History and Physical Exam and Simple Math Go a Long Way in Developing a Diagnostic Differential: A Case of Methanol Poisoning.

History and Physical Exam and Simple Math Go a Long Way in Developing a Diagnostic Differential: A Case of Methanol Poisoning.

Chest. 2012 Oct 1; 142(4_MeetingAbstracts): 361A
Lambrecht J, Pendurthi MK, Gogineni V, Rayl T, Maio A

SESSION TYPE: Critical Care Student/Resident Case Report Posters IIPRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM – 02:30 PMINTRODUCTION: Patients who present to the ER with altered mental status due to toxic ingestion or attempted suicide are difficult to treat because of unknown social and clinical factors. We present a case of methanol ingestion that highlights the importance of obtaining a good history and physical exam.CASE PRESENTATION: A 46-year-old male was brought to the ER with complaints of altered mental status, abdominal pain, and alcohol intoxication. The family reported that the patient had a history of alcohol dependence but had been sober for 2 years. However, recently, he developed severe depression and had been consuming large quantities of alcohol. The family also admitted he had possibly consumed household substances for their alcohol content. On examination, the patient was in moderate distress and had altered mental status. Except for severe right upper quadrant tenderness, the physical exam was unremarkable. Laboratory results showed WBC 10,200/dL. Electrolytes were sodium 139, potassium 4, chloride 110, bicarbonate 16, creatinine 1.4, total bilirubin 0.4, aspartate transaminase 64, alanine transaminase 56. Serum osmolality was 381. Ethanol level was less than 10 mg/dL. His calculated anion gap was 13, ABG pH 7.27, and calculated serum osmolality was 295, indicating anion gap metabolic acidosis with an increased osmolar gap of 86. As a precaution, the patient was started on intravenous fomepizole. At that time, additional questions were asked of the patient which resulted in admission of ingestion of a household product, but the specifics were not known. Methanol and ethylene glycol levels were ordered. Isopropyl alcohol, ethylene glycol, salicylate and acetaminophen levels were found to be within normal limits. The patient’s methanol and acetone levels were 154 mg/dL and 80mg/dL, respectively. As a result, emergent hemodialysis was initiated and within 24 hours, methanol levels were less than 10mg/dL.DISCUSSION: Methanol poisoning is one of the most common types of alcohol related toxicities and can mimic ethanol intoxication because it causes central nervous depression. In 2010, there were 719 possible methanol exposures (excluding automotive products and cleaning agents) and 12 deaths.CONCLUSIONS: A detailed history, recognition of abnormal lab parameters, application of simple calculations can narrow down the differential diagnosis in cases of possible overdose or suicide attempt. In this case, initial clinical exam and history increased suspicion of toxic ingestion. Appropriate lab tests were ordered based on the possible substances and timely identification and intervention with fomepizole and emergent dialysis played a significant role in preventing complications related to methanol toxicity including permanent loss of vision, multi-system organ failure, and subsequent death.1) AAPCC (American Association of poison control centers) 2010 Annual Report of the NPDS (National Poison Data System)DISCLOSURE: The following authors have nothing to disclose: Jason Lambrecht, Madhu Kalyan Pendurthi, Vijaya Gogineni, Thomas Rayl, Anna MaioNo Product/Research Disclosure InformationCreighton University Medical Center, Omaha, NE. HubMed – depression


Palliative Care for Metastatic Non-small Cell Lung Cancer With Chinese Herbs: A Prospective Observational Cohort Study.

Chest. 2012 Oct 1; 142(4_MeetingAbstracts): 617A
Hou W, Li C, Shi W, Li G, Hua B

SESSION TYPE: Lung Cancer IIIPRESENTED ON: Tuesday, October 23, 2012 at 02:45 PM – 04:15 PMPURPOSE: No previous studies were reported on the benefit of early palliative care for metastatic non-small cell lung cancer(NSCLC) with Chinese herbs. We performed a pilot longitude cohort study to investigate the role of palliative care with Chinese herb on metastatic NSCLC patients.METHODS: This is a prospective observational cohort study. From July 2007 to December 2009, all newly diagnosed NSCLC patients who agreed to participate in the study were assigned to the early palliative care with Chinese herb treatment. During the same study period, patients who agreed to be followed up but preferred integrated treatment including chemotherapy, radiotherapy and Chinese herb were assigned to standardized care. Physical status was assessed at baseline, three months and six months with Eastern Cooperative Oncology Group (ECOG) score. The primary outcome was the survival after newly diagnosis date. The secondary outcome was the physical status after at three and six months.RESULTS: Eleven metastatic NSCLC patients treated only with Chinese herb for palliative purpose were enrolled in this study from July 2007 to December 2009. At the same time, 20 patients who got integrated treatment including chemotherapy and radiotherapy were enrolled to the study for observational purpose. All patients were followed till April 2010. Five cases survived in palliative care group and 8 cases in standardized care group at the end of follow-up. The median survival time is 15.6(95%CI, 12.1-25.0) months in palliative care group vs. 13.2(95%CI, 10.6-21.1) months in standard care group (P=0.02). The mortality in palliative care group was 55% compared to 40% in standard care group (P=0.78). None suffered from NCI adverse reactions such as bone marrow depression, digestive tract reaction and neurotoxicity during treatment in the palliative group. The median performance status assessed by ECOG at six months was 1 in palliative care survivors and 2 in standard care (P=0.04).CONCLUSIONS: Among patients with metastatic NSCLC, those receiving early palliative care with Chinese herb had longer survival and better performance status when compared with patients receiving standard care.CLINICAL IMPLICATIONS: Early palliative care with Chinese herb should be integrated to the current management of metastatic NSCLC to improve survival and performance status.DISCLOSURE: The following authors have nothing to disclose: Wei Hou, Conghuang Li, Wenguang Shi, Guangxi Li, Baojin HuaNo Product/Research Disclosure InformationGuang An Men Hospital, China Academy of Chinese Medical Science, Beijing, China. HubMed – depression


Sleep-Related Breathing Disorders in Patients With Schistosomal Cor Pulmonale.

Chest. 2012 Oct 1; 142(4_MeetingAbstracts): 1072A
Ibrahim E

SESSION TYPE: Sleep PostersPRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM – 02:30 PMPURPOSE: To study Sleep-Related Breathing Disorders in Patients with Schistosomal Cor-Pulmonale.METHODS: All patients were subjected to thorough history and clinical examination and lab tests for Schistosomiasis. All patients has sleep study, Arterial blood gases, echocardiography, and radiological examination in form of chest Xray and CT.RESULTS: The present study was carried out on ten patients with schistosomal Cor-pulmonale; three females and seven males and compaired with ten non smoker healthy volunteers with no cardiorespiratory co-morbidities. They are matched with the patients as regard age, sex and BMI. The Mean age of patients group was 43.70±8.04, weight in patients group was 65.0±14.20 Kgm, and Mean± SD height in patients group was 1.66 ± 0.11 M . As regard patients’s complains related to underlying sleep disorders breathing; ESS of patients was ranging 4.0 -12.0 with mean + SD 7.60 ±3.10. loud snoring was present in 6 patients, choking attacks at night was present in 3 patients, Unrefreashing sleep was present in 9 presents, restless sleep was present in 7 patients, nocturia was present in 6 patients, morning headach in 8 patients, apneic episodes seen by bed partner in 3 patients, recurrent arousal was present in 8 patients, depression was present in 4 patients, insomnia was present in all patients except no. (6) and dry tongue was present in 4 patients.CONCLUSIONS: Sleeping disorders are not uncommon in patients with Schistosomal Cor-Pulmonale.CLINICAL IMPLICATIONS: Further studies are needed in patients with Schistosomal Cor-Pulmonale to evaluate the sleep disorders.DISCLOSURE: The following authors have nothing to disclose: Emad IbrahimNo Product/Research Disclosure InformationAlexandria Faculty of Medicine, Alexandria, Egypt. HubMed – depression