RESUMO
Diabetic ketoacidosis (DKA) and hyponatraemia associated with beer potomania are severe diagnoses warranting intensive care level management. Our patient, a middle-aged man, with a history of chronic alcohol abuse and insulin non-compliance, presents with severe DKA and severe hyponatraemia. Correcting sodium and metabolic derangements in each disorder require significant attention to fluid and electrolyte levels. Combined they prove challenging and require an individualised approach to prevent the overcorrection of sodium. Furthermore, management of these conditions lends to the importance of understanding the pathophysiology behind their hormonal and osmotic basis.
Assuntos
Cetoacidose Diabética , Hiponatremia , Cerveja , Cetoacidose Diabética/complicações , Cetoacidose Diabética/diagnóstico , Humanos , Hiponatremia/diagnóstico , Hiponatremia/etiologia , Insulina , Masculino , Pessoa de Meia-Idade , SódioRESUMO
A 40-year-old man presented with altered mental status after a recenthospitalisation for COVID-19 pneumonia. Cerebrospinal fluid (CSF) analysis showed lymphocytosis concerning for viral infection. The CSF PCR for SARS-CoV-2 was negative, yet this could not exclude COVID-19 meningoencephalitis. During hospitalisation, the patient's mentation deteriorated further requiring admission to the intensive care unit (ICU). Brain imaging and electroencephalogram (EEG) were unremarkable. He was, thus, treated with intravenous immunoglobulin (IVIg) for 5 days with clinical improvement back to baseline. This case illustrates the importance of considering COVID-19's impact on the central nervous system (CNS). Haematogenous, retrograde axonal transport, and the effects of cytokine storm are the main implicated mechanisms of CNS entry of SARS-CoV-2. While guidelines remain unclear, IVIg may be of potential benefit in the treatment of COVID-19-associated meningoencephalitis.
Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Meningoencefalite/tratamento farmacológico , Meningoencefalite/etiologia , Pneumonia Viral/complicações , Adulto , COVID-19 , Humanos , Masculino , Pandemias , SARS-CoV-2 , Resultado do TratamentoRESUMO
Polycythaemia vera is a recognised cause of ischaemic stroke. If not treated, this condition may result in recurrent strokes. This is a case of a 61-year-old Caucasian man presenting with the inability to ambulate for 3â days. Brain imaging revealed acute and chronic infarctions in the brain stem and the cerebrum. Polycythaemia vera was diagnosed and treated during the admission. The unique mechanisms and management issues of ischaemic stroke associated with polycythaemia vera are discussed.
Assuntos
Aspirina/uso terapêutico , Sangria/métodos , Ácidos Heptanoicos/uso terapêutico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Inibidores da Agregação Plaquetária/uso terapêutico , Policitemia Vera/complicações , Pirróis/uso terapêutico , Acidente Vascular Cerebral/etiologia , Atorvastatina , Seguimentos , Humanos , Policitemia Vera/fisiopatologia , Recidiva , Acidente Vascular Cerebral/fisiopatologia , Resultado do TratamentoRESUMO
Warfarin Induced Skin Necrosis is a well-known and dreaded complication in patients who is being started on warfarin without adequate bridging with other anticoagulants. The mechanism is thought to be due to protein C deficiency acquired after initial exposure to warfarin. We present a rather unusual cause of protein C deficiency due to sepsis resulting in warfarin induced skin necrosis. 43 year old lady who has been on chronic warfarin therapy secondary to anti phospholipid syndrome was admitted to the hospital for acute ischemic cerebellar stroke. Warfarin was held due to acute thrombocytopenia. She was discharged after restarting the warfarin. She presented back with septic shock due to pneumonia. She was found to have multiple necrotic areas consistent with skin necrosis. Unfortunately, patient died due to multi organ failure despite goal directed therapy. This case demonstrates the importance of recognizing the sepsis as an acquired cause of protein C deficiency.