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Case Reports in Critical Care

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https://www.readbyqxmd.com/read/27891260/intravenous-vitamin-c-administered-as-adjunctive-therapy-for-recurrent-acute-respiratory-distress-syndrome
#1
Amit Bharara, Catherine Grossman, Daniel Grinnan, Aamer Syed, Bernard Fisher, Christine DeWilde, Ramesh Natarajan, Alpha A Berry Fowler
This case report summarizes the first use of intravenous vitamin C employed as an adjunctive interventional agent in the therapy of recurrent acute respiratory distress syndrome (ARDS). The two episodes of ARDS occurred in a young female patient with Cronkhite-Canada syndrome, a rare, sporadically occurring, noninherited disorder that is characterized by extensive gastrointestinal polyposis and malabsorption. Prior to the episodes of sepsis, the patient was receiving nutrition via chronic hyperalimentation administered through a long-standing central venous catheter...
2016: Case Reports in Critical Care
https://www.readbyqxmd.com/read/27872767/diffuse-alveolar-hemorrhage-associated-with-edoxaban-therapy
#2
Kenichi Nitta, Hiroshi Imamura, Akihiro Yashio, Satoko Kashima, Katsunori Mochizuki
Introduction. The main adverse effect of anticoagulant therapy is bleeding, and major bleeding, including intracranial, gastrointestinal, and retroperitoneal bleeding, has been reported as an adverse effect of edoxaban, a direct oral anticoagulant (DOAC). Bleeding during systemic anticoagulation with edoxaban presents a therapeutic conundrum, because there is currently no safe or efficacious reversal agent to stop major bleeding. Case Report. A 51-year-old woman had multiple traumatic injuries, including lower limb fractures...
2016: Case Reports in Critical Care
https://www.readbyqxmd.com/read/27872766/an-atypical-case-of-myxedema-coma-with-concomitant-nonconvulsive-seizure
#3
Pratik Patel, Mikhael Bekkerman, Cristina Varallo-Rodriguez, Rajendra Rampersaud
Hypothyroidism is a prevalent condition in the general population that is treatable with appropriately dosed thyroid hormone replacement medication. Infrequently, patients will present with myxedema coma, characterized by hypothermia, hypotension, bradycardia, and altered mental status in the setting of severe hypothyroidism. Myxedema coma has also been known to manifest in a number of unusual and dangerous forms. Here, we present the case of a woman we diagnosed with an uncharacteristic expression of myxedema coma and nonconvulsive seizure complicated by a right middle cerebral artery infarct...
2016: Case Reports in Critical Care
https://www.readbyqxmd.com/read/27867668/a-rare-clinical-course-of-seronegative-pulmonary-renal-syndrome
#4
M Fröhlich-Gildhoff, W J Jabs, C Berhold, M K Kuhlmann, U Ketterer, S Kische, H Ince
Purpose. Pulmonary-renal syndrome (PRS) is characterized by diffuse alveolar hemorrhage and rapidly progressive glomerulonephritis mainly due to autoimmune etiologies. Seronegative PRS is a challenging entity to the clinician, since early diagnosis may be missed leading to delayed appropriate treatment. Materials and Methods. We present the clinical course of a 77-year-old patient who was admitted under the suspected diagnosis of pneumogenic sepsis and septic renal failure with fever, dyspnea, and elevated CRP levels...
2016: Case Reports in Critical Care
https://www.readbyqxmd.com/read/27847651/ethylene-glycol-poisoning-an-unusual-cause-of-altered-mental-status-and-the-lessons-learned-from-management-of-the-disease-in-the-acute-setting
#5
R Singh, E Arain, A Buth, J Kado, A Soubani, N Imran
Ethylene glycol is found in many household products and is a common toxic ingestion. Acute ingestions present with altered sensorium and an osmolal gap. The true toxicity of ethylene glycol is mediated by its metabolites, which are responsible for the increased anion gap metabolic acidosis, renal tubular damage, and crystalluria seen later in ingestions. Early intervention is key; however, diagnosis is often delayed, especially in elderly patients presenting with altered mental status. There are several laboratory tests which can be exploited for the diagnosis, quantification of ingestion, and monitoring of treatment, including the lactate and osmolal gaps...
2016: Case Reports in Critical Care
https://www.readbyqxmd.com/read/27833765/plasma-exchange-in-the-management-of-catastrophic-antiphospholipid-syndrome
#6
Dimitri Titeca-Beauport, Valery Salle, Loay Kontar, Julien Maizel, Gabriel Choukroun
: Objective. Report of a case of catastrophic antiphospholipid syndrome (CAPS) with multiple organ involvement leading to a life-threatening condition despite early combination corticosteroid and heparin therapy. Initiation of plasma exchange led to rapid improvement of the patient's general condition. Design. CASE REPORT: Setting. University teaching hospital medical intensive care unit. Patient. Single case: 52-year-old man hospitalized for catastrophic antiphospholipid syndrome (CAPS) with cardiac, renal, and cutaneous involvement...
2016: Case Reports in Critical Care
https://www.readbyqxmd.com/read/27752369/meralgia-paresthetica-after-prone-positioning-ventilation-in-the-intensive-care-unit
#7
Christian Svendsen Juhl, Martin Ballegaard, Morten H Bestle, Peer Tfelt-Hansen
Meralgia paresthetica (MP) is a mononeuropathy of the lateral femoral cutaneous nerve (LFCN) caused by external compression of the nerve during its course close to the anterior superior iliac spine. We present a case of a patient with acute respiratory distress induced by Legionella pneumonia who was admitted to the intensive care unit (ICU) for mechanical ventilation. In the ICU, the patient received one session of prone position ventilation for 8.5 consecutive hours. At evaluation six months later, the patient reported persistent bilateral numbness of the anterolateral thigh, which he complained had begun right after he woke up at the ICU...
2016: Case Reports in Critical Care
https://www.readbyqxmd.com/read/27747109/case-report-of-a-fatal-antifreeze-ingestion-with-a-record-high-level-and-impressive-renal-crystal-deposition
#8
Heidi L Erickson
Ethylene glycol, methanol, and diethylene glycol are readily available in many household and commercially available products. While these alcohols are relatively nontoxic themselves, their acidic metabolites are toxic and can result in significant morbidity and mortality. Herein we report a lethal case of massive ethylene glycol ingestion in a suicide with a record high level (1254 mg/dL) and images of the histologic examination of the kidneys revealing impressive calcium oxalate crystal deposition. Autopsy findings also showed evidence of mild cerebral edema...
2016: Case Reports in Critical Care
https://www.readbyqxmd.com/read/27721999/paliperidone-inducing-concomitantly-syndrome-of-inappropriate-antidiuretic-hormone-neuroleptic-malignant-syndrome-and-rhabdomyolysis
#9
Jaspinder Kaur, Dileep Kumar, Mostafa Alfishawy, Ricardo Lopez, Issac Sachmechi
Paliperidone, an active metabolite of risperidone, is a new atypical antipsychotic agent. Syndrome of inappropriate antidiuretic hormone (SIADH), neuroleptic malignant syndrome (NMS), and rhabdomyolysis are the uncommon side effects of psychotropic drugs. We report a case of 35-year-old male with schizoaffective disorder who was admitted for acute-on-chronic exacerbation of his psychotic disorder for which intramuscular paliperidone 234 mg injection was given. Two days later, the patient developed hyponatremic seizures secondary to SIADH which was treated with hypertonic saline...
2016: Case Reports in Critical Care
https://www.readbyqxmd.com/read/27699071/a-rare-case-of-persistent-lactic-acidosis-in-the-icu-glycogenic-hepatopathy-and-mauriac-syndrome
#10
Kirsten S Deemer, George F Alvarez
Mauriac syndrome is a rare disorder that can present with the single feature of glycogenic hepatopathy in children and adults with poorly controlled diabetes mellitus. An often underrecognized finding of glycogenic hepatopathy is lactic acidosis and hyperlactatemia. Primary treatment of glycogenic hepatopathy is improved long-term blood glucose control. Resolution of symptoms and hepatomegaly will occur with improvement in hemoglobin A1C. We present here a case of a young adult female presenting to the intensive care unit with Mauriac syndrome...
2016: Case Reports in Critical Care
https://www.readbyqxmd.com/read/27688917/compartment-syndrome-as-a-result-of-systemic-capillary-leak-syndrome
#11
Kwadwo Kyeremanteng, Gianni D'Egidio, Cynthia Wan, Alan Baxter, Hans Rosenberg
Objective. To describe a single case of Systemic Capillary Leak Syndrome (SCLS) with a rare complication of compartment syndrome. Patient. Our patient is a 57-year-old male, referred to our hospital due to polycythemia (hemoglobin (Hgb) of 220 g/L), hypotension, acute renal failure, and bilateral calf pain. Measurements and Main Results. The patient required bilateral forearm, thigh, and calf fasciotomies during his ICU stay and continuous renal replacement therapy was instituted following onset of acute renal failure and oliguria...
2016: Case Reports in Critical Care
https://www.readbyqxmd.com/read/27672457/acute-liver-and-renal-failure-a-rare-adverse-effect-exclusive-to-intravenous-form-of-amiodarone
#12
Robin Paudel, Prerna Dogra, Saurav Suman, Saurav Acharya, Jyoti Matta
Amiodarone is an antiarrhythmic drug which is highly effective against a wide spectrum of ventricular tachyarrhythmias making it irreplaceable in certain group of patients. We report an unusual case of acute liver and renal failure within 24 hours of initiation of intravenous (IV) amiodarone which resolved after stopping the medication. The mechanism of acute liver and renal toxicity is not clearly known but is believed to be secondary to amiodarone induced (relative) hypotension, idiosyncratic reaction to the drug, and toxicity of the vector that carries the medication, polysorbate-80...
2016: Case Reports in Critical Care
https://www.readbyqxmd.com/read/27672456/reversal-of-a-suspected-paradoxical-reaction-to-zopiclone-with-flumazenil
#13
Zarah Jordahn, Cheme Andersen, Anne Marie Roust Aaberg, Frank Christian Pott
We describe the care for an elderly woman who was admitted to the intensive care unit (ICU) to receive noninvasive ventilation for acute exacerbation of chronic obstructive pulmonary disease. After administration of the sleeping pill zopiclone, a nonbenzodiazepine receptor agonist (NBRA), the patient became agitated and was confused, a possible paradoxical reaction to benzodiazepines. These symptoms were immediately resolved after treatment with flumazenil, usually used to reverse the adverse effects of benzodiazepines or NBRAs and to reverse paradoxical reactions to benzodiazepines...
2016: Case Reports in Critical Care
https://www.readbyqxmd.com/read/27656300/pneumothorax-causing-pneumoperitoneum-role-of-surgical-intervention
#14
Fernanda Duarte, Jessica Wentling, Humayun Anjum, Joseph Varon, Salim Surani
The most common cause of a pneumoperitoneum is a perforation of a hollow viscus and the treatment is an exploratory laparotomy; nevertheless, not all pneumoperitoneums are due to a perforation and not all of them need surgical intervention. We hereby present a case of pneumoperitoneum due to a diaphragmatic defect, which allowed air from a pneumothorax to escape through the diaphragmatic hernia into the abdominal cavity.
2016: Case Reports in Critical Care
https://www.readbyqxmd.com/read/27648312/hemodynamic-transesophageal-echocardiography-guided-venous-arterial-extracorporeal-membrane-oxygenation-support-in-a-case-of-giant-cell-myocarditis
#15
Juan G Ripoll, Robert A Ratzlaff, David M Menke, Maria C Olave, Joseph J Maleszewski, José L Díaz-Gómez
Giant cell myocarditis (GCM) is a rare and commonly fatal form of fulminant myocarditis. During the acute phase, while immunosuppressive therapy is initiated, venoarterial extracorporeal membrane oxygenation (VA-ECMO) support is commonly used as a bridge to heart transplantation or recovery. Until recently, conventional transesophageal echocardiography and transthoracic echocardiography were the tools available for hemodynamic assessment of patients on this form of mechanical circulatory support. Nevertheless, both techniques have their limitations...
2016: Case Reports in Critical Care
https://www.readbyqxmd.com/read/27635266/fatal-cerebral-air-embolism-a-case-series-and-literature-review
#16
Rashmi Mishra, Pavithra Reddy, Misbahuddin Khaja
Cerebral air embolism (CAE) is an infrequently reported complication of routine medical procedures. We present two cases of CAE. The first patient was a 55-year-old male presenting with vomiting and loss of consciousness one day after his hemodialysis session. Physical exam was significant for hypotension and hypoxia with no focal neurologic deficits. Computed tomography (CT) scan of head showed gas in cerebral venous circulation. The patient did not undergo any procedures prior to presentation, and his last hemodialysis session was uneventful...
2016: Case Reports in Critical Care
https://www.readbyqxmd.com/read/27597903/guide-wire-induced-cardiac-tamponade-the-soft-j-tip-is-not-so-benign
#17
Sankalp Dwivedi, Fayez Siddiqui, Milan Patel, Shaun Cardozo
Central venous catheter (CVC) insertion rarely causes cardiac tamponade due to perforation. Although it is a rare complication, it can be lethal if not identified early. We report a case of cardiac tamponade caused by internal jugular (IJ) central venous catheter (CVC) insertion using a soft J-tipped guide wire which is considered safe and rarely implicated with cardiac tamponade. A bedside transthoracic echocardiogram (TTE) revealed a pericardial effusion with tamponade. An emergent bedside pericardiocentesis was done revealing bloody fluid and resulted in clinical stabilization...
2016: Case Reports in Critical Care
https://www.readbyqxmd.com/read/27579186/euglycemic-diabetic-ketoacidosis-in-a-patient-with-cocaine-intoxication
#18
Asma Abu-Abed Abdin, Muhammad Hamza, Muhammad S Khan, Awab Ahmed
Diabetic ketoacidosis (DKA) is characterized by elevated anion gap metabolic acidosis, hyperglycemia, and elevated ketones in urine and blood. Hyperglycemia is a key component of DKA; however, a subset of DKA patients can present with near-normal blood glucose, an entity described as "euglycemic DKA." This rare phenomenon is thought to be due to starvation and food restriction in insulin dependent diabetic patients. Cocaine abuse is considered a trigger for development of DKA. Cocaine also has anorexic effects...
2016: Case Reports in Critical Care
https://www.readbyqxmd.com/read/27529037/pentobarbital-induced-myocardial-stunning-in-status-epilepticus-requiring-extracorporeal-membrane-oxygenation-a-case-report-and-literature-review
#19
Tapan Kavi, Donna Molaie, Michael Nurok, Axel Rosengart, Shouri Lahiri
Introduction. Mild hypotension is a well-recognized complication of intravenous pentobarbital; however fulminant cardiopulmonary failure has not been previously reported. Case Report. A 28-year-old woman developed pentobarbital-induced cardiopulmonary failure that was successfully treated with maximal medical management including arteriovenous extracorporeal membrane oxygenation. She made an excellent cardiopulmonary and neurological recovery. Discussion and Conclusion. Pentobarbital is underrecognized as a potential cause of myocardial stunning...
2016: Case Reports in Critical Care
https://www.readbyqxmd.com/read/27478653/iatrogenic-transient-complete-heart-block-in-a-preexisting-lbbb
#20
Adil S Wani, Adebayo Fasanya, Prachi Kalamkar, Christopher A Bonnet, Omer A Bajwa
Catheter induced cardiac arrhythmia is a well-known complication encountered during pulmonary artery or cardiac catheterization. Injury to the cardiac conducting system often involves the right bundle branch which in a patient with preexisting left bundle branch block can lead to fatal arrhythmia including asystole. Such a complication during central venous cannulation is rare as it usually does not enter the heart. The guide wire or the cannula itself can cause such an injury during central venous cannulation...
2016: Case Reports in Critical Care
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