Refeeding Syndrome in Haemodialysis Patients.

Nutritional therapies have shown to be efficacious and efficient, despite the overall low level of evidence. It however hides the risk of refeeding syndrome in catabolic malnourished patients. Refeeding syndrome is the metabolic response due to the switch from a starvation to a fed state in the initial phase of nutritional therapy in patients who were severely malnourished or metabolically stressed due to severe illness. Here we describe two cases of chronic kidney disease patients on maintenance haemodialysis, who developed refeeding syndrome. Both the patients had tuberculosis and were severely malnourished with subjective global Assessment (SGA) of grade C. Timely diagnosis and proper management leads to good outcome.

Rare and Unusual Presentation as Immune Thrombocytopenic Purpura in Scrub Typhus Complicated by Meningitis and Acute Kidney Injury.

Scrub typhus is a known etiology of acute febrile illness in tropical regions such as Asia-Pacific. Several such reports are from the Indian subcontinent with manifestations such as non-specific febrile illness or multiorgan dysfunction [Acute respiratory distress syndrome (ARDS), myocarditis, hepatitis, acute kidney injury, or meningoencephalitis]. We came across a case with a presentation as immune thrombocytopenic purpura complicated by meningitis and acute kidney injury secondary to scrub typhus. This combination of presentation is rare and demands meticulous clinical examination and targeted management toward scrub typhus. How to cite this article: Chowdhary PK, Agrawal RK, Kumar S, Kale SA, Kumar V. Rare and Unusual Presentation as Immune Thrombocytopenic Purpura in Scrub Typhus Complicated by Meningitis and Acute Kidney Injury. Indian J Crit Care Med 2022;26(6):748-751.

Plasmapheresis in Hypertriglyceride-induced Pancreatitis: A Series of Four Cases.

Hypertriglyceride-induced Acute Pancreatitis is a devasting condition. The rapid reduction of serum triglyceride is a key factor in its management. Beside the reduction in Triglyceride level plasmapheresis has other added advantage. Early initiation of plasmapheresis within 48 hrs has a better outcome. Plasmapheresis should be performed until triglyceride levels have been lowered to 500mg/dl. Here, we present a series of four cases of hypertriglyceride induced pancreatitis who underwent plasmapheresis. All the patients were diabetics. All cases showed the rapid reduction of triglyceride levels after plasmapheresis. Three patients were discharge from hospital, where as one patient died due to Sepsis. Out of four patients only one required Renal Replacement therapy.

Postpartum Acute Kidney Injury in Tertiary Care Center: Single-Center Experience from Central India.

Acute kidney injury (AKI) in postpartum is a rare, but deadly complication of pregnancy. It has great impact on maternal and fetal outcomes. The study aimed to study the incidence and etiological profile with outcomes of postpartum AKI patients and to see whether need for hemodialysis (HD) alters the outcome. This is a retrospective observation study done in a tertiary care center at the Department of Nephrology, Ramkrishnan Care Hospital, Raipur, Chhattisgarh, India. All postpartum women suffering from AKI between May 2011 and May 2017 were included in this study. Demographic, clinical, and laboratory data of the patients were included. Outcome variables including maternal and fetal mortality with renal outcome during discharge and follow-up for three months were noted. Patients were divided into two groups: Group 1 underwent HD and Group 2 was managed conservatively. Statistical analysis was done on the Statistical Package for the Social Sciences software version 17.0. Categorical data were expressed as ratio and proportions, while continuous data were expressed as mean plus standard deviation (SD). Quantitative data were analyzed by percentage, mean, SD, and t-test. Qualitative data were analyzed by Chi-square test. The incidence of postpartum AKI was 3.26% and the mean age of the study population was 27.3 ± 4.77 years. Multifactorial (53.27%) etiology was the most cause of postpartum AKI, and the second was puerperal sepsis (32.7%). Seventy-three (68.22%) patients had undergone HD. Four (4.47%) patients require lifelong HD. Renal biopsy was done in seven patients, three had cortical necrosis among fetal outcomes, total live births were 92 (85.98%), and 15 (14.01%) died in the neonatal period. There was no statistically significant difference between Group 1 and Group 2 in etiological profile (P >0.55), maternal mortality (P >0.66), and renal outcome (P >0.11). Postpartum AKI was associated with poor maternal outcome and renal recovery. Maternal mortality and renal recovery were not affected by need of dialysis in our patients. Proper antenatal care and peripartum monitoring with practicing aseptic precaution will definitely help in reduction of postpartum AKI and maternal mortality in our state.