Geophagia leading to hypokalemic quadriparesis in a postpartum patient.

Pica is an eating disorder associated with ingestion of variety of non-food substances. A postpartum patient who presented with acute flaccid quadriparesis was detected to have severe hypokalemia. After extensive investigations for cause of hypokalemia, history of geophagia (clay-eating) was obtained. Approach to hypokalemia and health hazards of pica are discussed.

ARDS in a case of vesicular mole with secondary hyperthyroidism.

Vesicular mole is best regarded as a benign neoplasia of the chorion with malignant potentials. In India, the prevalence is one in four hundred pregnancies.We present one such case who presented with thyrotoxicosis and pulmonary edema.

Epidemic of leptospirosis: an ICU experience.

AIMS: To study the clinical profile and outcome of critically ill patients suffering from leptospirosis with organ dysfunction and correlate mortality with individual risk factors. METHODS: A study of critically ill patients suffering from leptospirosis was carried out in the Medical Intensive Care Unit of a tertiary centre of a metropolitan city between 1st June 2002 and 31st May 2003. All the patients in whom diagnosis was confirmed by ELISA IgM antibody testing underwent thorough clinical examination and necessary biochemical investigations. They received standard antimicrobial therapy and extensive supportive therapy as required. Mortality was correlated with individual risk factors. RESULTS: Out of 834 total admissions in this period, 60 (7.2%) patients suffered from leptospirosis. There were 48 males and 12 females with age ranging from 12 to 60 years, mean age being 40 years. The clinical manifestations varied from fever (58 patients), jaundice (38), subconjunctival haemorrhages (24), to altered sensorium (22). All the patients had evidence of severe sepsis. Forty six patients had multiple organ dysfunction syndrome (MODS) and 26 required ventilatory support. The total mortality in leptospirosis patients was 52% which was much higher compared to the total MICU mortality (31.4%) in the same period. CONCLUSION: Leptospirosis is an important infection associated with high mortality when associated with organ dysfunction. The poor prognostic factors are preponderance of male sex, alcohol dependence, age group > 50 years, MODS, acute respiratory distress syndrome (ARDS), presence of acidosis and need for mechanical ventilation. However, timelyintervention and intensive therapy can save many young lives.

Rhinocerebral mucormycosis in a pregnant woman with diabetic ketoacidosis.

Rhinocerebral mucormycosis (RCM) is a rare but often fatal condition characterized by aggressive necrotizing infection originating from nose and spreading to paranasal sinuses, orbit and central nervous system. Although Fungi and spores of mucorales show minimal intrinsic pathogenicity towards normal persons, they can initiate fulminant infections in patients with underlying debilitating conditions. A case of RCM in a pregnant woman with diabetic keto-acidosis successfully treated by supportive care, amphotericin B and surgery is reported.

Methanol poisoning in medical intensive care unit.

A series of eight cases of methyl alcohol poisoning resulting from consumption of adulterated alcohol is presented. Most of the patients had blurring of vision followed by coma, metabolic acidosis and hemodynamic unstability (SBP < 90 mmHg) on admission to medical ICU. Early recognition and prompt initiation of treatment lead to successful recovery in five of these patients. Analysis of correlation between clinical and biochemical indicators of severity and indication for various therapeutic interventions are discussed.

Nosocomial pneumonia in medical intensive care unit.

OBJECTIVES: This study was undertaken to determine incidence, clinical features, microbiological flora and prognosis of patients with nosocomial pneumonia (NP) in medical intensive care unit (ICU). Also to study impact of comorbid illnesses, intubation and mechanical ventilation on outcome. METHODS: In this prospective study over a period of one year 89 patients were detected to have nosocomial pneumonia amongst 948 total admissions in ICU. All these 89 patients were investigated radiologically, microbiologically and biochemically. Mortality in these patients was correlated with various factors using chi-square test. RESULTS: Incidence of NP was 9.38%. Enteric gram-negative organisms were commonest isolates (61.9%), followed by Staph aureus (29.8%). Sixty five (73%) patients had severe pneumonia, 47 (52.8%) required intubation and 42 (47.2%) mechanical ventilation. Total mortality was 19 out of 89 (21.3%). High mortality was associated with habits like smoking (33.3%), age group over 60 years (27.3%), presence of comorbid illness like DM and COAD (38.5%), complications like ARDS (61.3%, p < 0.001) or sepsis with end organ failure (73.7%, p < 0.001) and need of intubation (36.2%) or mechanical ventilation (40.5%, p < 0.005). CONCLUSION: Nosocomial pneumonias constitute important problem in medical ICU and are associated with high mortality. Patients with advanced age, co-morbid illness, ARDS and end organ failure are at high risk for mortality. However with intensive supportive care and appropriate antibiotics many such lives can be saved.

Nifedipine, captopril, metoprolol and nifedipine with metoprolol in hypertensive crisis in non-intensive care setting.

In 102 cases of severe hypertension (DBP > or = 115 mm Hg), with or without acute complications, efficacy and safety of SL Nifedipine 10 mg (NIF), SL Captopril 25 mg (CAP), IV Metoprolol 15 mg (MET) and SL NIF + IV MET were studied in an inpatient trial. Maximum mean percent reduction in SBP was 13.3, 9.7, 15.7 and 19.9 and in DBP was 21.2, 13.9, 12.5 and 20.4 with NIF, CAP, MET and NIF + MET respectively. A safe DBP of < or = 110 mm Hg (Kaplan) was achieved in 90, 61, 72.2 and 95.2 percent of patients. A statistically significant fall in DBP was observed at 5 minutes with all regimens except CAP which was at 15 minutes. Mild side effects observed were palpitations and flushing (NIF n = 4), taste disturbances (CAP n = 3), heaviness of head (CAP n = 1) and giddiness (MET n = 2, NIF + MET n = 2). The trial data suggest that hypertensive crisis can be managed, without intensive care facility, with all four regimens; this implies significant cost containment.