a triad of ophthalmoplegia, ataxia and disturbances of consciousness. Most frequently, the encephalopathy is a consequence of chronic alcoholism, but it may occur in other forms of malnutrition or malabsorption, such as in prolonged parenteral nutrition without the addition of thiamine, total gastrectomy, gastrojejunostomy, severe anorexia or hyperemesis gravidarum. Thiamine requirement increases during critical illness and in chronically depleted patients, and its supplementation may influence the outcome of the disease. We report a case of a 73-year-old man, who presented with recurred colon cancer, who was affected by Wernicke's encephalopathy while undergoing oral feeding and parenteral nutrition. This case suggests that we should be more aware of potential thiamine deficiency in critically ill patients, even those undergoing parenteral nutrition and temporary oral feeding.

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Two Cases of Wernicke's Encephalopathy That Developed during Total Parenteral Nutrition in Colon Cancer Patients Treated with 5-Fluorouracil-based Chemotherapy
Kyung Pyo Cho, Jae Sung Lee, Ji Seok Seong, Yong Moon Woo, Young Jun Cho, Beom Jin Jeong, Jee Hoon Sohn, Su-Jung Kim
The Korean Journal of Gastroenterology.2014; 64(3): 158. CrossRef
Experiences of Wet Beriberi and Wernicke's Encephalopathy Caused by Thiamine Deficiency in Critically Ill Patients
Ji Young Jang, Hongjin Shim, Jae Gil Lee
Korean Journal of Critical Care Medicine.2013; 28(2): 156. CrossRef

Reversal of Focal Neurologic Deficit due to Preoperative Intracranial Pressure Reduction in a Patient with Early Rebleeding of Cerebral Aneurysm: A Case Report: Hyo Seok Na, Sang Hyun Park, Young Tae Jeon, Song Hwan Do, Hwan Hee Kim, Sang Chul Lee, Hee Pyoung Park; Korean J Crit Care Med. 2008;23(1):40-43.; DOI: https://doi.org/10.4266/kjccm.2008.23.1.40

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Abstract PDF: In the first hours after initial hemorrhage, up to 15% of patients with subarachnoid hemorrhage (SAH) due to aneurysmal rupture may have a sudden episode of clinical deterioration resulting from rebleeding. In patients suffering from an aneurismal rebleeding, the prognosis becomes much poor. Early detection of rebleeding and preoperatively appropriate medical treatment for increased intracranial pressure (IICP) might be crucial to decrease the overall mortality and morbidity rate in a patient with aneurismal rebleeding. We report a case of a successful reversal of focal neurological deficit showed in a patient with abrupt rebleeding of ruptured aneurysm whose intracranial pressure was preoperatively reduced with hyperventilation, and thiopental and mannitol administration under general anesthesia in angiography suite, although the patient ended up in death due to postoperative IICP.

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