The PCQP Score for Volume Status of Acutely Ill Patients: Integrating Vascular Pedicle Width, Caval Index, Respiratory Variability of the QRS Complex and R Wave Amplitude.

INTRODUCTION: Techniques for measuring volume status of critically ill patients include invasive, less invasive, or noninvasive ones. The present study aims to assess the accuracy of noninvasive techniques for measuring volume status of critically ill patients. PATIENTS AND METHODS: A total of 111 critically ill patients admitted to the emergency department and undergoing central venous catheterization were included in the study. Five parameters were measured including vascular pedicle width (VPW), diameter of inferior vena cava, caval index, respiratory changes in QRS, and P wave amplitude. Patients with risk factors which could decrease the accuracy of central venous pressure (CVP) value were excluded from study. We compared these parameters with static CVP parameter. Finally, based on the afore-mentioned parameters, PCQP role in criteria was designed. RESULTS: In detecting loss of circulating blood volume, area under the curve of VPW was 0.92 (90%, confidence interval [CI]: 0.85-0.99), diameter of inferior vena cava was 0.82 (90%, CI: 0.72-0.91), caval index was 0.9 (90%, CI: 0.82-0.98), and changes in QRS and P waves were 0.88 (95%, CI: 0.81-0.95) and 0.73 (95%, CI: 0.63-0.82), respectively. PCQP role in criteria was designed according to these parameters, and at its best cutoff point (score 6), VPW had a sensitivity of 97.4% (95%, CI: 84.57-99.99) and specificity of 83.6% (95%, CI: 72.65-90.86) for the detection of loss of circulating blood volume (<8 cmH2O). CONCLUSION: PCQP score could be a reliable and noninvasive technique for the assessment of volume status in critically ill patients.

Acute hepatorenal failure in a patient following consumption of mushrooms: a case report.

INTRODUCTION: One of the highly toxic mushrooms that are common in the northwest region of Iran is Amanita phalloides, which might result in renal or liver failure. CASE PRESENTATION: This is a case report of a patient referred a few days after consumption of wild mushrooms to emergency department having gastrointestinal complaint whose experiments indicated liver and renal failure. The supportive treatment was given to the patient prescribing N-acetyl cysteine (NAC) and Livergol (silymarin) along with hemodialysis. A few days after admission to the hospital, the patient died due to severe clinical symptoms. CONCLUSIONS: The patient was poisoned by A. phalloides complaining gastrointestinal symptoms including nausea; vomiting and watery diarrhea about six hours after consumption and then, amatoxin in the mushroom caused damage to hepatocytes and renal cells and finally led to hepatorenal failure. Deaths caused by this type of mushroom are extremely high and necessary trainings should be provided to the people by the health system not to consume wild mushrooms, especially in spring and summer.