Successful Hemoperfusion in Acute Phenobarbital Intoxication / 대한신장학회잡지

Phenobarbital is long acting barbiturate with low lipid solubility that act as central nervous system depressants and used as anticonvulsant, sedative, hypnotic drug. In acute severe barbiturate intoxication, through CNS depression, coma, respiratory arrest and hypotension may occur, which are the major causes of mortality. Mortality is 3% for blood levels over 80 mg/mL and the lethal dose in adult is estimated as 6 to 10 g. We report a case of phenobarbital intoxication in a 20 years old female, who was successfully treated by emergency hemoperfusion. She was in semicomatous state and had respiratory difficulty on the day of admission. It was estimated that she intakes 1.6 g of phenobarbital. She was treated with mechanical ventilation, urine alkalization and charcoal administration. Hemoperfusion was attempted to remove rapidly phenobarbital from blood. After hemoperfusion the blood phenobarbital level was decreased from 96 mg/mL to 67 mg/mL. On 2nd hospital day, the blood phenobarbital level was 56 mg/mL and she recovered her self respiration and mentality.

A Case of Hungry Bone Syndrome after Parathyroidectomy / 대한신장학회잡지

Patients with secondary hyperparathyroidism usually present with a history of underlying disease such as chronic renal failure. Tertiary hyperparathyroidism usually exists in situations of secondary hyperparathyroidism. It occurs when parathyroid hyperplasia becomes so severe that removal of the underlying cause does not eliminate the stimulus for PTH secretion and hypertrophic chief cells become autonomous. Surgical parathyroidectomy sould be considered in patients with uncontrolled hyperparathyroidism. Hungry bone syndrome is known to be developed due to extensive remineralization of skeleton after parathyroidectomy. It is characterized by prolonged symptomatic hypocalcemia, as a complication of the parathyroidectomy for hyperthyroidism. We have experienced a female patient with hypercalcemia, who had been on maintenance hemodialysis for 15 years. She had elevated intact PTH and alkaline phosphatase. We decided parathyroidectomy because of uncontrolled hyperthyroidism despite of medical treatment. A few weeks after the operation she developed a muscle pain and arthralgia, which were found to be due to severe hypocalcaemia. Calcium suppletion led to normalization of the serum calcium level. she was discharged from the hospital in good condition after calcium supplement. We report a case of hungry bone syndrome developed after parathyroidectomy in this patient.

A Case of Kallmann's Syndrome with Unilateral Renal Aplasia and Diabetes Mellitus / 대한내분비학회지

Kallmann's syndrome is defined as the combination of hypogonadotropic hypogonadism and anosmia/hyposmia. The syndrome is a result of defect in the embryonic migratory pathway of gonadotropin-releasing hormone, which synthesizes neurons and olfactory axons. The hypogonadotropic hypogonadism results due to absence of or incomplete pubertal development and may be associated with anosmia, hyposmia, midline defect(color blindness, cleft-lip, cleft-palate, unilateral renal agenesis, sensorineural deafness), cryptorchidism and skeletal anomaly. Till date in Korea, few cases of Kallmann's syndrome have been reported but there are no available reports on cases of Kallmann's syndrome with unilateral renal aplasia and diabetes mellitus. We handled a case of Kallmann's syndrome associated with unilateral renal agenesis and diabetes mellitus. In the current work, we present a peculiar case as afore mentioned with the review of related literature.