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1.
BMC Endocr Disord ; 22(1): 148, 2022 Jun 02.
Article in English | MEDLINE | ID: covidwho-1902378

ABSTRACT

INTRODUCTION: Diabetic ketoacidosis (DKA) is a complication of diabetes presenting with high anion gap metabolic acidosis. Methanol poisoning, on the other hand, is a toxicology emergency which presents with the same feature. We present a case of methanol poisoning who presented with DKA. CASE PRESENTATION: A 28-year-old male was referred to us with blurred vision and loss of consciousness three days after ingestion of 1.5 L of an unknown mixture of bootleg alcoholic beverage. He had history of insulin-dependent diabetes and had neglected his insulin shots on the day prior to hospital admission due to progressive loss of consciousness. Vital signs were normal and venous blood gas analysis showed severe metabolic acidosis and a methanol level of 10.2 mg/dL. After eight hours of hemodialysis, he remained unresponsive. Diabetic ketoacidosis was suspected due to positive urine ketone and blood sugar of 411 mg/dL. Insulin infusion was initiated which was followed by full awakening and extubation. He was discharged completely symptom-free after 4 weeks. CONCLUSIONS: Diabetic ketoacidosis and methanol poisoning can happen simultaneously in a diabetic patient. Given the analogous high anion gap metabolic acidosis, physicians should pay particular attention to examination of the diabetic patients. Meticulous evaluation for both conditions is highly recommended.


Subject(s)
Acidosis , Diabetes Mellitus , Diabetic Ketoacidosis , Acidosis/chemically induced , Acidosis/complications , Adult , Diabetic Ketoacidosis/chemically induced , Diabetic Ketoacidosis/complications , Diabetic Ketoacidosis/therapy , Humans , Insulin/therapeutic use , Male , Methanol , Unconsciousness/complications
2.
Air Med J ; 41(4): 402-405, 2022.
Article in English | MEDLINE | ID: covidwho-1850584

ABSTRACT

A 43-year-old male Bell 214C helicopter pilot presented to the emergency ward with flu-like syndrome. His nasopharyngeal severe acute respiratory syndrome coronavirus 2 real-time polymerase chain reaction test was positive, and a chest computed tomographic scan confirmed coronavirus disease 2019 pneumonia. He was admitted, received treatment, was discharged, and returned to flying. During the mission debrief, copilots who had flown with him reported that he experienced episodes of in-flight dizziness and blacked out. They occurred briefly during the cruise and hovering flight, perhaps for a few seconds of disorientation and unconsciousness. Rapid identification of the copilot and control of the helicopter prevented any incident or accident. Afterward, he explained the sudden onset and unexpected brief periods of loss of consciousness after a headache. The flight safety office referred him to the aviation medical center for further investigations. The cardiovascular, neurologic, laboratory, and toxicologic assessments were inconclusive with the approach to sudden-onset transient loss of consciousness. The only abnormal finding was hippocampus lesions on brain magnetic resonance imaging (MRI). Because of the possible diagnosis of transient global amnesia, the aviation medical examiner suspended him from flight duties until complete recovery and the absence of any probable complications.


Subject(s)
Amnesia, Transient Global , COVID-19 , Adult , Amnesia, Transient Global/diagnosis , Amnesia, Transient Global/etiology , Brain , Humans , Male , Tomography, X-Ray Computed/adverse effects , Unconsciousness/complications
3.
Ann Neurol ; 91(6): 740-755, 2022 06.
Article in English | MEDLINE | ID: covidwho-1729093

ABSTRACT

OBJECTIVE: The purpose of this study was to estimate the time to recovery of command-following and associations between hypoxemia with time to recovery of command-following. METHODS: In this multicenter, retrospective, cohort study during the initial surge of the United States' pandemic (March-July 2020) we estimate the time from intubation to recovery of command-following, using Kaplan Meier cumulative-incidence curves and Cox proportional hazard models. Patients were included if they were admitted to 1 of 3 hospitals because of severe coronavirus disease 2019 (COVID-19), required endotracheal intubation for at least 7 days, and experienced impairment of consciousness (Glasgow Coma Scale motor score <6). RESULTS: Five hundred seventy-one patients of the 795 patients recovered command-following. The median time to recovery of command-following was 30 days (95% confidence interval [CI] = 27-32 days). Median time to recovery of command-following increased by 16 days for patients with at least one episode of an arterial partial pressure of oxygen (PaO2 ) value ≤55 mmHg (p < 0.001), and 25% recovered ≥10 days after cessation of mechanical ventilation. The time to recovery of command-following  was associated with hypoxemia (PaO2 ≤55 mmHg hazard ratio [HR] = 0.56, 95% CI = 0.46-0.68; PaO2 ≤70 HR = 0.88, 95% CI = 0.85-0.91), and each additional day of hypoxemia decreased the likelihood of recovery, accounting for confounders including sedation. These findings were confirmed among patients without any imagining evidence of structural brain injury (n = 199), and in a non-overlapping second surge cohort (N = 427, October 2020 to April 2021). INTERPRETATION: Survivors of severe COVID-19 commonly recover consciousness weeks after cessation of mechanical ventilation. Long recovery periods are associated with more severe hypoxemia. This relationship is not explained by sedation or brain injury identified on clinical imaging and should inform decisions about life-sustaining therapies. ANN NEUROL 2022;91:740-755.


Subject(s)
Brain Injuries , COVID-19 , Brain Injuries/complications , COVID-19/complications , Cohort Studies , Humans , Hypoxia , Retrospective Studies , Unconsciousness/complications
4.
J Neurovirol ; 26(5): 802-804, 2020 10.
Article in English | MEDLINE | ID: covidwho-716427

ABSTRACT

In this article, subarachnoidal hemorrhage developing in a case with Covid-19-related pneumonia was evaluated. In the presence of respiratory system infection signs such as cough and weakness in patient who present with sudden loss of consciousness, performing lung imaging as well as performing brain computerized tomography scan can allow the detection of an underlying Covid-19 infection.


Subject(s)
Betacoronavirus/pathogenicity , Brain/pathology , Coronavirus Infections/complications , Pneumonia, Viral/complications , Subarachnoid Hemorrhage/complications , Unconsciousness/complications , Brain/blood supply , Brain/diagnostic imaging , Brain/virology , COVID-19 , Coronavirus Infections/diagnostic imaging , Coronavirus Infections/pathology , Coronavirus Infections/virology , Fatal Outcome , Humans , Lung/diagnostic imaging , Lung/pathology , Lung/virology , Male , Middle Aged , Neuroimaging , Pandemics , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/pathology , Pneumonia, Viral/virology , SARS-CoV-2 , Subarachnoid Hemorrhage/diagnostic imaging , Subarachnoid Hemorrhage/pathology , Subarachnoid Hemorrhage/virology , Tomography, X-Ray Computed , Unconsciousness/diagnostic imaging , Unconsciousness/pathology , Unconsciousness/virology
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