Ethylene glycol intoxication following brake fluid ingestion complicated with unilateral facial nerve palsy: a case report.

BACKGROUND: Brake oil is an automobile transmission fluid composed of a mixture of toxic alcohols such as ethylene glycols and glycol ethers. Both accidental and intentional ingestion cases have been reported and they can present with multisystem involvement. Life-threatening complications evolve from deleterious effects on cardiopulmonary and renal systems. Effects on neurological and gastrointestinal systems give rise to a multitude of complications although non-fatal in nature. The biochemical panel consists of a high concentration of ethylene glycol with severe metabolic acidosis, high anion gap, high osmolar gap, oxaluria, and hypocalcemia. The mainstay of treatment is enhanced elimination of ethylene glycol and its metabolites by hemodialysis, together with general supportive care, gastric decontamination, and vitamins such as thiamine and pyridoxine to minimize the adverse effects of intoxication. CASE PRESENTATION: A 26-year-old Sinhalese woman presented with reduced urine output, shortness of breath, reduced level of consciousness, abdominal pain, and vomiting with mild degree fever of 2 days' duration. She had bilateral lower limb edema, crepitations over bilateral lower lung fields, and right-sided lower motor type facial nerve palsy. Investigations showed severe metabolic acidosis with high anion gap and high osmolar gap. With regular hemodialysis she made a complete recovery after 3 months. CONCLUSION: Even without a clear history of poisoning, the presence of a high anion, high osmolar gap metabolic acidosis should prompt one to search for ethylene glycol ingestion. Uncommon manifestations like cranial neuropathies need to be examined and considered. Timely aggressive treatment leads to a better prognosis.

Klebsiella pneumoniae liver abscess: a case report.

BACKGROUND: Liver abscess has formerly been a polymicrobial infection. Currently, liver abscess due to Klebsiella pneumoniae is increasingly reported, predominantly in Southeast Asia for unknown reasons. Liver abscess due to Klebsiella pneumonia has never been previously reported in Sri Lanka. CASE PRESENTATION: A 63-year-old Sinhalese man with diabetes mellitus and a poor glycemic control presented with fever, loose stools, and loss of appetite of 1 week's duration. An examination was unremarkable apart from a mild non-tender hepatomegaly. Investigations indicated a septic process with neutrophil leukocytosis, thrombocytopenia, and raised inflammatory markers with acute kidney injury. Sonography of his abdomen revealed a large liver abscess with two blood cultures positive for Klebsiella pneumoniae. He made a complete recovery following aspiration of the abscess and treatment with intravenously administered ceftriaxone. CONCLUSION: Liver abscess due to Klebsiella pneumoniae is an emerging infection and most commonly reported from Southeast Asia. In Sri Lanka, further studies are necessary to understand the epidemiology and modes of spread. Furthermore, a high index of suspicion is essential as early detection is the key to successful treatment and prevention of complications.