Prognostic values of blood pH and lactate levels in patients resuscitated from out-of-hospital cardiac arrest.

AIM: Early prediction of prognosis after out-of-hospital cardiac arrest (OHCA) remains difficult. High blood lactate or low pH levels may be associated with poor prognosis in OHCA patients, but these associations remain controversial. We compared blood lactate and pH levels in OHCA patients transferred to our hospital to measure their prognostic performance. METHODS: We investigated the associations between blood lactate and pH levels on admission and neurological outcomes in 372 OHCA patients who had a return of spontaneous circulation. RESULTS: Of the 372 OHCA patients, 31 had a favorable neurological outcome. Blood lactate levels were lower in patients with a favorable outcome than in those with an unfavorable outcome, but this difference did not reach statistical significance (82 ± 49 vs. 96 ± 41 mg/dL). However, pH levels were significantly higher in patients with a favorable outcome than in those with an unfavorable outcome (7.26 ± 0.16 vs. 6.93 ± 0.19, P < 0.001). The relative cumulative frequency distribution curve analysis showed the optimal cut-off points of lactate and pH to be approximately 80 mg/dL and 7.05, respectively. Sensitivity and specificity to predict a favorable outcome were 61% and 64% for lactate <80 mg/dL and 84% and 80% for pH >7.05, respectively. Areas under receiver-operating characteristic curves were significantly larger for pH than for lactate levels (P < 0.001). In multivariate analysis, pH >7.05 was an independent predictor for a favorable outcome. CONCLUSION: After OHCA, patients with a favorable outcome had lower lactate and higher pH levels than those with an unfavorable outcome, but pH level was a much better predictor for neurological outcome than lactate levels.

Prevalence of metabolic syndrome in stroke patients: a prospective multicenter study in Japan.

AIMS: The fact that Metabolic Syndrome (MetS) increases the risk of atherosclerosis has been epidemiologically studied and proven; however, a prospective study on the prevalence of MetS in stroke patients has never been conducted because of the difficulty in diagnosis under critical illness in the acute phase. Therefore, we conducted a prospective multicenter study to investigate the prevalence of MetS in stroke patients with modified diagnostic criteria for MetS. METHODS: Stroke patients admitted in the seven participating Emergency and Critical Care Centers within the two years from April 2007 were registered in this study as a prospective multicenter study. Inclusion criteria were 50 to 89 year-old stroke patients who presented within three days from the onset of symptoms. A total of 992 subjects were classified according to the stroke type and the prevalence of MetS and the associated risk factors were investigated. The participants in a medical checkup without any history of a stroke were enrolled as the control group, and compared between the two groups. RESULTS: The prevalence of MetS as well as hyperglycemia and dyslipidemia in the infarction group was significantly higher than that in the non-stroke group. While the hemorrhage group showed no significant difference in the prevalence of MetS, only hypertension was significantly high. According to a subtype analysis, there is a significant correlation between waist circumference increment of the stroke patients and the prevalence of the risk factors of hypertension, hyperglycemia and dyslipidemia. CONCLUSIONS: Different risk factors are significantly related to the type of stroke.

[Triage DOA screening in a case of methamphetamine and its analogue poisoning].

CASE REPORT: A 20-year-old woman presented with the chest pain, nausea, respiratory strange feeling, and a large quantity of sweating. On the stimulant zone of 8 groups of drugs of Triage DOA screening it showed an equivocal positivity while all of the other zones gave negative results. She denied taking drugs. No injection scar was found. And she was then hospitalized because little was known about her symptoms. When the unconscious patient was discovered at rest room inside hospital the next day, she was transferred to emergency and critical care center. In the same screening test positivity on the stimulant zone was observed, and furthermore both amphetamine and methamphetamine were detected by GCMS analysis. For 4 days positivity on the stimulant zone lasted. From the fact of disturbance of consciousness, restlessness, excitation and tachycardia, respiration disorder, and the pupil dilatation drug poisoning was deeply suspected. DISCUSSION: While the stimulant zone of Triage DOA showed the equivocal positivity when 7 hours has elapsed until she became aware of abnormality and hospitalized, in the same screening of 30 hours later positivity was verified clearly. Several problems derived from the detection method, pharmacokinetic factors and pharmacodynamic aspect were discussed as for the difference of the results detected.

Usefulness of serum concentration measurement for acute pentobarbital intoxication in patients.

Toxicokinetic parameters were analyzed in 25 patients who were acutely intoxicated with pentobarbital. The serum pentobarbital concentrations were at hypnotic / therapeutic levels (1- 10 microg/mL) in 11 patients, at toxic levels (10-24 microg/mL) in 10 patients, and at lethal levels (>24 microg/mL) in 4 patients. One fatal case was encountered with a serum pentobarbital concentration of 37.27 microg/ mL. The relationships between serum pentobarbital concentrations and the drug, the induced toxic symptoms, such as respiratory / cardiac depression and hypotension, were in good correlation. The therapy of direct hemoperfusion carried out for many pentobarbital-intoxicated patients was highly effective.

[Serum fenitrothion concentration and toxic symptom in acute intoxication patients].

The serum drug concentrations were measured by HPLC or GC/MS in 15 patients of acute fenitrothion (MEP), an organophosphorus insecticide, intoxication. There was no fatal case. The patients were admitted 0.5 approximately 12 hours after the ingestion of 5 approximately 50g MEP. The range of serum MEP concentrations were from undetectable level (< 0.01 microg/mL) to 9.73 microg/mL. Toxic symptoms were correlated with the serum MEP levels. About < 7 microg/mL of the serum MEP levels associated with mild cases and about > 7 microg/mL associated with serious cases. The elimination curves in mild cases were successfully simulated by the one-compartment model and the elimination half-lives (T1/2) were 9.9 +/- 7.7hr (mean +/- S.D.). The serum MEP concentrations declined below the detectable level in 48hr. The elimination curves in two serious cases were successfully simulated by the two-compartment model. The T1/2 in the alpha phase were 5.3hr and 6.7hr (under the direct hemoperfusion), and the T1/2 in the beta phase were 35hr and 52hr. The serum MEP concentrations declined below the detectable level in 300hr.

[Pharmacokinetics of bromazepam in 57 patients with acute drug intoxication].

Pharmacokinetic parameters of bromazepam were analyzed by 57 cases. The patients were admitted 7.3 +/- 8.9 hours (mean +/- S.D.) after ingestion of 88 +/- 127 mg bromazepam. Most patients had taken several drugs other than bromazepam and the number was 5.5 +/- 2.6 drugs. The serum bromazepam levels were 1,871 +/- 2,428 ng/ml and the elimination half-lives were 29 +/- 4 hours. Increased serum bromazepam levels were followed by extended elimination half-lives. There was no bromazepam toxic sign under 2,300 ng/ml. One case was treated with direct hemoperfusion and the therapy was effective.

[Serum and urine total arsenic concentration in a case of acute arsenic intoxication].

The 68-year-old man took arsenic pasta 1 g (arsenic trioxide 0.45 g) to commit suicide and was admitted 16 hours after ingestion. He developed vomiting and coma, followed by pancytopenia. He was treated with activated charcoal, laxative, dimercaprol, sodium thiosulfate and direct hemoperfusion with good recovery. Total arsenic concentrations in serum and urine were 39 ng/ml and 89 ng/ml on admission, respectively. Urine arsenic concentration showed the second peak around 48 hours after admission.