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Unlabelled: Paracetamol is a widely known over-the-counter analgesic and antipyretic which, in acute poisoning usually causes liver damage, and less commonly damage to the kidney, heart, and pancreas. In the present paper we report a case of acute suicidal paracetamol intoxication complicated by acute hepatic and renal failure. The discussion covers the pathogenesis, clinical course, and treatment of acute renal failure in the course of paracetamol poisoning., Case Report: A thirty-four-year-old woman was admitted to hospital in the second day after ingestion of nearly 17 g of acetaminophen. During admission to the hospital, the maximum values of transaminases (AST 19 350 U/L, ALT 11 760 U/L) were found; they have gradually normalized over the next few weeks. Sequentially monitored serum creatinine showed an upward trend, reaching a value of 588 micromol/L in the fifth day after drug ingestion. The patient underwent 1 haemodiafiltration and 4 haemodialysis treatments resulting in an improvement in renal function., Conclusions: In acute acetaminophen poisoning, in addition to standard monitoring of liver function, the monitoring of kidney function is necessary because of the risk of acute renal failure due to acute tubular necrosis. Kidney damage is likely to be transient and generally will not need long-term renal replacement therapy.

Background: Gastric motor functions are disturbed in patients with chronic renal failure (CRF). The aim of this study was to find the relationship between GI symptoms, gastric myoelectrical activity and regulatory peptides (gastrin, motilin, VIP, CCK) in patients with CRF treated with hemodialyses (HD) and peritoneal dialyses (CAPD)., Methods: Gastric myoelectric activity was evaluated with cutaneously recorded electrogastrographs (EGGs) measurement in: group A: 23 pts with CRF treated with CAPD, group B: 21 pts treated with HD and group C: 48 matched healthy controls. GI symptoms severity was quantified with specially designed questionnaire. The laboratory evaluation of plasma parameters, such as: gastrin, motilin, VIP and CCK was performed., Results: The patients with CRF treated with CAPD and HD showed a significantly lower percentage of normal 2-4 cpm wave's rhythm in both fasting (65.3 +/- 29.3% vs 43.5 +/- 35.9% vs 86.4 +/- 10.2%) and fed conditions (72.7 +/- 34.2% vs 69.5 +/- 22.1% vs 89.3 +/- 9.5%) in comparison to controls. In the fasting state, none of the healthy controls had an abnormal EGG, whereas the 27 patients with CRF (61.3%) had an abnormal EGG. In the fed state the 18 patients with CRF (40.9%). No significant increase of the dominant power (PDP) after meal in CRF patients was observed. The plasma concentrations of gastrin, CCK were increased in fasted and fed CRF patients, whereas VIP and motilin only in fed state., Conclusions: The patients with CRF showed impaired gastric myoelectrical activity in response to food and high levels of GI hormones. Gastric dysmotility and high peptides appears to be partially responsible for GI symptoms.

Aim: The aim of our study was to estimate the correlation between GERD symptoms and nutritional status of (PD) patients., Methods: 52 patients (32 m, 20 f; age 30-86, mean 61.6+/-14.3) treated with continuous ambulatory PD were reviewed using standarized GERD symptoms questionnaire. The frequency, duration, intensity and day/night prevalence of typical GERD sypmtoms were estimated and calculated as symptom score index (0-80). Than to evaluate the nutritional status, normalized protein catabolic rate (nPCR) was calculated. Correlation was calculated with r - Pearson's correlation coefficient. Additionally the correlation between GERD symptom score index and following parameters was evaluated: the time from the diagnosis of chronic renal failure, the time from the onset of CAPD, weekly clearance of endogenous creatinine and Kt/V value., Results: 43 patients had symptoms of GERD. The symptom score index was between 4 and 50 (mean 11.3+/-10.7). Symptoms were present also in patients with ongoing H2-blockers (18 pts) and PPI therapy (2 pts). Mean value of nPCR for the study group was 0.99+/-0.26. Evident negative correlation was observed between these two values (R = -0.28; p = 0.04). Kt/V index was 2.28+/-0.57 and weekly KEK was 89.26+/-23.37. Both parameters showed only very weak correlation with GERD index (respectively: R = -0.16; p = 0.25 and R = -0.142; p = 0.31). There was no correlation between symptom score index and albumin nor transferine level. Interestingly, there was positive correlation observed between GERD symptom score and the time from onset of CAPD (R = 0.229; p = 0.10) and no correlation with the time from the first diagnosis of chronic renal failure., Conclusions: Gastro-esophageal reflux disease symptoms adversely affect nutritional status, estimated via nPCR value in chronic renal failure patients, treated with peritoneal dialysis. Moreover, as all the patients had weekly clearance of endogenous creatinine within normal range or even above, we can conclude that the occurrence of GERD symptoms in CAPD patients is not related to the adequacy of dialysis but rather to other factors as the presence of fluid in peritoneal cavity. Even more probable is that other mechanisms (autonomic dysfunction or hormonal imbalance) contribute, as the GERD symptom score index correlates with the time past from the CAPD onset.

In the chronic renal failure (CRF) there are several upper gastrointestinal symptoms, which result from both disturbed motor function (associated with the delayed gastric emptying) and myoelectrical one (associated with abnormal electrogastrography registration). In patients suffering from CRF, disturbances of the endocrine digestive system function were also demonstrated, which are related to the observations of many gastrointestinal hormones increased levels.