Acute and Critical Care

Case Reports

Toxicology
Polyethylene Glycol (PEG-3350, Colyte) Poisoning due to Intra-Peritoneal Leakage in an Elderly Patient: Jae Hee Chung, Seok Chan Kim, Jun-Gi Kim; Korean J Crit Care Med. 2015;30(1):56-60. Published online February 28, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.1.56

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Polyethylene glycol (PEG)-3350 is the most frequently used lavage solution for bowel cleansing prior to colonoscopy or elective surgery because its large molecular weight means that it is poorly absorbed. However, if it leaks into the peritoneal cavity, complications may arise. Few published studies have assessed the absorption, distribution, metabolism and excretion of PEG. Moreover, no published clinical data regarding complications due to the intra-peritoneal leakage of PEG-3350 could be found. We report on an elderly patient who developed the poisoning caused by leaking of PEG-3350 during bowel preparation. It resulted in severe metabolic acidosis, hypernatremia, hyperosmolality and a high anion gap, but it was effectively treated with early continuous renal replacement therapy after surgery.

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Severe hypernatremia and transient azotemia in a cat following inadvertent intravenous administration of a commercial polyethylene glycol solution
Sabrina N. Hoehne, Casey J. Kohen, Birgit Puschner, Ingrid Gennity, Simon P. Hagley, Kate S. Farrell, Karin Unger, Laura A. Cagle, Karl E. Jandrey
Journal of Veterinary Emergency and Critical Care.2019; 29(6): 690. CrossRef

A Case of Severe Acute Exacerbation of Bronchial Asthma Treated with Low Minute Ventilation: A Case Report: Young Joo Han, Dong In Suh, Young Seung Lee, June Dong Park; Korean J Crit Care Med. 2010;25(4):257-262.; DOI: https://doi.org/10.4266/kjccm.2010.25.4.257

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Abstract PDF: We report a case of severe status asthmaticus in a 3-year-old boy who required mechanical ventilatory support. He initially presented with rapidly progressing respiratory distress and spontaneous air leaks. Although he was intubated and received mechanical ventilation, dynamic hyperinflation and air leaks were aggravated. We applied the volume control mode, providing sufficient tidal volume (10 ml/kg), a reduced respiratory rate (25/minute), and a prolonged expiratory time (1.8 seconds) to overcome dynamic hyperinflation. After allowing full expiration of trapped air, his over-expanded lung volumes were decreased and the air leaks resolved. He made a complete recovery without sequelae. Dynamic hyperinflation in asthmatic patients occurs from incomplete exhalation throughout narrowed airways. Controlled hypoventilation or permissive hypercapnia is an important lung-protective ventilator strategy and is beneficial in reducing dynamic hyperinflation. We suggest a controlled hypoventilation strategy with a prolonged expiratory time for patients in severe status asthmaticus with dynamic hyperinflation.

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