Life-threatening Deficiency Research Articles

Massive copper and selenium losses cause life-threatening deficiencies during prolonged continuous renal replacement

ObjectiveSeveral trace elements are essential for immunity and wound healing, particularly after major burns. Continuous renal replacement therapy (CRRT), which is used to treat renal failure, causes significant trace elements losses. The aim of the present review is to update the current literature and draw attention to this type of complication, as copper deficiency is rarely suspected and diagnosed in clinical conditions and may occur in chronic critically ill patients. MethodsThis is an emblematic case report and review of literature. ResultsMajor copper and selenium deficiencies were documented in a patient with major burns complicated by renal failure. The main cause was effluent loss during prolonged CRRT. The copper deficit resulted in life-threatening bradycardia and the alteration of lipid metabolism with severe hypertriglyceridemia. The published data are scarce, but trace element losses with effluent have been previously documented, as has the affect of copper deficiency on cardiac rhythm. ConclusionThe literature regarding the specific requirements for chronically critically ill patients is limited. During prolonged CRRT, copper and selenium levels decrease and probably should be monitored during prolonged therapy. Research in this area is required.

PP028-MON: Massive Copper (CU) and Selenium (SE) Losses Cause Life Threatening Deficiencies During Prolonged Renal Replacement Therapy

PP028-MON: Massive Copper (CU) and Selenium (SE) Losses Cause Life Threatening Deficiencies During Prolonged Renal Replacement Therapy

Prospective Analysis of Rural Interhospital Transfer of Injured Patients to a Referral Trauma Center

A 1-year prospective review of 78 multiply injured patients initially treated at local community hospitals and subsequently transported more than 25 miles to a referral trauma center was completed. Injury mechanisms were blunt in 74 (95%) patients and penetrating in four. Patient ages ranged from 6 to 88 years (mean, 33 years). Trauma Scores ranged from 6 to 16 (mean, 13.9) and Injury Severity Scores ranged from 4 to 54 (mean, 21.5). The quality of care during initial stabilization and transport was evaluated by ATLS guidelines for airway management, treatment of shock, spine and fracture immobilization, neurologic evaluation, secondary assessment, and chart documentation. Most frequent departures from these standards involved failure to place a nasogastric tube before transport (72%), failure to document neurologic status (47%), inadequate cervical spine immobilization (32%), inadequate intravenous access (29%), inadequate oxygen delivery (28%), and incomplete or absent records (22%). Life-threatening deficiencies were identified in four (5%) patients and serious deficiencies in 62 (80%). This study demonstrates the need for further education of rural physicians about priorities in trauma management. Increased emphasis on stabilization and transport should be added to ATLS training courses. Established transport protocols between institutions would enhance the quality of care and engender improved interhospital communication. The implementation of trauma systems designed specifically for rural areas must be supported.