ABSTRACT
Objective: Most cases of severe metabolic alkalosis have many causes that may result in renal failure and death. Therefore, these should be treated promptly for successful recovery.Patient: A 61-year-old man was hospitalized due to an acute kidney injury (creatinine level of 4.36 mg/dL) after a 3-month history of anorexia and recurrent vomiting. He had been treated for tuberculosis in the past.Results: Blood gas analysis revealed severe metabolic alkalosis with pH=7.66, HCO3=94 mmol/L, and pCO2=82.0 mmHg. Routine biochemical examination revealed severe hypokalemia (K 2.9 mEq/L) that was associated with prolonged QTc interval (0.52 seconds) on the electrocardiogram. Gastrofiberscopic examination also revealed severe stenosis and ulcerated scarring of the gastric pylorus and severe esophagitis. Intravenous hydration and correction of hypokalemia improved renal function and resolved metabolic alkalosis. An investigation that was repeated after 6 days revealed a creatinine level of 1.58 mg/dL, pH=7.47, HCO3=23.4 mmol/L, K=3.6 mEq/L, and QTc of 0.45 seconds. The patient underwent gastrectomy and adenocarcinoma was observed.Conclusion: We described a resolved case of severe metabolic alkalosis and acute kidney injury in a rural medical setting following conservative management.
ABSTRACT
Objective: Immunosuppressive therapy for interstitial lung disease (ILD) is often necessary, but the standard regimen for antisynthetase-associated ILD has not been established.Patient: An 80-year-old man was hospitalized for severely progressive dyspnea. Bilateral interstitial shadows occurred 1 month before the event. Serological findings showed that he had antisynthetase-associated ILD, as identified by strong positivity for anti-aminoacyl-transfer RNA synthetase (ARS) antibody, despite no evidence of myositis. He was treated transiently with noninvasive positive pressure ventilation and steroid-pulse therapy followed by 60 mg/day of oral prednisolone. However, his diabetes mellitus was aggravated by corticosteroid therapy; thus, a combination of low-dose steroid and mizoribine (MZB), which has a low risk of aggravating glucose intolerance, was used.Results: The patient’s clinical symptoms and daily life activities have been well persevered as an outpatient and well maintained with 200 mg of MZB and 10 mg of prednisolone for several months without obvious clinical recurrence and without any remarkable steroid- and MZB-related side effects.Conclusion: The use of MZB appeared to suppress the pathophysiology of anti-ARS antibody-associated ILD.
ABSTRACT
Objective To investigate the characteristics and prognosis of acute and chronic pancreatic pseudocysts and to identify the predictive factors of interventional treatment of pancreatic pseudocysts. Methods From January 1995 to December 2004, 36 patients with pancreatic pseudocysts at Nippon Medical School were studied retrospectively. Group 1 included 9 patients with acute pancreatitis associated pseudocysts which resolved spontaneously. Group 2 included 9 patients with acute pancreatitis associated pseudocysts and symptoms persisted or with complications which requiring interventional treatment. Group 3 included 9 patients with chronic pancreatitis associated pseudocysts which resolved spontaneously. Group 4 included 9 patients with chronic pancreatitis associated pseudocysts with symptoms persisted or with complications which requiring interventional treatment. Results Among the 36 patients, there were 13 women and 23 men. The etiology of pancreatitis due to alcohol was 18(50.0%) cases, biliary tract disease 8(22.2%)cases, others 10(27.8%) cases. The average duration of follow up was (24. 2 ± 18.5) months. The majority of pseudocysts (32/36, 88.9%) were not communicated with the main pancreatic duct;the number and location of the 4 groups of pseudocysts were not significantly different;the biggest diameter of pancreatic pseudocysts in group 3 was the smallest, all below 4 cm, which was significantly less than those in other 3 groups (P < 0.05) ;the majority of volume of pancreatic pseudocysts in group 1 and 3 was not increased, while it was increased in group 2 and 4.