- A Case of Ethylene Glycol intoxication with Acute Renal Injury: Successful Recovery by Fomepizole and Renal Replacement Therapy. [Journal Article]
- EBElectrolyte Blood Press 2017; 15(2):47-51
- Ethylene glycol is a widely used and readily available substance. Ethylene glycol ingestion does not cause direct toxicity; however, its metabolites are highly toxic and can be fatal even in trace am...
Ethylene glycol is a widely used and readily available substance. Ethylene glycol ingestion does not cause direct toxicity; however, its metabolites are highly toxic and can be fatal even in trace amounts. Poisoning is best diagnosed through inquiry, but as an impaired state of consciousness is observed in most cases, poisoning must be suspected when a significantly elevated osmolar gap or high anion gap metabolic acidosis is found in blood tests. Hemodialysis and alcohol dehydrogenase inhibitors such as ethanol and fomepizole are a part of the basic treatment, and timely diagnosis and treatment are crucial because any delays can lead to death. However, there are few reported cases in Korea, and no report on the use of fomepizole. Herein, we report a case of acute renal failure caused by ethylene glycol poisoning that was treated with fomepizole and hemodialysis and present a literature review.
- Hyperosmolar metabolic acidosis in burn patients exposed to glycol based topical antimicrobials-A systematic review. [Review]
- BBurns 2017 Aug 07
- CONCLUSIONS: This first systematic review found very few cases of documented hyperosmolar metabolic acidosis, all within one study that had set to specifically explore this toxidrome. High index of suspicion with frequent osmolar gap monitoring may help identify future toxicities in a timely manner.
- Targeted metabolomics in colorectal cancer: a strategic approach using standardized laboratory tests of the blood and urine. [Journal Article]
- HHypoxia (Auckl) 2017; 5:61-66
- CONCLUSIONS: Patients with mCRC had higher venous pCO2 levels than those with local disease. Although causation cannot be established, we hypothesize that pCO2 elevation may stem from a perturbed metabolism in mCRC.
- Formulas for Calculated Osmolarity and Osmolal Gap: A Study of Diagnostic Accuracy. [Journal Article]
- AJAm J Kidney Dis 2017; 70(3):347-356
- CONCLUSIONS: Single center, no external validation, limited number of cases with detectable toxic alcohols.In a large cohort, coefficients from regression analyses estimating the contribution of glucose, urea, and ethanol were higher than 1.0. Our simplified formula to precisely calculate osmolarity yielded improved diagnostic accuracy for suspected toxic alcohol exposures than previously published formulas.
- Flexible DNA Path in the MCM Double Hexamer Loaded on DNA. [Journal Article]
- BBiochemistry 2017 May 16; 56(19):2435-2445
- The formation of the pre-replicative complex (pre-RC) during the G1 phase, which is also called the licensing of DNA replication, is the initial and essential step of faithful DNA replication during ...
The formation of the pre-replicative complex (pre-RC) during the G1 phase, which is also called the licensing of DNA replication, is the initial and essential step of faithful DNA replication during the subsequent S phase. It is widely accepted that in the pre-RC, double-stranded DNA passes through the holes of two ring-shaped minichromosome maintenance (MCM) 2-7 hexamers; however, the spatial organization of the DNA and proteins involved in pre-RC formation is unclear. Here we reconstituted the pre-RC from purified DNA and proteins and visualized the complex using atomic force microscopy (AFM). AFM revealed that the MCM double hexamers formed elliptical particles on DNA. Analysis of the angle of binding of DNA to the MCM double hexamer suggests that the DNA does not completely pass through both holes of the MCM hexamers, possibly because the DNA exited from the gap between Mcm2 and Mcm5. A DNA loop fastened by the MCM double hexamer was detected in pre-RC samples reconstituted from purified proteins as well as those purified from yeast cells, suggesting a higher-order architecture of the loaded MCM hexamers and DNA strands.
- Continuous-Infusion Etomidate in a Patient Receiving Extracorporeal Membrane Oxygenation. [Journal Article]
- JPJ Pediatr Pharmacol Ther 2017 Jan-Feb; 22(1):65-68
- We describe a 16-year-old, 65-kg male deployed on extracorporeal membrane oxygenation (ECMO) for refractory respiratory failure secondary to ingestion of multiple substances. During his ECMO course, ...
We describe a 16-year-old, 65-kg male deployed on extracorporeal membrane oxygenation (ECMO) for refractory respiratory failure secondary to ingestion of multiple substances. During his ECMO course, standard sedative and analgesic strategies failed and alternative medications were used. The patient received various dosages of fentanyl, morphine, hydromorphone, clonidine patches, dexmedetomidine, lorazepam, methadone, pentobarbital, olanzapine, and propofol. Despite administration of multiple agents, on day 29 of ECMO the patient experienced elevated blood pressures due to agitation, and continuous infusion etomidate was started. At the time of etomidate initiation, the osmolar gap was 8 mOsm/kg. During etomidate therapy, the blood pressure remained normal, sedative agents were slowly weaned, and the patient required few PRN medications. On day 6 of etomidate, the osmolar gap increased to 127 mOsm/kg and etomidate was discontinued. Continuous-infusion ketamine was started, but the blood pressure was not controlled. Metabolic acidosis is a known side effect of etomidate due to inclusion of propylene glycol as a pharmaceutical solvent in the formulation. Despite high-dose etomidate (20 mcg/kg/min) for approximately 6 days, our patient did not experience metabolic acidosis. Absence of this adverse effect caused us to question the role of the ECMO circuit. To our knowledge, this is the first report of the use of continuous-infusion etomidate during ECMO. Etomidate infusion could be considered in difficult-to-manage patients after other alternatives have failed.
- Serum osmolal gap in clinical practice: usefulness and limitations. [Review]
- PMPostgrad Med 2017; 129(4):456-459
- CONCLUSIONS: The definition and the best formula used for the calculation of osmolal gap, the main causes of increased osmolal gap with or without increased anion gap metabolic acidosis, as well as the role of concurrent lactic acidosis or ketoacidosis are presented under a clinical point of view.The calculation of osmolal gap is crucial in the differential diagnosis of many patients presenting in emergency departments with possible drug or substance overdose as well as in comatose hospitalized patients.
- Biological responses to phenylurea herbicides in fish and amphibians: New directions for characterizing mechanisms of toxicity. [Review]
- CBComp Biochem Physiol C Toxicol Pharmacol 2017; 194:9-21
- Urea-based herbicides are applied in agriculture to control broadleaf and grassy weeds, acting to either inhibit photosynthesis at photosystem II (phenylureas) or to inhibit acetolactate synthase ace...
Urea-based herbicides are applied in agriculture to control broadleaf and grassy weeds, acting to either inhibit photosynthesis at photosystem II (phenylureas) or to inhibit acetolactate synthase acetohydroxyacid synthase (sulfonylureas). While there are different chemical formulas for urea-based herbicides, the phenylureas are a widely used class in North America and have been detected in aquatic environments due to agricultural run-off. Here, we summarize the current state of the literature, synthesizing data on phenylureas and their biological effects in two non-target animals, fish and amphibians, with a primary focus on diuron and linuron. In fish, although the acutely lethal effects of diuron in early life stages appear to be >1mg/L, recent studies measuring sub-lethal behavioural and developmental endpoints suggest that diuron causes adverse effects at lower concentrations (i.e. <0.1mg/L). Considerably less toxicity data exist for amphibians, and this is a knowledge gap in the literature. In terms of sub-lethal effects and mode of action (MOA), linuron is well documented to have anti-androgenic effects in vertebrates, including fish. However, there are other MOAs that are not adequately assessed in toxicology studies. In order to identify additional potential MOAs, we conducted in silico analyses for linuron and diuron that were based upon transcriptome studies and chemical structure-function relationships (i.e. ToxCast™, Prediction of Activity Spectra of Substances). Based upon these analyses, we suggest that steroid biosynthesis, cholesterol metabolism and pregnane X receptor activation are common targets, and offer some new endpoints for future investigations of phenylurea herbicides in non-target animals.
- Basic concepts and practical equations on osmolality: Biochemical approach. [Review]
- CBClin Biochem 2016; 49(12):936-41
- The terms osmotic pressure, osmotic coefficient, osmole, osmolarity, osmolality, effective osmolality and delta osmolality are formally defined. Osmole is unit of the amount of substance, one mole of...
The terms osmotic pressure, osmotic coefficient, osmole, osmolarity, osmolality, effective osmolality and delta osmolality are formally defined. Osmole is unit of the amount of substance, one mole of nonionized impermeant solute is one osmole. Assuming an ideal solution, osmotic pressure (π) in mmHg is 19.3 times the osmolarity. Osmolarity is defined as the number of milliosmoles of the solutes per liter of solution. Suitable equations are presented for the rapid calculation of the osmolarity of different solutions. The concentrations of electrolytes are expressed by mEq/L that is, equal to their osmolarity as mOsm/L. If the solute concentration (C) is expressed as mg/L, mg/dL and g%, osmolarity is calculated as: C.n' /MW, C.n' (10)/MW and C.n' (10(4))/MW respectively. Osmolality is milliosmoles of solutes per one kilogram (or liter) of water of solution (plasma) and is calculated by osmolarity divided to plasma water. The osmolal concentration is corrected to osmolal activity by using the osmotic coefficient, φ. The salts of sodium (choloride and bicarbonate) and nonelectrolyte glucose and urea are the major five osmoles of plasma. The equation: Posm =2 [Na(+)]+glucose (mg/dL)/18+BUN (mg/dL)//2.8 is also the simplest and best formula to calculate plasma osmolality. The concentration of only effective osmoles evaluates effective osmolality or tonicity as: Eosm =2 [Na(+)]+glucose/18. The normal range of plasma tonicity is 275-295mOsm/kg of water. The difference between the measured and calculated osmolality is called osmolal gap. It is recommended to withdraw the formula of Dorwart-Chalmers from the textbooks and autoanalyzers and to use the simplest equation of Worthley et al. as the best equation for calculating serum osmolality. Furthermore the normal ranges of osmolal gap also must be corrected to 0±2mOsm/L.
New Search Next
- Can Neural Activity Propagate by Endogenous Electrical Field? [Journal Article]
- JNJ Neurosci 2015 Dec 2; 35(48):15800-11
- It is widely accepted that synaptic transmissions and gap junctions are the major governing mechanisms for signal traveling in the neural system. Yet, a group of neural waves, either physiological or...
It is widely accepted that synaptic transmissions and gap junctions are the major governing mechanisms for signal traveling in the neural system. Yet, a group of neural waves, either physiological or pathological, share the same speed of ∼0.1 m/s without synaptic transmission or gap junctions, and this speed is not consistent with axonal conduction or ionic diffusion. The only explanation left is an electrical field effect. We tested the hypothesis that endogenous electric fields are sufficient to explain the propagation with in silico and in vitro experiments. Simulation results show that field effects alone can indeed mediate propagation across layers of neurons with speeds of 0.12 ± 0.09 m/s with pathological kinetics, and 0.11 ± 0.03 m/s with physiologic kinetics, both generating weak field amplitudes of ∼2-6 mV/mm. Further, the model predicted that propagation speed values are inversely proportional to the cell-to-cell distances, but do not significantly change with extracellular resistivity, membrane capacitance, or membrane resistance. In vitro recordings in mice hippocampi produced similar speeds (0.10 ± 0.03 m/s) and field amplitudes (2.5-5 mV/mm), and by applying a blocking field, the propagation speed was greatly reduced. Finally, osmolarity experiments confirmed the model's prediction that cell-to-cell distance inversely affects propagation speed. Together, these results show that despite their weak amplitude, electric fields can be solely responsible for spike propagation at ∼0.1 m/s. This phenomenon could be important to explain the slow propagation of epileptic activity and other normal propagations at similar speeds.