Acute and Critical Care

Original Articles

Trauma
Prevalence and clinical impact of vitamin D deficiency in critically ill Korean patients with traumatic injuries: a single-center, prospective, observational study: Kyoung Hoon Lim, Jihoon Jang, Jinyoung Park; Acute Crit Care. 2021;36(2):92-98. Published online April 29, 2021; DOI: https://doi.org/10.4266/acc.2020.00801

4,191 View
126 Download

Abstract PDF: Background
This study investigated the prevalence and impact of 25-hydroxyvitamin D (25(OH) vitamin D) deficiency in critically ill Korean patients with traumatic injuries.
Methods
This prospective observational cohort study assessed the 25(OH) vitamin D status of consecutive trauma patients admitted to the trauma intensive care unit (TICU) of Kyungpook National University Hospital between January and December 2018. We analyzed the prevalence of 25(OH) vitamin D deficiency and its impact on clinical outcomes.
Results
There were no significant differences in the duration of mechanical ventilation (MV), lengths of TICU and hospital stays, and rates of nosocomial infection and mortality between patients with 25(OH) vitamin D <20 ng/ml and those with 25(OH) vitamin D ≥20 ng/ml within 24 hours of TICU admission. The duration of MV and lengths of TICU and hospital stays were shorter and the rate of nosocomial infection was lower in patients with 25(OH) vitamin D level ≥20 ng/ml on day 7 of hospitalization. The duration of MV, lengths of TICU and hospital stays, and nosocomial infection rate were significantly lower in patients with increased concentrations compared with those with decreased concentrations on day 7 of hospitalization, but the mortality rate did not differ significantly.
Conclusions
The 25(OH) vitamin D level measured within 24 hours after TICU admission was unrelated to clinical outcomes in critically ill patients with traumatic injuries. However, patients with increased 25(OH) vitamin D level after 7 days of hospitalization had better clinical outcomes than those with decreased levels.

Endocrinology
Prevalence and Related Factors of Vitamin D Deficiency in Critically Ill Patients: Hyun Jung Kim, Min Su Sohn, Eun Young Choi; Korean J Crit Care Med. 2016;31(4):300-307. Published online November 30, 2016; DOI: https://doi.org/10.4266/kjccm.2016.00276

7,216 View
182 Download
3 Crossref

Background
To identify the prevalence and related factors for vitamin D deficiency in the patients who admitted to the medical intensive care unit (ICU) of a Korean tertiary care hospital.
Methods
We retrospectively analyzed the data from ICU patients requiring mechanical ventilation (MV) for a period of > 48 h to identify the prevalence and associated factors for vitamin D deficiency. Vitamin D deficiency was defined as serum 25-hydroxyvitamin D [25(OH)D] level < 20 ng/mL.
Results
Among 570 patients admitted to the ICU, 221 were enrolled in the study, 194 in the vitamin D deficient group and 27 in the non-deficient group. Prevalence of vitamin D deficiency in critically ill patients was 87.8%. The patient age was lower in the vitamin D deficient group compared with the non-deficient group (64.4 ± 15.4 vs. 71.0 ± 9.6 years, p = 0.049). A higher acute physiology and chronic health evaluation II (APACHE II) score (odds ratio [OR] 1.23, 95% confidence interval [CI] 1.10-1.37) and chronic illness (OR 3.12, 95% CI 1.08-9.01) were associated with vitamin D deficiency after adjusting for age and body mass index. Clinical outcomes of duration of MV, ICU stay, and 28- and 90-day mortality rates were not significantly different between the vitamin D deficient and nondeficient groups.
Conclusions
Vitamin D deficiency was common in critically ill patients, particularly among younger patients. Higher APACHE II score and chronic illness were associated with vitamin D deficiency.

Citations

Citations to this article as recorded by

Vitamin D deficiency and mortality among critically ill surgical patients in an urban Korean hospital
Ji-hyun Lee, Seo-rin Doo, Dongha Kim, Yoo-kyoung Park, Eun-jeong Park, Jae-myeong Lee
International Journal for Vitamin and Nutrition Research.2022; 92(2): 101. CrossRef
Vitamin D Deficiency in Critically Ill Patients
Ji Hyun Lee, Jae-Myeong Lee
Surgical Metabolism and Nutrition.2017; 8(2): 17. CrossRef
Should We Measure Vitamin D Level?
Jae Hwa Cho
The Korean Journal of Critical Care Medicine.2016; 31(4): 369. CrossRef

Case Reports

Genetic
Lethal Hyperammonemia due to Ornithine Transcarbamylase Deficiency in a Patient with Severe Septic Shock: Ji An Hwang, Joo Han Song, Young Seok Lee, Kyung Soo Chung, Song Yee Kim, Eun Young Kim, Ji Ye Jung, Young Ae Kang, Young Sam Kim, Joon Chang, Moo Suk Park; Korean J Crit Care Med. 2016;31(2):140-145. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.140

7,277 View
83 Download

Abstract PDF: Severe hyperammonemia can occur as a result of inherited or acquired liver enzyme defects in the urea cycle, among which ornithine transcarbamylase deficiency (OTCD) is the most common form. We report a very rare case of a 45-year-old Korean male who was admitted to the intensive care unit (ICU) due to severe septic shock with acute respiratory failure caused by Pneumocystis jiroveci pneumonia. During his ICU stay with ventilator care, the patient suffered from marked hyperammonemia (>1,700 μg/dL) with abrupt mental change leading to life-threatening cerebral edema. Despite every effort including continuous renal replacement therapy and use of a molecular adsorbent recirculating system (extracorporeal liver support–albumin dialysis) to lower his serum ammonia level, the patient was not recovered. The lethal hyperammonemia in the patient was later proven to be a manifestation of acquired liver enzyme defect known as OTCD, which is triggered by serious catabolic conditions, such as severe septic shock with acute respiratory failure.

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 J Crit Care Med. 2013;28(2):156-159.; DOI: https://doi.org/10.4266/kjccm.2013.28.2.156

3,145 View
30 Download
1 Crossref

Abstract PDF

Wet beriberi and Wernicke's encephalopathy (WE) are caused by thiamine deficiency and are potentially lethal and serious diseases. Thiamine deficiency occurs mainly due to poor oral intake or inadequate provision of thiamine in enteral or parenteral nutrition therapy. We report cases of wet beriberi and WE that developed after surgery in a surgical intensive care unit. The first patient, who was diagnosed with wet beriberi, underwent right total mastectomy and radical subtotal gastrectomy, simultaneously. The second was diagnosed with irreversible WE, respectively, due to long-term malnutrition. In both cases, intravenous replacement of thiamine was initiated after the admission to the surgical intensive care unit. However, comatose mentality of the second patient did not improve. As a result, we conclude that, if a patient's clinical feature is suspected to be thiamine deficiency, prompt intravenous thiamine replacement is needed.

Citations

Citations to this article as recorded by

A Critical Case of Wernicke's Encephalopathy Induced by Hyperemesis Gravidarum
Byung Ju Kang, Min Gu Kim, Jwa Hoon Kim, Mingee Lee, Sang-Beom Jeon, Ha Il Kim, Jin Won Huh
The Korean Journal of Critical Care Medicine.2015; 30(2): 128. CrossRef

Pneumocystis jiroveci Pneumonia in a 5-month-old Boy with Agammaglobulinemia: A Case Report: Bo Hyun Chung, Hyo Kyoung Nam, Young Jun Rhie, Kwang Chul Lee, Ji Tae Choung, Choon Hak Lim, Young Yoo; Korean J Crit Care Med. 2012;27(4):274-278.; DOI: https://doi.org/10.4266/kjccm.2012.27.4.274

2,277 View
20 Download

Abstract PDF: Pneumocystis jiroveci (P. jiroveci) pneumonia is known as a common opportunistic infection in patients with impaired immunity. Underlying disease or conditions related to the development of P. jiroveci pneumonia include acquired immunodeficiency syndromes, as well as malignancies and congenital immune deficiency disorders. We describe a 5-month-old boy without significant medical history who was admitted at our hospital because of fever, tachypnea, vomiting, diarrhea, and lethargy whose condition became worse within several hours after admission. A chest X-ray showed bilateral diffuse infiltration and high resolution computed tomography showed diffuse bilateral ground-glass opacity. The patient was diagnosed with P. jiroveci pneumonia by direct immunofluorescent antibody staining from lung biopsy and he was later diagnosed with agammaglobulinemia. Although the boy was treated with antibiotics, high-dose corticosteroids and mechanical ventilation, he expired on the 5th hospital day. Here, we report the case of P. jiroveci pneumonia in a boy with agammaglobulinemia.

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

2,638 View
23 Download
2 Crossref

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.

Citations

Citations to this article as recorded by

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

The Effect of Hemodilution Treatment for Patient with Hemorrhagic Cerebral Venous Thrombosis due to Iron Deficiency Anemia: A Case Report: Mi Hye Lim, Sun Young Oh, Young Hyun Kim, Byoung Soo Shin; Korean J Crit Care Med. 2009;24(1):47-50.; DOI: https://doi.org/10.4266/kjccm.2009.24.1.47

2,373 View
15 Download

Abstract PDF: Cerebral venous sinus thrombosis (CVT) is a rare disease that's associated with a wide variety of clinical signs and symptoms, and CVT is a potentially lethal condition. Iron deficiency anemia (IDA) as the cause of an adult case of CVT is very rare. We report here on a patient with CVT with intracerebral hemorrhage that was caused by IDA, and the patient was treated with hemodilution. We suggest that hemodilution should be considered as another therapeutic option for CVT with cerebral hemorrhage in a patient suffering with IDA.

Original Article

Energy Deficiency Aggravates Clinical Outcomes of Critically Ill Patients: Hye Kyung Chung, Song Mi Lee, Jae Hoon Lee, Cheung Soo Shin; Korean J Crit Care Med. 2005;20(1):49-53.

1,808 View
29 Download

Abstract PDF: BACKGROUND
Adequate nutrition support reduces infectious complications, mortality and length of hospitalizationin intensive care unit. However, there are multi factors like frequent null per os (NPO) due to examination, intolerance to tube feeding, complication of TPN (total parenteral nutrition) and ineffective recognition by medical staff. The purpose of this study is to identify detrimental effects of cumulative energy deficiency in critically ill patients.
METHODS
The patients who were received tube feeding or total parenteral nutrition for more than 5 days were investigated. Daily and cumulative energy deficiency was tabulated until oral intake was achieved or until they discharged or died. Patients were divided into two groups, severe energy deficient group (>10, 000 kcal) or mild energy deficient group (<5, 000 kcal). Then we compared clinical outcomes between two groups. RESULTS: Total 150 patients were studied. 48 (32%) patients were severe energy deficient group and 42 (28%) patients were mild energy deficient group. Mortality and nosocomial infection were significantly higher in severe energy deficient group than in mild group. Hospital day and ICU day were significantly higher in severe energy deficient group than in mild group. CONCLUSIONS: Severe energy deficiency was very common in critically ill patients and it deteriorated the clinical outcomes such as mortality, nosocomial infection, hospital day and ICU day.

First
Prev
Page of 1
Next
Last

Search