ABSTRACT
The authors present a case of diplopia and eye pain due to orbital myositis in a patient with a de novo diagnosis of systemic lupus erythematosus. Systemic lupus erythematosus is a rare cause of orbital myositis and should be considered when other, more common, conditions have been excluded.
ABSTRACT
Indwelling bladder catheter-associated leakage, or catheter bypassing, is a frequently experienced problem, necessitating a carefully planned intervention. Once a bladder catheter is in place, urine may flow intermittently between the catheter shaft and the urethra mucosa, or from around the catheter when inserted suprapubically. A review of the literature identified several reasons for this leakage, including catheter size and anatomical abnormalities. Based on clinical experience, the authors posit that indwelling catheter leakage may also occur as a result of a catheter design flaw. This article provides the theoretical rationale for this hypothesis and a potential solution; formal, rigorous, and appropriate research should be performed to test the hypothesis.
Subject(s)
Catheters, Indwelling , Equipment Failure Analysis , Urinary Catheterization/instrumentation , Equipment Design , Humans , Urinary Catheterization/nursingABSTRACT
Many of the common causes of a high anion gap metabolic acidosis, like salicylate toxicity or diabetic ketoacidosis, are well recognized and promptly treated. Pyroglutamic acidosis (or 5-oxoproline acidosis) is a less common cause and is likely substantially underdiagnosed for two reasons: firstly, urine or serum measurements of pyroglutamic acid are performed only in specialist laboratories, and secondly, because awareness of the condition is still low, despite widespread reports in the medical and biochemical literature. The condition is often precipitated by the chronic use of paracetamol. Paracetamol is increasingly being widely prescribed as an alternative to NSAIDs often in maximal doses, given its innocuous reputation, and we anticipate more similar presentations. We present a case of a young pregnant woman who developed a severe metabolic acidosis secondary to raised pyroglutamate. Her treatment necessitated an emergency Caesarean section, ventilation and haemodiafiltration, despite normal renal function. We provide a reminder of other risk factors associated with the diagnosis.
