The Korean Association of Internal Medicine
344 32nd World Congress of Internal Medicine (October 24-28, 2014)
PS 1358 Nephrology
Painless Acute Myocardial Infarction Associated with Escherichia Coli Urosepsis
Gi Jun Kim1, Kyung Yoon Chang1, Seongyul Ryu1, Hoon Suk Park1, Dong Chan Jin1, Gee Hee Kim2, Hyung Wook Kim1
Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea, Korea1, Divi- sion of Cardiology, Department of Internal Medicine, The Catholic University of Korea, Korea2
A 72-year-old woman with diabetic chronic kidney disease presented with fever, dy- suria and left fl ank pain. She was treated with antibiotics and percutaneous nephros- tomy for Escherichia coli (E. coli) urosepsis and obstructive nephropathy, and contin- uous venovenous hemodiafi ltration for uncontrolled pulmonary edema. Although she did not complain typical angina on admission, given the presence of new onset left bundle branch block, elevated cardiac enzyme, documented E. coli septicemia, and ab- sence of other trigger that can induce acute coronary syndrome, we suggested acute coronary syndrome associated with E.coli urosepsis. Coronary angiography was per- formed and percutaneous coronary interventions were performed successfully for mid left anterior descending artery and mid to distal right coronary artery. We should keep in mind that the urosepsis in patients with diabetic chronic kidney disease, who are at high risk for cardiovascular disease, can be associated with painless acute myocardial infarction and acute heart failure.
PS 1359 Nephrology
The Amount of Albuminuria Does Not Contribute to the Development of Cardiovascular Disease in Diabetic Patients with Renal Insuffi ciency
Eunyoung Lee1, Youn Kyung Kee1, Chang-Yun Yoon1, Young Su Joo1, Seung Gyu Han1, In Mee Han1, Mi Jung Lee1, Hyung Jung Oh1, Jung Tak Park1, Seung Hyeok Han1, Shin- Wook Kang1, Tae-Hyun Yoo1
Department of Internal Medicine, College of Medicine, Yonsei University, Korea1
Background: Diabetic patients are likely to progress from normoalbuminuria (NA) to microalbuminuria (MA), and eventually to overt proteinuria (P) coincided with renal insuffi ciency. Recently, however, several studies have demonstrated that diabetic pa- tients show diverse renal presentations and that 20-40% of patients are normo- to micro-albuminuric despite decreased renal function. In this study, the renal and car- diovascular (CV) outcomes in normo-, micro-, or macro-albuminuric diabetic patients with renal insuffi ciency were investigated.
Methods: Data from 1,136 diabetic patients with chronic kidney disease stage III or IV between 2007 and 2009 were retrospectively collected. Subjects were divided into NA, MA, and P groups. The primary outcome was new-onset CV events or death, and the secondary outcome was the onset of end-stage renal disease (ESRD).
Results: The mean age was 61.7±10.1 years and the mean estimated glomerular fi ltra- tion rate was 38.9 ml/min/1.73m2. Among 1,136 patients, 255 patients (22.4%) were NA, 275 patients (24.2%) were MA, and 606 patients (53.3%) were P group. During a mean follow-up duration of 44 months, the development of CV disease was not different among the three groups (P=0.67). However, progression to ESRD was signif- icantly more observed in the P group compared to the NA and MA groups (P<0.001).
Multivariate Cox analysis revealed that P was an independent predictor of progression to ESRD (odds ratio=2.414, 95% confi dence interval=1.730-3.369, P<0.001), whereas the amount of albuminuria was not a risk factor for the development of CV disease.
Conclusions: There are signifi cant and substantial differences in the clinical outcomes of diabetic patients with renal dysfunction according to the degree of albuminuria. In particular, CV outcome was comparable, while renal outcome was signifi cantly different according to the amount of albuminuria in diabetic patients with renal insuffi ciency.
PS 1360 Nephrology
Change in Serum Magnesium Concentration after Use of a Proton Pump Inhibitor
Kyu-Tae Yoon1
Soon Chun Hyang University Hospital Cheonan, Korea1
Background: Although cross-sectional studies suggested a relationship between pro- ton pump inhibitor (PPI) use and hypomagnesemia, no large-scale cohort study has been conducted to date. Here, we examined the changes in serum magnesium levels in response to PPI use.
Methods: Of 2892 patients hospitalized for percutaneous coronary intervention be- tween January 2007 and May 2012, 1076 with normal baseline (1.6–2.5 mg/dL) and follow-up serum magnesium concentrations were enrolled. The patients were divided into two groups, namely a PPI and a control group.
Results: The mean follow-up was 9.51 ± 2.94 months. The incidence of hypomagne- semia (<1.6 mg/dL) was 0.4% (3/834) in the PPI group and 0.4% (1/242) in the control group (P = 0.904). The change of magnesium levels did not differ between the two groups, and this result was maintained in the analysis of covariance after adjusting for confounding factors (P = 0.381). Moreover, magnesium levels did not signifi cant differ between the long-term (duration of use ≥ 12 months, n=76) and short-term PPI groups (duration of use < 12 months, n = 763), and the control group (n =242;
P=0.620). The effect of PPI use on change of serum magnesium was altered by the use of multiple diuretics (-0.01±0.25 mg/dL), although the single diuretic use with PPI did not effect on the change of Magnesium (0.12±0.27 mg/dL; P=0.025).
Conclusion: The change of magnesium might be subtle after PPI use in patients with baseline normal value of magnesium. Serum magnesium should be monitored in PPI user with concurrent taking multiple diuretics
PS 1361 Nephrology
Plasma Exchange Successfully Treats Central Pontine Myelinolysis after Acute Hypernatremia from Intrave- nous Sodium Bicarbonate Therapy
Seongyul Ryu1, Kyung Yoon Chang2, Hyung Wook Kim2, Hoon Suk Park2
The Catholic University of Korea, Yeouido St. Mary`s Hospital, Korea1, The Catholic University of Korea, St. Vincent’s Hospital, Korea2
Background: Osmotic demyelination syndrome (ODS) primarily occurs after rapid correction of severe hyponatremia. There are no proven effective therapies for ODS, but we describe the fi rst case showing the successful treatment of central pontine myelinolysis (CPM) by plasma exchange, which occurred after rapid development of hypernatremia from intravenous sodium bicarbonate therapy.
Case presentation: A 40-year-old woman presented with general weakness, hypo- kalemia, and metabolic acidosis. She was treated with oral potassium chloride, along with intravenous sodium bicarbonate. Although her bicarbonate defi cit was 365 mEq, we treated her with an overdose of sodium bicarbonate, 480 mEq for 24 hours, due to the severity of her acidemia and altered mental status. The next day, she developed hypernatremia with serum sodium levels rising from 142.8 mEq/L to 172.8 mEq/L. Six days after developing hypernatremia, she exhibited tetraparesis, drooling, and dysar- thria, and a brain MRI revealed high signal intensity in the central pons with sparing of the peripheral portion, suggesting CPM. We diagnosed her with CPM associated with the rapid development of hypernatremia after intravenous sodium bicarbonate therapy and treated her with plasma exchange. After two consecutive plasma ex- change sessions, her neurologic symptoms were markedly improved except for mild diplopia. After the plasma exchange sessions, we examined the patient to determine the reason for her symptoms upon presentation to the hospital. She had normal anion gap metabolic acidosis, low blood bicarbonate levels, a urine pH of 6.5, and a calyceal stone in her left kidney. We performed a sodium bicarbonate loading test and diag- nosed distal renal tubular acidosis (RTA). We also found that she had Sjögren’s syn- drome after a positive screen for anti-Lo, anti-Ra, and after the results of Schirmer’s
