Clinical characteristics of patients with diabetic ketoacidosis at the Intensive Care Unit of a University Hospital

Objectives: The aims of this study were assessing the frequency of clinical characteristics of patients with severe Diabetic ketoacidosis [DKA] who were admitted to the intensive care unit [ICU] and investigating the relationship between paraclinical [glucose, anion gap, and serum bicarbonate] and clinical parameters in patients with severe DKA

Method: A retrospective chart review of all adult patients with DKA who were admitted to the ICU at King Abdulaziz University Hospital, Jeddah, Saudi Arabia between January 2012 and December 2013. The data collected include the demographic data, clinical presentation, precipitating factors, duration of hospital stay and mortality rate. The data were analyzed using STAT software

Results: A total of 60 patients were included. Of these, 50 were men [83.3%]. The median age was 23 years [ranging 18-29 years]. Newly diagnosed diabetics accounted for 15 [25%] of the cases; the remainder were previously known patients of type1 diabetes on treatment. The main precipitating factors of DKA were insulin treatment cessation [87.5%] and infection/sepsis [39.6%]. Serum blood glucose, serum bicarbonate level, and the calculated anion gap did not significantly correlate with clinical parameters of severe DKA

Conclusion: Most patients with severe DKA who were admitted to the ICU of our institution presented with gastrointestinal symptoms. Non-compliance to insulin therapy was the main precipitating factor of DKA

Pheochromocytoma, papillary thyroid carcinoma

A 53-year-old woman presented with labile and difficult to control hypertension on 3 different anti-hypertensive medications. Abdominal computed tomography and ultrasonography of the thyroid gland showed a 1.8 cm thyroid nodule. Fine needle aspiration biopsy of the thyroid nodule revealed papillary thyroid carcinoma. Serum thyroid stimulating hormone and free thyroxine, calcitonin, carcinoembryonic antigen, intact parathyroid hormone, and calcium levels were within normal limits. A 24-hour urine metanephrine showed significant elevation in urine metanephrine of approximately 3 times the upper limit of normal, and the result of 131I-metaiodobenzyleguanjdjne [131I-MIBG] scintography confirmed that the adrenal mass was pheochromocytoma. Right adrenalectomy and total thyroidectomy were performed. The final pathology was pheochromocytoma and papillary thyroid carcinoma. An analysis of c-ret porto-oncogene mutation yielded a negative result. This unusual association of 2 tumors represents a new entity

Estimation of ionized calcium levels after thyroidectomy at King Abdulaziz university hospital [Jeddah]

Aim: - To determine the incidence of hypocalcaemia and the need for calcium supplementation after thyroid surgery in 120 cases

Methods:- A retrospective study of 120 patients who underwent thyroidectomy at King Abdul aziz University hospital between January 1999 to September 2003 to determine the incidence of hypocalcaemia by measuring ionized calcium level. The data included pre operative and post operative ionized calcium level, albumin, free thyroxine, thyrotopin and alkaline phosphatase. The medical notes were reviewed for age, gender, type of thyroidectomy and pathological characteristics of resected thyroid tissue and aoutotransplantion of parathyroid gland. Treatment of post operative hypocalcaemia and duration of treatment was recorded

Results: - Hypocalcaemia occurred in 18 patients[15 %] from total of 120 patients who underwent tota4 thyroidectomy, and had a significant lower calcium level of [1.78+/-0.054] as compared to 102 [85%] patients with normal calcium level 55.5%. Sixteen patients required calcium supplementation with or without oral vitamin D3. Three patients developed peremenant hypoparathyroidim with PTH level of 23 pg/L Two patients developed laryngeal stridor and were treated initially by intravenous infusion of calcium gluconate

Conclusion:- Measuring or calculating ionized calcium level post thyroidectomy, to ovoid unnecessary calcium supplementation resulting from diagnosing hypocalcaemia from measuring total calcium level alone is more accurate and more appropriate

Study of deliberate selff-harm by drug overdose King Abdulaziz University Hospital, Jeddah, Saudi Arabia 1989-1993

To determine the precipitating factors for deliberate self-harm [DSH], the drugs commonly used for DSH, the psychiatric disorders involved and the reasons for admitting such patients to hospital. This study addresses the issue of deliberate self-harm [DSH] by drug overdose of patients admitted to King Abdulaziz University Hospital [KAUH], in Jeddah, Saudi Arabia. Fifty-four patients constituted 0.54% of the admissions at KAUH medical unit over a 5-year period [1989-1993]. The study found that DSH by drug overdose was higher in Saudi patients. By gender, the female to male ratio was 2.6:1 and the majority of patients [85.1%], were between the age of 13 years and 29 years. Mefenamic acid [Ponstan [Registered]] was the most commonly used drug by more than 48% of the patients. Personal problems [66.7%] were considered to be the predominant precipitating factor for DSH by drug overdose, and it was found to be highly significant in female patients. Psychiatric disorders were more significant in male patients. The most common psychiatric disorder diagnosed was depression in 55.6% of the patients. No deaths were reported from attempts of DSH by drug overdose during the period of the study. There is a need for further population-based studies to determine the extent of the problem of DSH by drug overdose. Such findings will provide measures to develop intervention strategies, promote public awareness, and develop improved methods of preventing DSH by overdose

Insulinoma presented as epileptic seizure for 10 years

For the past 10 years, a 52-year old female Saudi patient had repeated episods of convulsions. She was diagnosed as a case of epilepsy and treated accordingly, However, the patient's history and investigations indicated that her symptoms were related to insulin-secreting tumor [lnsulinoma]. It was successfully treated surgically. The presence of insulinoma should be considered in any patient with unusual or unexplained neurology picture especially when it was intermittent. The diagnosis can be confirmed by demonstration of an inappropriately high circulating insulin level for the ambient blood glucose concentration. The case of insulinoma in a Saudi patient is presented and insulinoma is briefly discussed

Leukocytosis with HIV infection in a Saudi Arabian patient with sickle cell anemia

Transfusion associated Acquired Immunodeficiency Syndrome [AIDS] has recently been reported from Saudi Arabia. AIDS has been reported in a few sickle cell patients, most of whom have been heavily transfused. Patients with AIDS and AIDS related complex are usually neutropenic. This report describes a Saudi patient with sickle cell anaemia and transfusion acquired HIV disease who demonstrated a marked leukemoid reaction