In periarrest situations and during resuscitation it is essential to rule out reversible causes. Hyperkalemia is one of the most common, reversible causes of periarrest situations. Typical electrocardiogram (ECG) alterations may indicate hyperkalemia. The aim of our study was to compare the prevalence of ECG alterations suggestive of hyperkalemia in normokalemic and hyperkalemic patients. 170 patients with normal potassium (K+) levels and 135 patients with moderate (serum K+ = 6.0–7.0 mmol/l) or severe (K+ > 7.0 mmol/l) hyperkalemia, admitted to the Department of Emergency Medicine at the Somogy County Kaposi Mór General Hospital, were selected for this retrospective, cross-sectional study. ECG obtained upon admission were analyzed by two emergency physicians, independently, blinded to the objectives of the study. Statistical analysis was performed using SPSS22 software. χ2 test and Fischer exact tests were applied. 24% of normokalemic patients and 46% of patients with elevated potassium levels had some kind of ECG alteration suggestive of hyperkalemia. Wide QRS (31.6%), peaked T-waves (18.4%), Ist degree AV-block (18.4%) and bradycardia (18.4%) were the most common and significantly more frequent ECG alterations suggestive of hyperkalemia in severely hyperkalemic patients compared with normokalemic patients (8.2, 4.7, 7.1 and 6.5%, respectively). There was no significant difference between the frequency of ECG alterations suggestive of hyperkalemia in normokalemic and moderately hyperkalemic patients. Upon examining ECG alterations not typically associated with hyperkalemia, we found that prolonged QTc was the only ECG alteration which was significantly more prevalent in both patients with moderate (17.5%) and severe hyperkalemia (21.1%) compared to patients with normokalemia (5.3%). A minority of patients with normal potassium levels may also exhibit ECG alterations considered to be suggestive of hyperkalemia, while more than half of the patients with hyperkalemia do not have ECG alterations suggesting hyperkalemia. These results imply that treatment of hyperkalemia in the prehospital setting should be initiated with caution. Multiple ECG alterations, however, should draw attention to potentially life threatening conditions.

Background: Zinc phosphide (ZnP) is the basic component of several insecticides easily accessible worldwide. Intentional or accidental intoxication may lead to severe complications and multiple organ failure, resulting in high mortality. No known antidote is currently available. The iron-chelation and the antioxidative effects are well-known features of alpha-lipoic acid (ALA), although its use in the treatment of ZnP poisoning has not been documented previously. We describe the case of a patient with serious ZnP poisoning with multiple organ failure, where ALA was also included in the patient’s supportive therapy. Case presentation: A 65-year-old man ingested 125 g of Arvalin® (containing 5 g ZnP) and presented to the Emergency Department, with respiratory insufficiency and decreased consciousness. He developed hypokalemia, hypocalcemia, low white blood cell count, elevated C-reactive protein level, mixed acidosis, hepatic and kidney damage, thickening of the jejunal wall, and lung atelectasis, which served as a basis for the ensuing bacterial pneumonia. Antibiotics and adequate supportive therapy were provided. Laboratory tests indicated liver damage (slightly increased liver enzymes, low pseudocholinesterase levels; 706 U/L on day 2), possibly caused by the patient’s chronic alcoholism or the ZnP poison itself, therefore, hepatoprotective agents, ALA (Thiogamma Turbo-Set®) with N-acetylcysteine were administered for six consecutive days. Pseudocholinesterase values increased sixfold until the end of the second week of care. Fifteen days after admission, the patient was relocated to the department of psychiatry with stable vital functions, clear consciousness, declining inflammatory markers, and improved liver function. He was discharged 1 month later, fully recovered. Conclusions: Our case is the first documented voluntary and severe ZnP poisoning in Hungary. Our patient developed multiple organ failure and atelectasis, possibly resulting in the observed respiratory infection. The development of bacterial pneumonia highlighted the dangers of phosphine-induced atelectasis. The use of ALA in our patient’s case, as an antioxidant and agent for metal chelation, suggested that this agent could be a promising tool in the prevention and treatment of ZnP-induced hepatic damage.

Introduction: More than twenty emergency departments were opened across Hungary in the past years. Data deficiency on patient flow, trends and lack of knowledge of indicators could raise numerous logistical and organisational problems. Aim: Collection, analysis and provision of data to facilitate successful operations of emergency medical care services. Method: During a three-year period investigated, at the multidisciplinary Emergency Department of “Moritz Kaposi” Teaching Hospital, data on patient flow (n = 106,203), epidemiology, triage and international classification of diseases were analysed. Results: Analysis showed 73% of patients were suitable for medical discharge within 24 hours. Predominantly internal medicine, paediatric and neurological diseases indicated hospitalisation (21%). Patients in critical condition were found to be low (<2%). Distinct diurnal, weekly, monthly variations were found. Majority of cases were injuries and intoxications (40%). Low mortality rate (0.3%) validates the effectiveness of stabilisation. Conclusions: The patient safety value of the examined emergency medical care is great, and could exempt the hospital wards from unjustified hospitalisations of the patients. Orv Hetil. 2017; 158(21): 811–822.

Absztrakt: Bevezetés: Az Európai Betegségmegelőzési és Járványvédelmi Központ adatai szerint a nyugat-nílusi vírus (West Nile virus, WNV) által okozott neuroinvazív tünetegyüttes előfordulása nagymértékben emelkedett Európában és hazánkban az elmúlt években. Ennek hátterében a klíma- és csapadékviszonyok változása valószínűsíthető. A WNV által okozott zoonosist szúnyogok terjesztik. A vírusfertőzés többnyire tünetmentes, 20%-ban általános vírusfertőzéses tüneteket okoz, és kevesebb, mint 1%-ban halálos kimenetelű neuroinvazív betegséghez vezethet. Célkitűzés: Közleményünk célja saját eseteinken keresztül a WNV által okozott neuroinvazív tünetegyüttes és az alkalmazott diagnosztikai és terápiás teendők bemutatása, valamint az infekció kapcsán a differenciáldiagnosztikai dilemmák feloldása. Módszer: A Somogy Megyei Kaposi Mór Kórházban 2018. július 31. és 2018. szeptember 4. között kezelt 4 beteg esetét mutatjuk be, akiknél szerológiai és molekuláris biológiai módszerekkel igazolódott a WNV-fertőzés. A retrospektív esetelemzést a WNV-fertőzés epidemiológiai áttekintésével egészítettük ki. Eredmények: A jelzett időintervallumban intézményünkben 4 betegnél igazolódott WNV-fertőzés. Minden esetben a neurológiai tünetek széles skáláját észleltük, egy haláleset következett be. A fertőzött betegek idősebbek voltak, valamint számos társbetegségben szenvedtek. Következtetések: A WNV-fertőzésekre a súlyosabb, neuroinvazív tünetekkel járó kórlefolyás megjelenése jellemző hazánkban is. A fertőzés terápiája szupportív, fájdalomcsillapítást és a szekunder infekciók kezelését foglalja magában. Az ismeretlen etiológiájú neurológiai kórképeknél – különösen encephalitisre utaló tünettan esetén – fontos gondolni a WNV-fertőzésre. Orv Hetil. 2019; 160(51): 2026–2035.