• Neonatal Medicine
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• 제17권2호
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• pp.168-180
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• 2010

Acute renal failure (ARF) is common in the neonatal period, however, there are no uniform treatment strategies of ARF. The main treatment strategies are conservative management including medical treatment and the renal replacement therapy. Because ARF in the newborn is commonly acquired by hypoxic ischemic injury and toxic insults, removal of all the offending causes is important. Aminoglycoside, indomethacin, and amphotericin-B are the most common nephrotoxic drugs of ARF. To relieve the possible prerenal ARF, initial fluid challenge can be followed by diuretics. If there is no response, fluid restriction and correction of electrolyte imbalance should begin. Adequate nutritional support and drug dosing according to the pharmacokinetics of such drugs will be difficult problems. Renal replacement therapies may be provided by peritoneal dialysis, intermittent hemodialysis, or hemofiltration. New promising agents, bioartificial kidney, and stem cell will enable us to extend our therapeutic repertoire.

• Clinical and Experimental Pediatrics
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• 제50권10호
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• pp.938-947
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• 2007

Many dialysis modalities such as peritoneal dialysis (PD), hemodialysis (HD) and continuous hemofiltration or hemodialysis (CRRT) are available for the management of pediatric patients with acute renal failure (ARF). PD is a relatively simple, inexpensive modality and can be used in hemodynamically unstable patients. But, it may not be the optimal therapy for patients with severe volume overload or life threatening hyperkalemia. HD is the preferred modality for the treatment of severe volume overload, severe hyperkalemia, but it needs vascular access. Improvements in the HD equipment have allowed HD to be performend in small children. Recents technological improvements in CRRT therapies have enabled pediatric patients who are less stable to be treated. CRRT is becoming the preferred method of acute therapy in pediatric intensive care units. A sound knowledge of the underlying principles of dialysis and awareness of recent technological advancements in differnet dialysis modalities will hopefully result in improved management of children with ARF.

• Journal of Chest Surgery
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• 제25권3호
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• pp.232-239
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• 1992

Acute renal failure is a well known serious complication following open heart surgery and is associated with a significant increase in morbidity and mortality rate. From 1984 to 1990, 33 patients who had acute renal failure following cardiopulmonary bypass received renal replacement therapy. PD[Peritonial dialysis] was employed in 11 patients and CAVH[continous arteriovenous hemofiltration] was employed in 22 patients. Their age ranged from 3 months to 64 years[mean 25.5$\pm$7.8 years]. The disease entities included congenital cardiac anomaly in 18, valvular heart disease in 15 and aorta disease in 2 cases. Low cardiac output was thought as a primary cause of ARF except two redo valve cases who showed severe Aemolysis k depressed renal function preoperatively. Mean serum BUN and creatinine level at the onset renal replacement therapy were 65$\pm$8 mg/dl and 3.5$\pm$0.4 mg/dl respectively, declining only after reaching peak level 7&10 days following the onset of therapy. Overall hospital mortality was 72.7%[24/33]; 81%[9/11] in PD group and 68.2% [15/22] in CAVH group respectively. The primary cause of death was low cardiac output & hemodynamic depression in all the cases. The fatal complications included multiorgan failure in 7, disseminated intravascular coagulation and sepsis in 6, neurologic damage in 4 and mediastinitis in 3 cases. No measurable differences were observed between CAVH and PD group upon consequence of acute renal failure and disease per se. The age at operation, BUN/Cr level at the onset of bypass and highest BUN/Cr level and the consequence of low output status were regarded as important risk factors, determining outcome of ARF and success of renal replacement therapy. Thus, we concluded that althoght the prognosis is largely determined by severity of low cardiac output status and other organ complication, early institution of renal replacement therapy with other intensive supportive measures could improve salvage rate in established ARF patients following CPB.

• 대한의용생체공학회:의공학회지
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• 제26권5호
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• pp.337-341
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• 2005

Blood pulsation has been reported to have an advantageous effect on extracorporeal blood circulation. However, the study of pulsatile blood flow in renal replacement therapy is very limited. The in-vitro experimental results of pulsatile blood flow on ultrafiltration, when compared with the conventional roller pump, are described in this paper. Methods: Blood flow rate (QB) and transmembrane pressure (TMP) were considered as regulating factors that have an influence on ultrafiltration. Experiments were performed under the condition of equal TMP and OB in both pulsatile and roller pump groups, Several kinds of hollow fiber dialyzers were tested using distilled water containing chemicals as a blood substitute. Mean TMP (mTMP) varied from 10 to 90mmHg while the QB was 200ml/min. Results: Ultrafiltration rate (QUF) was found to be linearly proportional to TMP, whereas QB had little influence on QUF. In addition, QUF was higher in the pulsatile group than the roller pump group at the identical TMP. Conclusion: In the controlled test, QUF increased solely as a consequence of blood pulsation, which implies that the pulse frequency represents an additional and important clinical variable during renal replacement therapy.

• Parasites, Hosts and Diseases
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• 제51권5호
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• pp.551-555
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• 2013

Complicated malaria is mainly caused by Plasmodium falciparum, but, increasingly, Plasmodium vivax is also being reported as a cause. Since the reemergence of indigenous vivax malaria in 1993, cases of severe malaria have been steadily reported in Korea. Herein, we report a case of vivax malaria complicated by adult respiratory distress syndrome (ARDS) that was successfully managed with extracorporeal membrane oxygenation (ECMO). A 59-year-old man presented at our hospital with fever and abdominal pain, which had persisted for 10 days. On admission, the patient had impaired consciousness, shock, hypoxia and haziness in both lungs, jaundice, thrombocytopenia and disseminated intravascular coagulation, metabolic acidosis, and acute kidney injury. A peripheral blood smear and a rapid diagnostic test verified P. vivax mono-infection. Ten hours after admission, hypoxia became more severe, despite providing maximal ventilatory support. The administration of antimalarial agents, ECMO, and continuous venovenous hemofiltration resulted in an improvement of his vital signs and laboratory findings. He was discharged from the hospital 7 weeks later, without any sequelae.

• 대한임상독성학회지
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• 제5권2호
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• pp.126-130
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• 2007

Metformin is antihyperglycemic, not hypoglycemic. It causes neither insulin release from the pancreas nor hypo glycemia, even when taken in large doses. But, there are several reports of metformin-associated lactic acidosis (MALT). We present a case report of severe lactic acidosis most probably resulting from high doses of metformin in a patient with no known contraindications for metformin. A 43-year-old female was admitted to the emergency department due to a metformin overdose. She had diabetes for 6 years, well-controlled with metformin and novolet. One hour before admission, she impulsively took 50g metformin (100 mg or 100 tablets). Physical examination for symptoms revealed only irritability, and laboratory evaluation revealed only mild leukocytosis. After one hour the patient was drowsy, and arterial blood gas analysis showed severe lactic acidemia Seven hours after ED arrival, she commenced hemofiltration treatment and was admitted to the intensive care unit. Continuous venovenous hemodiafiltration was initiated. Forty-eight hours later, full clinical recovery was observed, with return to a normal serum lactate level. The patient was discharged from the intensive care unit on the third day. A progressive recovery was observed and she was discharged from the general word on the thirteenth day.

• Journal of Chest Surgery
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• 제37권8호
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• pp.660-664
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• 2004

배경: 냉혈심정지액은 저온에서 적혈구응집현상을 방지하고 미세순환을 좋게 하기 위해 심정지액을 4 : 1로 희석하여 사용하도록 권장되었는데 간헐적전방온혈심정액(IAWBC)에서는 심정지액을 냉각하지 않기 때문에 희석할 필요가 없이 고농도 포타슘을 바로 사용할 수 있게 되었다. 본 연구는 IAWBC에서 희석되지 않은 고농도 포타슘 사용의 안전성과 유용성을 알아보고자 한다. 대상 및 방법: 관상동맥우회로 조성수술을 받은 환자 중 IAWBC를 이용한 환자 30명을 대상으로 하였다. 1 : 4로 희석된 온혈심정지액을 사용한 군을 dilutedplegia군으로 하고 희석되지 않은 포타슘을 사용한 군을 microplegia군으로 하였다. dilutedplegia군의 심정지액은 1 : 4 delivery kit를 이용하여 상행대동맥뿌리에 주입되었고 microplegia군에서는 희석되지 않은 포타슘을 infusion pump를 이용하여 산소포화 된 혈액에 직접 연결하여 대동맥뿌리에 주입하였다. 걸과: microplegia군이 16명, 대조군인 dilutedplegia군이 14명으로 나이, 성별, 좌심실 구획률, 이식혈관 수, 대동맥차단시간, 수술 후 심근효소치에서는 두 군에서 차이가 없었다(p＞0.05). 모든 환자에서 수술 후 심근경색과 수술사망은 없었다. dilutedplegia군에서 사용된 crystalloid심정지액의 양은 1346$\pm$597 mL (평균$\pm$표준편차)이었고 microplegia군에서는 28$\pm$9mL이었다. 체외순환 중 적혈구 구획률은 microplegia군에서 24$\pm$3%로 dilutedplegia군의 21$\pm$4%에 비해 약간 높았으나 통계학적 의의는 없었다. 체외순환 중에 수혈을 받은 환자는 microplegia군에서 4명인데 비해 dilutedplegia군에서는 11명으로 높았다(p＜0.05). 수술 중 환자의 소변량과 혈액여과한 양에서 microplegia군이 959$\pm$410 mL와 1481$\pm$784 mL로 dilutedplegia군의 1250$\pm$810mL와 1689$\pm$548 mL에 비해 통계학적으로 의의 있게 적었다(p<0.05). 결론: 관상동맥우회로 조성수술에서 전방온혈심정지액을 사용할 때 희석되지 많은 고농도 포타슘은 fliud overload와 수혈을 피하고 delivery kit를 사용하지 않음으로써 효과적이고 만족할 만한 심근보호 효과를 보였다.