Faculty Bibliography

Ethylene glycol classically produces an elevated anion gap metabolic acidosis. We report a series of patients with ethylene glycol toxicity with a component of non-anion gap metabolic acidosis without known associated confounding factors. A retrospective review of Poison Control Center records were searched more than 8 years (2000-2007) for ethylene glycol and antifreeze. Cases were reviewed and excluded for miscoding, information calls, animal exposures, or non-ingestion exposures. The bicarbonate gap, or delta ratio (DR), was calculated using the formula: DR = (

The emergence of prothrombotic agents (e.g. activated factor VII) to treat traumatic brain injury (TBI) requires a better understanding of the association of coagulopathy with isolated head injury (IHI). OBJECTIVE: To investigate the association of IHI and coagulopathy. METHODS: Prospective, observational study in an urban level I trauma center. Inclusion criteria: Adult (> or = 13 years of age) patients with IHI. Exclusion criteria: patients with known coagulopathies or on anticoagulant therapy. Predictor Variables: TBI (head abbreviated injury severity score > 2, or brain hematoma on CT scan), age, gender, mechanism of injury, Glasgow Coma Score (GCS), and loss of consciousness (LOC). Outcome variables: coagulopathy defined as elevated International Normalized Ratio (INR > 1.3) or activated partial thromboplastin time (PTT) greater than 34 s. We divided IHI subjects into two groups of patients with and without TBI. Statistical Analysis: Fisher's exact test and Mann-Whitney U were used to compare data where appropriate (alpha: 0.05, two-tailed). RESULTS: From July 2005 to December 2006, 276 patients with IHI were studied. The median age was 35 years (interquartile range: 25-52) with a 79% male predominance and 88% blunt trauma. Eight percent (95% CI, 5-12%) of patients had coagulopathy. The rate of coagulopathy in TBI patients (17%) was significantly higher than non-TBI patients (6%) (11% difference, 95% CI, 3-20%]. The relative risk of coagulopathy in TBI patients was 2.9 (95% CI, 1.3-6.6). CONCLUSION: Coagulopathy as defined by elevated INR and/or PTT is associated with TBI after isolated head injury.

INTRODUCTION: Base deficit (BD) is a validated surrogate for lactate in injured patients and correlates with trauma severity. Stewart proposed a more comprehensive measure of acidosis based on the strong ion difference (SID) (SID = Na + K + Mg + Ca -

BACKGROUND: Increase in lactate (LAC) within the central nervous system after head trauma is an established marker of traumatic brain injury (TBI). OBJECTIVE: To investigate the utility of arterial base deficit (BD) and LAC in identifying TBI in patients with isolated head injury (IHI). Materials and METHODS: TBI was defined as Glasgow Coma Scale < or =8, head Abbreviated Injury Severity Score >2 or brain haematoma on CT scan. Patients were divided into two groups: IHI with and without TBI. Data were reported as means (SDs). 131 patients with IHI were studied (mean (SD) age 39 (19) years, 78% male). RESULTS: 17% of the patients sustained TBI. The mean differences for arterial BD (0.65 mmol/l, 95% CI -0.8 to 2.1) and LAC (0.34 mmol/l, 95% CI -0.7 to 1.4) in patients with and without TBI were not significant. Analysis of receiver operating characteristic curves confirmed that arterial BD and LAC were unable to detect TBI in patients with IHI. CONCLUSION: Arterial BD and LAC are poor predictors of TBI in isolated head trauma.