Anticoagulant rodenticide ingestion: Who will develop coagulopathy?

Introduction: Development of coagulopathy after anticoagulant rodenticide ingestion varies among patients. This study aimed to identify factors that were associated with coagulopathy after anticoagulant rodenticide ingestion. Methods: This was a retrospective cohort study, conducted in the Hong Kong Poison Information Centre. All patients who reported rodenticide exposure and presented to the Accident and Emergency Department from 1 January 2010 to 31 December 2019 were recruited. Coagulopathy was defined as International Normalized Ratio of 1.3 or above. Results: One hundred sixty-nine patients were included in the final analysis. The median age was 44 years old. Forty-nine patients developed coagulopathy (International Normalized Ratio ⩾1.3). Univariate analysis (at p < 0.05) showed that age (p = 0.003), ingestion of first-generation anticoagulant rodenticide (p = 0.017), ingestion of more than one pack (p < 0.001), intentional ingestion (p = 0.002), hypoalbuminemia (p < 0.001), elevated alanine aminotransferase level (p = 0.041) and abnormal estimated glomerular filtration rate (p = 0.005) on presentation, and co-ingestion with paracetamol (p = 0.018) were associated with coagulopathy after anticoagulant rodenticide ingestion. Among these, ingestion of more than one pack (p < 0.001; odds ratio = 19.8; 95% confidence interval = 6.78–65.7), ingestion of first-generation anticoagulant rodenticide (p = 0.006; odds ratio = 5.2; 95% confidence interval = 1.96–15.2), hypoalbuminemia (p < 0.001; odds ratio = 22.4; 95% confidence interval = 6.17–99.0) and elevated alanine aminotransferase level on presentation (p = 0.039; odds ratio = 7.11; 95% confidence interval = 1.58–33.1) were statistically significant in the multivariate analysis. Conclusion: Ingestion of more than one pack and ingestion of first-generation anticoagulant rodenticides were significantly associated with the development of coagulopathy after anticoagulant rodenticide ingestion. Patients who developed hypoalbuminemia or elevated alanine aminotransferase level as a result of anticoagulant rodenticide ingestion were also significantly associated with the development of coagulopathy.

A RETROSPECTIVE OBSERVATINAL STUDY OF SERUM AMINOTRANSFERSASE LEVELS IN THE ASSESSMENT OF SEVERITY OF DENGUE FEVER

Liver involvement in dengue fever is manifested by the elevation of transaminases due to direct attack of virus itself or the use of hepatotoxic drugs.Objective of our study was to assess the serum aminotransferase level in patient with dengue fever and to correlate serum aminotransferase level and severity of dengue fever. This is a prospective observational study. Atotal of 50 fever patients admitted with positive dengue serology in Medicial ward, ZMCH ,Dahod,were included after satisfying the inclusion and exclusion criteria. All the patients were subjected to complete history taking and clinical examination. Investigations like complete blood count, liver function test, dengue serology and abdominal ultrasound were done in all patients.A total of 50 dengue serology positive patient were included in the study. Among them there were 27 (54%) males and 24(46%) females. In our study 41 patients (82%) had elevated serum transaminase level, Mean ASTlevel was 134.84 IU/Land the mean ALTlevel was 107.88 IU/L. The level of AST is higher when compared to ALT in most of the patients. Among those who had elevated aminotransferase level 12 patients (24%) had both elevated aminotransferase level and free uid in the abdomen. Out of 50 patients 32 (64%) had reduced platelet count (less than one lakh) and all the 32 patients had elevated serum aminotransferase level. There was signicant negative correlation between serum aminotransferase level and platelet count (P value < 0.001).Hepatic dysfunction is very common in all forms of Dengue infection. Serum Aminotransferase level correlate with severity of Dengue fever. Aspartate Aminotransferase was signicantly raised when compared to Alanine Aminotransferase in most of the patients

Liver injury caused by fenofibrate within 48 h after first administration: a case report

Background Fenofibrate is commonly used in the treatment of dyslipidemia. Fenofibrate is related to mild aminotransferase elevations and in some cases severe chronic injury such as fibrosis or cirrhosis, resulting in liver transplantation or death. The latency of disease has been reported to range between weeks to years. Case presentation A 63 years old male with hypertriglyceridemia developed symptoms of fatigue and anorexia 48 h after taking fenofibrate for the first time. The patient’s aminotransferase level was more than 10 times ULN. Immediately, fenofibrate was discontinued and aminotransferase level returned to normal 23 days later. To assess causality between the drug and liver damage, the standardized Roussel Uclaf Causality Assessment Method (RUCAM) was used. The patient's RUCAM score was 7, which fell in the group of “probable”. Eight months later, follow-up examination suggested the liver function was normal. Conclusions Weakness, fatigue and abnormal liver function during fenofibrate therapy should be closely monitored and trigger prompt withdrawal if these symptoms occur.

Diagnosis and Treatment of Patients with Traumatic Retroperitoneal Hematoma Complicated with Bone Fractures

Objective: Traumatic retroperitoneal hematoma (RPH) is an underdiagnosed entity, turned to have a high mortality rate, when is not earlier diagnosed. Our aim was to analyze our experiences in patients with traumatic RPH complicated with bone fractures, and highlight the problems in diagnosis and treatment to facilitate the surgeon’s decision. Methods: In this retrospective study, all cases who presented to the emergency room (ER) and/or admitted to our center with bone fractures complicated with RPH from January 2016 to December 2019 were included (4-years data). Data collected included age, hematoma zones, fracture production mechanisms, mortality, surgical intervention, bones lesions frequency, frequency of pelvic bone injuries, complications and biochemical and hematological analysis (e.g. hemoglobin (Hb), hematocrit (Ht), platelets (PLT), leukocytes (Leu), aspartate aminotransferase level (AST), alanine aminotransferase level (ALT) and creatinine (Cr). All RPHs were diagnosed using computed tomography scan. Results: A total number of 173 RPH cases with bone fractures were included with a mean age of 48.80±1.40. Zone II and III (lateral and pelvic hematoma) bleed were the most common type of RPH. The main fracture production mechanism was road accident (n=110). The bone lesions frequency besides pelvis, was seen in lumbar vertebral fractures (e.g. 19 cases in 2016, 38 cases in 2017, 45 in 2018 and 40 in 2019), comparing with the other fractures, without any statistical significance. An important significance was seen for frequency of pelvic bone injuries, when comparing 2016 with 2018 year (p=0.040). Furthermore, the complications seem to have a statistical significance when 2016 year was compared with all the other years (p=0.030, p=0.035, p=0.052). Regarding the biochemical and hematological analysis, a statistical significance was seen at Hb (when 2016 was compared with 2017 year, p=0.007 and 2018 year, p=0.001), Ht (when 2016 was compared with 2017, p=0.054 and 2018, p=0.002), PLT (when 2016 was compared with 2018 year, p=0.0004, and 2019 year, p=0.002) and ALT (when 2016 was compared with 2017 year, p=0.026, and 2018 year, p=0.026). The highest mortality was registered in 2019 (n=11), being statistically significant in comparison with 2016 year (p=0.030). About 109 patients were treated conservatively, and 64 by surgical interventions. Conclusion: There is a lack of evidence for the best management in RPH, conservative approaching being reserved only for patients who are stable. Therefore, traumatic RPH complicated with bone fractures, especially lumbar vertebral fractures, represent a life-threatening condition, early diagnosis and correct treatment is of upmost importance.

The Frequency of Parenchimatous Lesions in Patients with Traumatic Retroperitoneal Hematoma

Objective: The retroperitoneum represent the anatomical region with the highest mortality rates, in which lesions in this region need special relevance. The aim of this study is to find out the frequency of different parenchimatous injuries related to different zones.Methods: In this retrospective study, all cases who presented to the emergency room and/or admitted to our center with retroperitoneal hematoma (RPH) complicated with parenchimatous lesions from January 2016 to December 2019 were included (4-years data). Data collected included age, hematoma zones, the production mechanisms, mortality, surgical interventions, parenchymatous lesions, complications and biochemical and hematological analysis (e.g. hemoglobin (Hb), hematocrit (Ht), platelets (PLT), leukocytes (Leu), aspartate aminotransferase level (AST), alanine aminotransferase level (ALT) and creatinine (Cr). All RPHs were diagnosed using computed tomography scan.Results: A total number of 119 RPH cases with parenchimatous lesions were included with a mean age of 45.56±2.52. The most common type of RPH was located in lateral zone (zone II) with 65 cases, followed by pelvic zone (zone III) with 36 cases. The main production mechanism for parenchimatous lesions was by road accident (n=57). The highest prevalence of parenchimatous lesions was seen in both lung and splenic lesions (n=54), followed by liver lesion (n=36) and kidney lesions (n=11), without any statistical significance. The complications showed a statistical significance when 2016 year was compare with 2018 (p=0.013). Regarding the biochemical and hematological analysis, a statistical significance was seen at PLT (when 2016 was compared with 2017, p=0.03 and 2018, p=0.008). Only 67 patients were treated by surgical interventions, and the highest mortality was registered in 2019 (n=11).Conclusion: There is a lack of evidence in the frequency of different parenchimatous lesions in RPH cases. We conclude on the basis of our study that mandatory exploration of zone II and III haematoma in parenchimatous lesions should be early diagnosed in order to reduce the morbidity and mortality of the patients.

Safety and feasibility of laparoscopy technology in right hemihepatectomy

Laparoscopic hepatectomy (LH) has been accepted widely owing to its advantages as a minimally invasive surgery; however, laparoscopic right hemihepatectomy (LRH) has rarely been reported. We aimed to compare the benefits and drawbacks of LRH and open approaches. Between January 2014 and October 2017, 85 patients with tumor and hepatolithiasis who underwent LRH (n = 30) and open right hemihepatectomy (ORH) (n = 55) were enrolled in this study. For tumors, LRH showed significantly better results with respect to blood loss (P = 0.024) and duration of hospital stay (P = 0.008) than ORH, while hospital expenses (P = 0.031) and bile leakage rate (P = 0.012) were higher with LRH. However, the operative time and rate of other complications were not significantly different between the two groups. However, for hepatolithiasis, there was less blood loss (P = 0.015) and longer operative time (P = 0.036) with LRH than with ORH. There were no significant difference between LRH and ORH in terms of hospital stay, hospital expenses, and complication rate (P > 0.05). Moreover, the postoperative white blood cell count, alanine aminotransferase level, aspartate aminotransferase level, and total bilirubin were not significantly different in both types of patients (P > 0.05). Our results suggest the safety and feasibility of laparoscopy technology for right hemihepatectomy in both tumor and hepatolithiasis patients.

1443. N-Acetyl Cysteine Coadministration in Prevention of Amphotericin--Induced Electrolytes Imbalances in Children

Background Amphotericin B (AmB) can cause electrolyte abnormalities, including hypokalemia, hypomagnesemia, hypernatremia, and metabolic acidosis; and most important, acute renal failure. Methods We conducted a randomized prospective cohort study from March 2012 to February 2018 at Hacettepe University Ihsan Doğramacı Children Hospital to children receiving AmB. Results A total of 87 patients including 37 patients with NAC and 50 patients without NAC received liposomal amphotericin B during the study period.Serum creatinine, blood urea nitrogen, phosphorus were not different statistically in both groups during the study period. Serum sodium, potassium, calcium, phosphorus, magnesium values taken on third day of AmB treatment were not statistically different in both groups. Mean serum magnesium value was higher in NAC received group on the seventh day of AmB treatment; 1.97 ± 0.33 and 1.69 ± 0.46, respectively, it was statistically significant (P = 0.025). Mean serum magnesium value was also statistically significantly higher in NAC received group on the 14th day of treatment; 1.93 ± 0.20 and 1.72 ± 0.247, respectively, in both groups (P = 0.01). Mean serum sodium values on the 14th day of AmB treatment were also statistically different between 2 groups; 136.7 ± 3.7 and 140.04 ± 5.1, respectively (P = 0.005). Serum sodium values on the 14th day of AmB treatment was in more normal limits in NAC received group. Serum alanine aminotransferase level was significantly lower in NAC received group (P = 0.02). Serum aspartate aminotransferase level was significantly lower in NAC received group (P = 0.007). Nineteen of 37 (51.4%) patients who received NAC concomitantly with AmB and 44 of 50 patients (88%) who received AmB without NAC supplemented with potassium due to hypokalemia (P < 0.001). Two of NAC received 37 patients (5.4%) and 10 of NAC not received 50 patients (20%) died. Mortality was found 2.3 times more in NAC not-received group. Conclusion Co-treatment with oral NAC once daily in children during AmB treatment course was significantly effective in preventing or ameliorating different features of its nephrotoxicity including hypokalemia, hypomagnesemia, and renal potassium as well as magnesium wasting Disclosures All authors: No reported disclosures.