Dual Cardiac Arrests Leading to Hypercoagulability and Extensive Upper Extremity Deep Vein Thrombosis: A Hematological Case Report.

Upper extremity (UE) deep vein thrombosis (DVT) is a rare yet significant complication that can occur following cardiac arrest (CA). CA initiates a prothrombotic state via various processes, including stasis, endothelial damage, and an impaired balance between thrombogenesis and fibrinolysis, which may contribute to UE DVT formation. Inadequate cardiopulmonary resuscitation (CPR) in the field may further exacerbate blood stasis and clot formation. This case report describes an 80-year-old male with a history of bladder cancer who experienced two cardiac arrest events and subsequently developed an extensive left UE DVT. Despite treatment with a heparin drip and other supportive measures, the patient's condition deteriorated, and he passed away on the tenth day of hospitalization. This case is the first to describe UE DVT post-CA. It underscores the importance of recognizing and proactively managing hypercoagulable states post-CA, which can lead to significant DVTs in atypical locations that may evolve into life-threatening conditions.

Pneumatosis Intestinalis Following Surgical Gastrostomy Tube Placement in a Patient With Glottic Squamous Cell Carcinoma: A Case Report.

Pneumatosis intestinalis (PI) is a rare medical and post-surgical sequela of multiple different etiologies which can be either benign or life-threatening. Various mechanisms have been proposed to explain the occurrence of PI; however, the pathophysiology is dependent on the suspected cause. The condition is largely categorized into two broad groups: idiopathic PI, which remains relatively uncommon, and secondary PI. The latter often surfaces as a result of a wide array of both gastrointestinal and non-gastrointestinal illnesses. These encompass vascular compromise, bowel mucosal disruption, gastrointestinal dysmotility, as well as infectious and immunological etiologies. Management ranges from conservative medical strategies to emergent surgical intervention. We present the first case to our knowledge of spontaneous PI developing within five days of a surgical gastrostomy tube (SGT) placement in a 79-year-old female with glottic squamous cell carcinoma which unfortunately proved fatal. The purpose of this case report is to highlight a rare fatal complication of a common surgical procedure and the necessity of initiating interdisciplinary management quickly to determine the best treatment course.

Filling In the Gaps: Ethylene Glycol Poisoning Presenting With Isolated Lactate and Osmolar Gaps.

Ethylene glycol (EG) is an organic compound used in antifreeze. In 2020 alone, there were 5,277 EG exposures, with only 617 reported as intentional ingestions. Therefore, encountering EG toxicity is rare; however, it is essential to identify it promptly based on a focused history, exam, and rapid identification of commonly associated EG-induced metabolic derangements. If the diagnosis is not made within 12 hours of ingestion or exposure, severe morbidity and mortality can occur. Previous reports of EG poisoning have occurred in the setting of a lactate gap (LG) and osmolar gap (OG); however, they also had commonly associated findings of EG toxicity such as high anion gap acidosis (HAGMA), acute kidney injury (AKI), hypocalcemia, calcium oxalate stones, and suggestive histories of EG ingestion. We present a case of a 57-year-old male who presented from home for slurred speech and gait imbalance. He was intubated for airway protection due to obtundation. Labs only revealed the presence of both LG and OG, non-anion gap acidosis (NAGMA), and an EG level of 112 mg/dL three days after admission. Hemodialysis (HD) was initiated solely based on these findings within eight hours of admission, and he was subsequently able to be extubated without developing an acute or chronic cardio-pulmonary or renal injury. The patient's partner reported to the care team that they found multiple empty bottles of rum and whisky, an empty anti-freeze bottle, and a Sprite bottle with a light blue substance that was nearly empty in their basement. After extubation, the patient admitted to ingesting the antifreeze with the intention of self-harm. He recovered without complication and was transferred to the inpatient psychiatric unit to manage his depression and suicidality further. The early diagnosis and treatment of EG poisoning is critical to prevent severe morbidity and mortality occurring only 12 hours after ingestion. Therefore, reliance on prompt recognition of common laboratory findings, understanding of EG toxicity-specific signs and symptoms, and awareness of other rapid diagnostic tools for EG are essential in clinching the diagnosis. This case highlights the potential atypical presentations of EG toxicity, helpful diagnostic strategies, and the importance of avoiding anchoring bias when commonly associated disease processes are absent.