Acute interstitial nephritis with only three doses of pantoprazole.

Several antibiotics, proton pump inhibitors, and nonsteroidal anti-inflammatory drugs can cause acute interstitial nephritis. This is not dose-dependent, and recurrence can occur with a second exposure of the same drug. Stopping the culprit is critical for successful management.

If You Go Up, You May Fall: A Rare Case of Rapidly Progressing Multifocal High-Altitude Vascular Thrombosis.

A high-altitude (HA) exposure can lead to hypercoagulability, increasing the risk for major thromboembolic events. The spontaneous vascular thrombosis can be arterial or venous, and may occur after a short or extended stay at higher elevations. Diagnosis is often challenging, and delays in treatment can lead to inevitable and disabling sequelae. With a limited scope of experimental studies and trials to prove HA thrombogenicity, a greater awareness of the diversity of presentations and management is imperative to those engaged in treating such patients. We report a case of rapidly progressing HA vascular thrombosis.

New-onset atrial fibrillation in a young patient detected by smartwatch.

Atrial fibrillation (Afib) is associated with 15%-25% of strokes. Wearable devices like Apple watch can generate an electrocardiogram and can increase detection of Afib in general population. Early diagnosis and treatment can decrease the risk of strokes.

Ceftriaxone-Induced Immune Hemolytic Anemia.

Ceftriaxone is a commonly used antibiotic in hospitals for the treatment of pneumonia, urinary tract infection, bacteremia, meningitis, skin, and soft tissue infection. It can be associated with common allergic reactions like skin rash, itching, and, rarely, angioedema. Ceftriaxone-induced immune hemolytic anemia (IHA) is a rare and potentially fatal complication if not identified and managed in time. We report a case of ceftriaxone-induced IHA in a young woman.

Acute Pulmonary Embolism in a Healthy Male With Elevated Lipoprotein(a).

Elevated lipoprotein(a) [Lp(a)] is a well-known risk factor for cardiovascular disease. Its role in venous thromboembolism (VTE) is unclear. We present a case of a healthy man presenting with bilateral pulmonary embolism and investigations suggested elevated Lp(a) being the only risk factor. In this case report, we would like to emphasize the role of Lp(a) in VTE without any other clear predisposing factors.

Euglycemic Diabetic Ketoacidosis in a Young Pregnant Woman Precipitated by Urinary Tract Infection.

Diabetic ketoacidosis (DKA) is a life-threatening diabetic complication and medical emergency. Euglycemic DKA (EKDA) is a variant of DKA with normal range glucose levels. The condition can be difficult to diagnose due to the misleading euglycemic levels. Pregnancy, infection, low-calorie intake, and use of insulin are some of the common etiologies of EDKA. We report a case of a young, pregnant female, with type I diabetes mellitus, in her third trimester admitted with EKDA. The EKDA was triggered by urinary tract infection (UTI), and the patient had other etiologies that have predisposed her to EKDA. Along with the case presentation, we discuss the common etiologies, pathophysiology, and management of EKDA. Euglycemic DKA is a life-threatening emergency that needs to be recognized early and treated aggressively, especially in pregnant patients, to avoid deleterious effects to maternal and fetal health.

A resident-driven mortality case review innovation to teach and drive system-based practice improvements in the United States.

PURPOSE: Traditionally, Morbidity and Mortality Conference (M&MC) are forums where medical errors are discussed. Though M&MC can lead to identification of opportunities for system wide improvements, there is little in the literature to describe the use for this purpose, particularly in residency training programs. This paper describes the use of M&MC case review as a quality improvement activity that teaches systems-based practice and can engage residents in improving systems of care. METHODS: Internal medicine residents at a tertiary care academic medical center reviewed 347 consecutive mortalities from March 2104 to September 2017. Residents used case review worksheets to categorize and track causes of mortality. The residents then debriefed with a faculty member. Selected cases were then presented at a larger interdepartmental meeting and action items were implemented. Descriptive statistics and thematic analysis were used to analyze the results. RESULTS: The residents identified a diagnosis mismatch from admission to death in 54.5 % (n=189) of cases and possible need for improvement in management in 48.0% cases. Three 'management failure' themes were identified including failures to plan, failure to communicate and failure to rescue, consisting of 21.9%, 10.7 %, and 10.1% of cases respectively. Following the reviews, quality improvement initiatives proposed by residents lead to system-based changes. CONCLUSION: A resident-driven mortality review curriculum can lead to improvement in systems of care. This type of novel curriculum can teach systems-based practice. The recruitment of teaching faculty with expertise in quality improvement and mortality case analyses is essential for such a project.