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

study of paraneoplastic syndrome patterns in patients with bronchogenic carcinoma

Paraneoplastic syndromes, which are the distant effect of underlying carcinoma, which can present early, well before the primary lung lesion produces local symptoms and even when the tumor is undetected or very small. Paraneoplastic syndromes are common in patients with bronchogenic carcinoma. They may be the presenting finding or the first sign of recurrence. To assess the incidence and pattern of paraneoplastic syndrome [PNS] in patients with bronchogenic carcinoma. Peripheral Hospital in Kuwait. Retrospective study. A retrospective study of 52 confirmed bronchogenic carcinoma patients occurring from January 2000 to June 2004 in our hospital was carried out. The Medical records of all the confirmed cases of bronchogenic carcinoma admitted between January 2000 and June 2004 were reviewed. The clinical and biochemical parameters recorded were: age, sex, underlying medical illness, presentation complete blood count, blood urea, electrolytes and serum calcium levels, and appropriate hormone levels where indicated. The localization of the tumors was done by chest x-ray and CT scan. Tissue biopsy was obtained by bronchoscopy or under CT scan guidance and histopathological examination of the specimen was carried out. The type and pattern of PNS if any was noted. These parameters were entered into a database and later analyzed. The data management and statistical package used was Epi Info version 6 provided readily by the CDC [Centre for Disease Control] Bethesda USA. Forty-nine patients were male and 3 were females. All were heavy smokers or exsmokers. The histological types were 12 [22.4%] small cell carcinoma and 40 [67.6%] nonsmall carcinoma. The mean age 67.46 +/- 12.15 years. Associated illness found was diabetes mellitus [DM] ' 24 [46%], hypertension - 33 [63.6%], and chronic obstructive pulmonary disease [COPD] - 14 [27%]. Almost all the patients presented with cough - 52 [100%], shortness of breath [SOB] - 51 [99%], haemoptysis - 22 [42%], pleural pain - 16 [31%] and fever - 22 [42%] and weight loss - 39 [75%]. The PNS found were: Hypercalcemia - 22 [42%], thrombocytosis - 5 [9.6%], limbic encephalitis - 3 [5.8%], SIADH - 3 [5.8%], peripheral neuropathy - 2 [3.8%], GBS - 1 [1.9%], pancytopenia - 3 [5.8%]. There was no case with ACTH secretion or Lambert-Eaton syndrome. Hypercalcemia, thrombocytosis, SIADH, pancytopenia, limbic encephalitis and other unexplained neurological problems occurring in the middle aged or elderly smokers should arouse the suspicion of an occult bronchogenic carcinoma