Hypernatremia among in-patients in intensive care unit and medical wards of a general hospital in Kuwait

To determine the incidence and etiology of hypernatremia in adult patients admitted to a general hospital in Kuwait. A hospital based retrospective study carried out between July 2009 and December 2009. Intensive Care Unit [ICU] and Medical inpatient wards, Department of Medicine, Al-Jahra Hospital, Kuwait. Ninety-two hypernatremia patients [41 male and 51 female] out of a total of 1825 patients were analyzed and their etiology studied. All blood samples were analyzed in biochemistry department on LX20 machine. Information regarding age, gender, highest serum sodium levels, clinical diagnoses and further clinical information suggesting causes of hypernatremia was gathered. Frequency, etiology, outcome and management of hypernatremia in adult inpatients. Out of a total of 1825 patients analyzed, 5.04% were diagnosed with hypernatremia with mean serum sodium of 150.9 mmol/l. Among major causes of hypernatremia were hyperglycemia [21.7%], IV fluids [21.7%] and dehydration [17.4%]. The overall incidence of hypernatremia in this hospital was 5.04%. Hyperglycemia and IV fluid administration were the commonest causes [21.7% each]. All patients were treated based on the treatment recommendations mentioned in the discussion. There were no cases with cerebral edema due to the treatment. However two patients with severe hypernatremia and sodium level of >/= 165 mmol/l, who had central diabetes insipidus [CDI] secondary to traumatic head injury, died in spite of the appropriate management of hypernatremia

Sweet's syndrome

Sweet's syndrome [acute febrile neutrophilic dermatosis] is characterized by classical skin lesions accompanied by fever and malaise. Systemic involvement may be present and lung involvement in Sweet's syndrome has been reported in the form of bilateral pulmonary infiltrates,bronchiolitis obliterans organizing pneumonia and pleural effusion. There are dense papillary neutrophilic infiltrates on histopathology. We present a case of Sweet's syndrome with right lower lobe consolidation and persistent fever which was non-responsive to antibiotics but showed clinical improvement with clearing of radiological opacities on oral steroid therapy

Assessment of pneumonia severity

Pneumonia remains an important cause of hospital admission and carries an appreciative mortality. The diagnosis of pneumonia is based on certain clinical manifestations and chest radiograph. There is considerable variability in rates of hospitalization of patients with community-acquired pneumonia, in part because of physicians' uncertainty in assessing the severity of illness at presentation. We present a case of pneumonia with certain severity and discuss the methods of assessing severity