A carbamazepine intoxication with suicide attempt is a relatively common clinical problem that presenting with coma, respiratory depression, arrhythmia, hemodynamic instability and even death. We report a case of severe carbamazepine poisoning that was successfully treated with one session charcoal hemoperfusion. On admission, the patient was comatose and required ventilator support. Hemoperfusion with coated activated charcoal successfully decreased the serum carbamazepine concentration from 45 µg mL−1 to 21 µg mL−1 within 2 h, with subsequent clinical improvement.

Myasthenia gravis is an autoimmune disorder that is characterized by muscle weakness that fluctuates, worsening with exertion, and improving with rest. Diagnosis of myasthenia gravis is made following clinical and physical examination and is confirmed by serum immunoassays to measure autoantibody levels. Myasthenia gravis especially when associated with pregnancy is a high-risk disease, and its course is unpredictable. We described the second report about use of sugammadex after rocuronium for a caesarean delivery with myasthenia gravis, but, unlike our case that formerly was diagnosed with myasthenia gravis, the patient was extubated on postoperative successfully and we did not encounter any respiratory problems.

BackgroundEnd stage renal disease is related to increased cardiovascular mortality and morbidity. Hypertension is an important risk factor for cardiovascular disorder among hemodialysis (HD) patients. The aim of this study was to investigate the effect of low-sodium dialysate on the systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels detected by ambulatory BP monitoring (ABPM) and interdialytic weight gain (IDWG) in patients undergoing sustained HD treatment.Patients and methodsThe study included 46 patients who had creatinine clearance levels less than 10 mL/min/1.73 m2 and had been on chronic HD treatment for at least 1 year. After the enrollment stage, the patients were allocated low-sodium dialysate or standard sodium dialysate for 6 months via computer-generated randomization.ResultsTwenty-four hour SBP, daytime SBP, nighttime SBP, and nighttime DBP were significantly decreased in the low-sodium dialysate group (P<0.05). No significant reduction was observed in both groups in terms of 24-hour DBP and daytime DBP (P=NS). No difference was found in the standard sodium dialysate group in terms of ABPM. Furthermore, IDWG was found to be significantly decreased in the low-sodium dialysate group after 6 months (P<0.001).ConclusionThe study revealed that low-sodium dialysate leads to a decrease in ABPM parameters including 24-hour SBP, daytime SBP, nighttime SBP, and nighttime DBP and it also reduces the number of antihypertensive drugs used and IDWG.

No abstract

The effectiveness of many physiological parameters and laboratory tests was investigated in predicting mortality. In this study, we investigated hematocrit, C-reactive protein, transferrin and total lymphocyte count along with Acute Physiology and Chronic Health Evaluation II and Glasgow Coma Scores of patients who were hospitalized in the intensive care unit. The data were retrospectively analyzed from hospital information management system, doctors' records and nurse observing forms. The mortality rate was 42.6%. The Acute Physiology and Chronic Health Evaluation II scores were significantly higher in cases with mortality compared to those without mortality. The admission and discharge Glasgow Coma Scores were significantly lower in patients who showed mortality compared with patients without mortality. Admission and discharge hematocrit and transferrin values were significantly lower in cases with mortality compared to those without mortality. Discharge C-reactive protein values were significantly higher in cases with mortality compared to those without mortality. Discharge total lymphocyte count values were significantly lower in cases with mortality compared to those without mortality. Consequently, we believe that hematocrit and transferrin values at the time of admission to the intensive care unit and total lymphocyte count and C-reactive protein at the time of discharge from the intensive care unit can be effective in predicting mortality. Yoğun Bakım Hastalarında Hematokrit, Lenfosit, C-Reaktif Protein ve Transferrin Düzeylerinin MortaliteTahmininde Etkinliği ÖZET Mortalite tahmininde birçok fizyolojik parametre ve laboratuvar testinin etkinliği araştırılmıştır. Bu çalışmada, yoğun bakım ünitesinde yatan hastaların Akut Fizyoloji ve Kronik Sağlık Değerlendirmesi II ve Glasgow Koma Skalası skorları ile hematokrit, C-reaktif protein, transferrin ve total lenfosit sayısı değerleri incelendi. Veriler retrospektif olarak hastane bilgi yönetim sistemi, doktor notları ve hemşire gözlem formlarından elde edildi. Mortalite oranı % 42,6 olarak bulundu. Mortalite görülen olguların Akut Fizyoloji ve Kronik Sağlık Değerlendirmesi II değerleri, mortalite görülmeyen olgulardan anlamlı şekilde yüksek bulundu. Mortalite görülen olguların giriş ve çıkış Glasgow Koma Skalası değerleri, mortalite görülmeyen olgulardan anlamlı şekilde düşük bulundu. Mortalite görülen olguların giriş ve çıkış hematokrit ve transferrin değerleri, mortalite görülmeyen olgulardan anlamlı şekilde düşük bulundu. Mortalite görülen olguların çıkış C-reaktif protein değerleri, mortalite görülmeyen olgulardan anlamlı şekilde yüksek bulundu. Mortalite görülen olguların çıkış total lenfosit değerleri, mortalite görülmeyen olgulardan anlamlı şekilde düşük bulundu. Sonuç olarak, hematokrit ve transferrinin yoğun bakım ünitesine giriş değerlerinin; total lenfosit sayısı ve C-reaktif proteinin yoğun bakım ünitesinden çıkış değerlerinin mortalite tahmininde efektif olabileceği kanısındayız.Anahtar kelimeler: C-reaktif protein, hematokrit, mortalite tahmini, ...