It is estimated that there are over 5,000 species of mushrooms worldwide. Some of them are edible and some are poisonous due to containing significant toxins. In more than 95% of mushroom toxicity cases, poisoning occurs as a result of misidentification of the mushroom by an amateur mushroom hunter. The severity of mushroom poisoning may vary, depending on the geographic location where the mushroom is grown, growth conditions, the amount of toxin delivered, and the genetic characteristics of the mushroom. Amanita phalloides is the most common and fatal cause of mushroom poisoning. This mushroom contains amanitins, which are powerful hepatotoxins that inhibit RNA polymerase II in liver. Mushroom poisoning is a relatively rare cause of acute liver failure. A 63-year-old male patient was admitted to the emergency room with weakness, nausea, vomiting, and diarrhea. He reported ingesting several wild mushrooms about 36 hours earlier. In this article we report a case of lethal Amanita phalloides intoxication from stored mushrooms.

Objective: The aim of this study was to examine the effect of volume status on the progressions of renal disease in normovolemic and hypervolemic patients with advanced non-dialysis-dependent chronic kidney disease (CKD) who were apparently normovolemic in conventional physical exam­ination. Materials and Methods: This was a prospective interventional study performed in a group of stage 3–5 CKD patients followed up for 1 year. Three measurements were made for volume and renal status for every patient. The fluid status was assessed by a bioimpedance spectroscopy method. A blood pressure (BP) value > 130/80 mm Hg prompted the initiation or dose increment of diuretic treatment in normovolemic patients. Result: Forty-eight patients (48%) were hypervolemic. At the end of the 1-year follow-up, hypervolemic patients were found to have a significantly lower estimated glomerular filtration rate and higher systolic BP compared to baseline. Hypervolemia was associated with an increased incidence of death. Conclusion: We have shown that maintenance of normovolemia with diuretic therapy in normovolemic patients was able to slow down and even improve the progression of renal disease. Volume overload leads to an increased risk for dialysis initiation and a decrease in renal function in advanced CKD. Volume overload exhibits a stronger association with mortality in CKD patients.

IntroductionGestational diabetes mellitus (GDM) is a common condition that is defined as glucose intolerance of varying degree with onset or first recognition during pregnancy and it affects approximately 5% of all pregnancies all over the world. GDM is not only associated with adverse pregnancy outcomes such as macrosomia, dystocia, birth trauma, and metabolic complications in newborns, but it is also a strong predictor of transitioning to overt DM postpartum. The association of ABO blood groups with DM has been observed before in several epidemiological and genetic studies and resulted with inconsistent findings, but still there are not enough studies in the literature about the association of ABO blood groups with GDM. In this study, we aimed at investigating any possible relationship between the ABO blood group system and GDM and also the transitioning of GDM to overt DM postpartum, in Turkey.Patients and methodsA total of 233 patients with GDM from Kayseri Training and Research Hospital between 2002 and 2012 were included in the study. The cases that have serologically determined blood groups and Rh factor in the hospital records were included in the study, and the patients with unknown blood groups were excluded. Patients were classified according to blood groups (A, B, AB, and O) and Rh status (+/−). GDM was diagnosed based on the glucose cut-points of the International Association of the Diabetes and Pregnancy Society Groups. The distributions of blood groups of the patients with GDM were compared with the distribution of blood groups of 17,314 healthy donors who were admitted to the Turkish Red Crescent Blood Service in our city in 2012.ResultsThere was a significant difference between the patients with GDM and control group in terms of distribution of ABO blood groups. Blood group AB was found to be higher in the patients with GDM compared to the control group (P=0.029). When the patients were compared according to the development of DM, the ratio of group O was higher than others, while the ratio of group B was lower in the group developing DM (P=0.001). There was a significant difference between the groups – GDM patients with or without DM – in terms of distribution of ABO blood groups with Rh factor and the ratio of developing DM is found to be higher in patients with +Rh factor among all the blood groups except for group B (P=0.008).ConclusionIn this study, we found a higher risk of GDM for the patients with blood group AB, which means that we have to be more careful on the follow-up of pregnant women with blood group AB. The patients with GDM of blood group O are under a higher risk of developing DM and also +Rh factor must be considered as another risk factor, so these patients should be closely followed postpartum by the oral glucose tolerance tests. To our knowledge, this is the first analysis that investigates the association between the ABO blood groups and transitioning to DM after GDM.

IntroductionPreeclampsia (PE) is a pregnancy-related disorder characterized by hypertension (HT) and proteinuria noticeable after 20 weeks of gestation. PE is now considered as a cardiovascular disease risk factor and a number of studies have shown that experiencing PE increases the prevalence of various cardiovascular risk factors, such as metabolic syndrome and HT. In this study, we aimed to investigate any possible relationship between the ABO/Rh blood group system and PE in Turkey. In the second part of the study, we examined the relationship between the ABO blood group system and development of HT after PE.Patients and methodsA total of 250 patients with PE from Kayseri Training and Research Hospital between 2002 and 2012 were included in the study. Patients were classified according to blood groups (A, B, AB, and O) and Rh status (+/−).ResultsThere was a significant difference between the patients with PE and the control group in terms of distribution of ABO blood groups and the percentage of group AB was found to be higher in patients with PE compared to the control group (P=0.029). The risk of developing PE was significantly higher in group AB than other blood groups (P=0.006). The risk of developing HT after PE was significantly higher in group O than other blood groups (P=0.004).DiscussionIn this study, we found that the patients with blood group AB have a higher risk for PE. The patients with PE of blood group O are at high risk of developing HT, and Rh factor was identified as another risk at this point and these patients should be closely followed postpartum.

The syndrome of inappropriate antidiuretic hormone (SI-ADH) was first described in 1957 by Schwartz and colleagues in two lung cancer cases that showed urinary sodium loss (1). SIADH is characterised by hyponatraemia, inappropriately increased urine osmolality, increased urine sodium, and decreased serum osmolality in a euvolemic patient without edema. Also, these findings should be considered in a patient with normal cardiac, renal, adrenal, hepatic, and thyroid functions and taking no diuretics. Excess water is the main problem in SIADH and therefore dilutional hyponatraemia develops (2).Codeine is an opioid analgesic used for moderate to severe pain. Its analgesic effect is dependent on the conversion to morphine and morphine-6-glucuronide because the binding affinity of codeine to µ (mu) opioid receptors is 200-fold less than that of morphine (3). Constipation and lethargy are frequent side effects. The side effect profile, such as nausea, vomiting, hypotension, tachycardia-bradycardia, confusion, imbalance, headache, dizziness, fatigue, urticaria, ureteral spasm, reduction in miction, and the very rarely seen tonicclonic seizures and respiratory depression is quite wide (4). However, some of the symptoms observed during the use of codeine such as nausea, vomiting, headache, fatigue, confusion, and seizures can also be the symptoms of hyponatraemia. In this case report, we present a SIADH patient with reduced urine volume, increased urine sodium, and decreased serum sodium concentration after using codeine-paracetamol combination medication, which is rarely encountered before, according to our review of the literature. CASE PRESENTATIONA previously healthy 77-year-old female of 82 kg in weight and 161 cm in height presented to the emergency service with a 3 to 4 day history of reduced amount of urine, nausea, vomiting, weakness, anorexia, dizziness, abdominal pain, constipation, and abdominal bloating. Fifteen days ago, she was admitted to the dermatology clinic for the vesicular and painful lesions on the right middle of the abdomen. She was prescribed hydroxyzine 25 mg tablets, topical mupirocin pomade, flurbiprofen tablets, and a combination of vitamin B1 and B6 pills for the diagnosis of herpes zoster; however, she used these medications only once because her pain was not resolved. After that, she used the combination of codeine phosphate 30 mg and paracetamol 500 mg, which is unused in our country and was brought by her son from abroad, for her painful lesions.On physical examination, the patient showed full cooperation and orientation. Her vital signs were as follows: temperature 36.6°C, heart rate: 102/minute, respiratory rate: 18/minute, and blood pressure: 107/82 mmHg. Her mucous membranes were wet; turgor and tonus were normal. She had Background: The syndrome of inappropriate antidiuretic hormone was first described in 1957 by Schwartz, and is characterised by hyponatraemia, inappropriately increased urine osmolality and urine sodium, and decreased serum osmolality in a euvolemic patient without e...