These results suggest that the compensatory metabolic response to acute respiratory alkalosis is exaggerated by increased lactic acid production in panic disorder patients. Here, we call attention to the diagnosis of acid-base derangements by means of plasma [HCO(3)(-)] and lactate concentration in panic disorder patients.

Purpose: Atypical mycobacterial infection is a rare but serious hazard in immunocompromised patients including those undergoing maintenance hemodialysis and immunosuppressive therapy. Recognition of unusual involvement patterns is important. Methods: We describe an extremely rare combination of complications caused by such an organism in a patient with end-stage renal disease: spinal osteolysis and multiple skin lesions associated with synovitis. Results: The patient had received a renal allograft 18 years previously but developed infection with Mycobacterium avium-M. intracellulare complex including dermatologic manifestations, spondylitis, and synovitis involving the wrist and lateral malleolus after initiation of hemodialysis when the transplanted kidney failed. An empirical antibiotic regimen failed to alleviate skin lesions or fevers, or to lower an elevated C-reactive protein concentration, until the patient’s dose of methylprednisolone was increased to treat mild adrenal insufficiency. The increase resulted in rapid resolution of skin lesions. A compression fracture 6 months later was attributed to spondylitis caused by the same organism. Conclusion: We suspect that spondylitis represented the primary focus of M. intracellulare infection.

We report a case of overdosage of tranexamic acid (TNA), which was suggested as the cause of visual impairment in a 56-year-old man. He had been undergoing chronic hemodialysis for 1 year, following 10 years of peritoneal dialysis. He had been hospitalized for an emergency operation for a bleeding ulcer of the stomach and duodenum. After the operation, he experienced a gradual loss of sight over about 1 week, although his general condition was good. He received intravenous injections of TNA as a hemostat during hospitalization for the operation. Two weeks after the operation he became blind. Retinography was flat and his visual field had become narrowed. On fluorescein angiography, microgranular hyperfluorescence, which indicated malfunction of the pigmented layer of the retina, was observed. No abnormality of the brain or the optic nerve was shown by magnetic resonance imaging. Concentrations of vitamins and trace minerals in the blood were within the normal ranges. Administration of vitamins A and B(12) did not improve his sight. However, discontinuation of TNA rapidly restored his sight, within a few days. He had received TNA once before because of bleeding ulcer, and his sight had been impaired at that time. Based on the repeated episodes, it was strongly suggested that an overdose of TNA in this dialysis patient caused the sight disturbance. Because TNA is metabolized by the kidney, caution is necessary when prescribing TNA for patients with renal failure.

Background/Aims: The mesothelium of patients undergoing peritoneal dialysis (PD) is exposed to glucose in dialysate. Glucose metabolites 3-deoxyglucosone and advanced glycation endproducts (AGEs) in the PD fluid induce peritoneal damage. Circulating factors also affect the peritoneum in the uremic model and predialysis patients. Aldose reductase (AR) generates precursors of 3-deoxyglucosone. We have reported AR acceleration in uremic patients. Therefore, AR acceleration might affect the peritoneum. The purpose of this study was to evaluate the AR level in PD patients and to determine the factors that change the peritoneum of these patients. Methods: We measured the PD effluent (eff-) concentration of cancer antigen 125 (CA125) as a marker of mesothelial viability in PD patients. Erythrocyte AR, eff-, and plasma (p-) concentrations of 3-deoxyglucosone, AGEs, and malondialdehyde were also studied in 30 PD patients, 18 patients undergoing hemodialysis, and 8 control subjects. Results: In the PD group, AR, p-3-deoxyglucosone, p-AGEs, and p-malondialdehyde were higher than in the control group. The predictors for eff-CA125 were not only PD duration and eff-3-deoxyglucosone, but also AR. Conclusion: AR was upregulated in PD patients. AR acceleration may affect the peritoneum in these patients. Further studies are needed to clarify the role of AR in PD patients.

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