Two cases of Vibrio vulnificus peritonitis after ingestion of seafood in patients receiving continuous ambulatory peritoneal dialysis / 대한내과학회지

Peritonitis is the most common infectious complication of continuous ambulatory peritoneal dialysis (CAPD). However, CAPD-related peritonitis caused by Vibrio vulnificus is rarely reported. V. vulnificus is marine bacterium and opportunistic human pathogen. In an immunocompromised host, e.g. with chronic liver disease, end-stage renal disease, hemochromatosis, and other iron-overload disorders, this organism has been associated with the development of life-threatening primary septicemia and severe wound infection. However, CAPD-related peritonitis caused by V. vulnificus has not been reported, except for one case in Hong Kong, China. We report on two patients receiving CAPD who developed peritonitis caused by V. vulnificus after ingestion of seafood, for the first time in Korea.

A Case of Mercury Intoxication Associated with Pernicious Anemia / 영남의대학술지

Pernicious anemia is the frequent cause of megaloblastic anemia, and it is the result of a vitamin B12 deficiency due to the decrease or absence of intrinsic factor (IF) because of gastric mucosa atrophy or autoimmune destruction of IF-producing parietal cells. With the existence of a severe gastric atrophy, there is a decreased in acid and IF production and a further change in vitamin B12 absorption. Mercury is ubiquitous in nature and exists in 3 forms, elemental mercury, inorganic salts and organic compounds. Organic forms, specifically methyl mercury, are the most toxic of the 3 classes of mercurials. Methyl mercury exerts its most devastating effect on the central nervous system by causing psychiatric disturbances, ataxia, visual loss, hearing loss, and neuropathy. We report a case of mercury intoxication associated with pernicious anemia. The 77 years old patient was referred to Yeungnam University Hospital for tongue pain, somatitis, headache and aggressive behavior. He had taken an unevaluated medicine for a long time. After clinical evaluation, this case was diagnosed as a pernicious anemia and the unevaluated medicine was made up of mercury. After the administration of D-penicillamine and intramuscular injection of BAL and cobalamine, clinical symptoms and aggressive behavior were improved as well as laboratory findings.

Why are Diabetic Patients Requiring Hypertonic Glucose Dialysate to Achieve Comparable Ultrafiltration Volume During CAPD? / 대한신장학회잡지

PURPOSE: Hyperglycemia, hypoalbuminemia and other factors make diabetic CRF patient vulnerable to salt and fluid retention, which is partial explanation of high mortality rate of DM dialysis patients. This prospective study was carried out to investigate the different membrane characteristics associated with ultrafiltration between diabetic and non diabetic CAPD patients. METHODS: Among new CAPD patients from May 2001 to January 2004 in our hospitals, 60 patients who had complete data more than 12 month were enrolled. Peritoneal equilibration test and D/P1hr Na using 4.25% dialysate, daily ultrafiltration and urine volume, serum albumin and glucose level, daily exposed and daily absorbed glucose amount through the peritoneal cavity and clinical indices were measured at 1st, 6th, and 12th months after initiation of CAPD. We analyzed data with independent t test, repeated measure of ANOVA and multiple regression by STATA. RESULTS: We can summarized the RESULTS: Changes of body weight, total body water, daily ultrafiltration volume (UFV), D/P4Cr, UFV during PET and RRF were not significantly different between DM and non-DM at 1st, 6th, and 12th months. But 1st month serum albumin was lower in DM (p=0.01). Daily exposed glucose amount was significantly higher in DM group at 1st and 12th months (161.7+/-44.5 g/day vs. 140.3+/-21.1 g/day and 157.4+/-43.8 g/ day vs. 134.0+/-11.3 g/day, p=0.019, p=0.006, respectively). At 1st month, D/P1hr Na was not significantly different between DM and non-DM but DM group showed getting higher (D/P)1hr Na at 6th and 12th month (p=0.04, p=0.006, respectively). Factors associated with D/P1hr Na were DM (beta-coeff= -0.015, p=0.042), log hs CRP (beta-coeff=0.012, p= 0.025), 24 hours dialysate albumin (beta-coeff=-0.010, p=0.000), and D/P4Cr (beta-coeff=0.150, p=0.000). CONCLUSION: Diabetic CAPD patients showed more rapid increase of D/P1hr Na during initial 1 year. It might be due to more rapid deterioration of water channel function with time on PD. In terms of achieving adequate ultrafiltration in diabetic peritoneal dialysis patient with time, higher concentration of glucose or icodextrin containing dialysate might be needed to overcome decreased water channel function.