When a harmless procedure causes a life-threatening problem: a case report of metformin-associated lactic acidosis following a colonoscopy

AbstractMetformin is an oral antidiabetic medication which belongs to the class biguanide. Its most hazardous and life-threatening side effect is lactic acidosis which has been increasingly reported in recent years. Early diagnosis and aggressive treatment approaches have significantly reduced morbidity and mortality rates in metformin intoxication. In this case report, we emphasize the importance of early continuous renal replacement therapy in metformin-associated lactic acidosis in a 16-year-old patient who developed severe renal damage during the follow-up period of renal replacement therapy due to lactic acidosis after taking metformin in a suicide attempt.

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Presentation of Gall Stone Ileus as Gut Obstruction

JMS SKIMS ◽

10.33883/jms.v21i2.328 ◽

2019 ◽

Vol 21 (2) ◽

pp. 117-119

Author(s):

Munir Ahmad Wani ◽

Mubarak Ahmad Shan ◽

Syed Muzamil Andrabi ◽

Ajaz Ahmad Malik

Keyword(s):

Abdominal Pain ◽

Case Report ◽

Ct Scan ◽

Bowel Obstruction ◽

Emergency Surgery ◽

Gallstone Ileus ◽

Gall Stone ◽

Life Threatening ◽

Life Threatening Complication ◽

Gall Stone Ileus

Gallstone ileus is an uncommon and often life-threatening complication of cholelithiasis. In this case report, we discuss a difficult diagnostic case of gallstone ileus presenting as small gut obstruction with ischemia. A 56-year-old female presented with abdominal pain and vomiting. A CT scan was performed and showed an evolving bowel obstruction with features of gut ischemia with pneumobilia although no frank hyper density suggestive of a gallstone was noted. The patient underwent emergency surgery and a 60 mm obstructing calculus was removed from the patient's jejunum, with a formal tube cholecystostomy. JMS 2018: 21 (2):117-119

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Proposal for the administration of metformin in patients with chronic kidney disease

Orvosi Hetilap ◽

10.1556/oh.2012.29448 ◽

2012 ◽

Vol 153 (39) ◽

pp. 1527-1535 ◽

Cited By ~ 1

Author(s):

Zoltán Balogh ◽

János Mátyus

Keyword(s):

Lactic Acidosis ◽

Chronic Renal Disease ◽

Antidiabetic Agent ◽

First Line ◽

Oral Antidiabetic Agent ◽

Oral Antidiabetic ◽

Cardiovascular Morbidity And Mortality ◽

Glomerular Filtrate ◽

Life Threatening

Metformin is the first-line, widely used oral antidiabetic agent for the management of type 2 diabetes. There is increasing evidence that metformin use results in a reduction in cardiovascular morbidity and mortality, and might have anticancer activity. An extremely rare, but potentially life-threatening adverse effect of metformin is lactic acidosis, therefore, its use is traditionally contraindicated if the glomerular filtrate rate is below 60 mL/min. However, lactic acidosis is always associated with acute events, such as hypovolemia, acute cardiorespiratory illness, severe sepsis and acute renal or hepatic failure. Furthermore, administration of insulins and conventional antihyperglycemic agents increases the risk of severe hypoglycemic events when renal function is reduced. Therefore, the magnitude of the benefit of metformin use would outweigh potential risk of lactic acidosis in moderate chronic renal disease. After reviewing the literature, the authors give a proposal for the administration of metformin, according to the calculated glomerular filtrate rate. Orv.Hetil., 2012, 153, 1527–1535.

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Burkitt lymphoma of the nasopharynx causing life-threatening airway obstruction: A case report

American Journal of Otolaryngology ◽

10.1016/j.amjoto.2021.102977 ◽

2021 ◽

Vol 42 (4) ◽

pp. 102977

Author(s):

Alexander N. Goel ◽

Andrey Filimonov ◽

Julie Teruya-Feldstein ◽

Christian Salib ◽

Joseph J. Rousso ◽

...

Keyword(s):

Case Report ◽

Airway Obstruction ◽

Burkitt Lymphoma ◽

Life Threatening

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Thermal burns in electroconvulsive therapy

Proceedings of Singapore Healthcare ◽

10.1177/20101058211031049 ◽

2021 ◽

pp. 201010582110310

Author(s):

Ernest Weisheng Ho ◽

Eng Leonard ◽

Lee Tih-Shih ◽

Gregory James Meredith

Keyword(s):

Case Report ◽

Mood Disorders ◽

Electroconvulsive Therapy ◽

Ignition Source ◽

Thermal Burns ◽

High Impedance ◽

Temporal Placement ◽

Close Proximity ◽

Life Threatening

Electroconvulsive therapy (ECT) is effective for mood disorders and schizophrenia. Thermal burns, while rare, are potentially sight and life threatening. The three elements necessary for a fire are often in close proximity during a session: an oxidiser (oxygen), an ignition source (faulty electrodes, poor contact with skin producing a spark) and fuel (hair, residual alcohol cleanser). This case report describes one such incident when a patient sustained a burn during ECT, with poor contact of electrode pad with skin, high impedance and an oxygen-rich environment possibly contributing. Given that ECT is conducted relatively frequently (once every 2–3 days) in a usual regimen, we make recommendations for safe application of electrode pads for temporal placement ECT.

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Asymptomatic mediastinal extra-adrenal paraganglioma as a cause of sudden death: a case Report

Open Life Sciences ◽

10.1515/biol-2019-0062 ◽

2019 ◽

Vol 14 (1) ◽

pp. 564-567

Author(s):

Qiancheng Xu ◽

Yingya Cao ◽

Hongzhen Yin ◽

Rongrong Wu ◽

Tao Yu ◽

...

Keyword(s):

Blood Pressure ◽

Case Report ◽

Respiratory Failure ◽

Pressure Drop ◽

Thoracic Cavity ◽

Severe Hypotension ◽

Life Threatening ◽

History Of ◽

Posterior Mediastinal ◽

Extra Adrenal Paraganglioma

AbstractA 23-year-old female patient was referred for treatment of a posterior mediastinal tumour. There was no history of hypertension or headache and no other complaints. The patient’s blood pressure increased to 210/125 mmHg after surgically manipulating the tumour, subsequently reversing to severe hypotension (25/15 mmHg) immediately after the tumour was removed. The life-threatening and irreversible blood pressure drop was difficult to treat with fluid and vasopressors, and the patient ultimately died of cardio-respiratory failure. Asymptomatic paraganglioma can be non-functional but can also be fatal. For any lump in the thoracic cavity, paraganglioma should be ruled out.

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Perforation of the atrial wall and aortic sinus after closure of an atrial septal defect with an Atriasept occluder: a case report

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01441-x ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Zai-Qiang Zhang ◽

Jia-Wang Ding

Keyword(s):

Case Report ◽

Atrial Septal Defect ◽

Septal Defect ◽

Emergency Operation ◽

Atrial Wall ◽

Aortic Sinus ◽

Case Presentation ◽

Lethal Complications ◽

Life Threatening

Abstract Background While the perforation of the atrial wall and aortic sinus after closure of an atrial septal defect (ASD) is rare, it’s life-threatening, with rapid progress and high mortality. To the best of our knowledge, 21 similar cases have been reported since 1976. Case presentation We report a 16-year-old male whose atrial septal defect (ASD) was closed using a 12-mm Amplatzer septal occluder (ASO). Atrial wall and aortic sinus perforation occurred 3 months after transcatheter closure, and the patient was discharged after emergency operation. He was discharged on the 12th postoperative day in good overall condition. Conclusions With this case report, we want to illustrate that although percutaneous closure of ASD is regarded as a routine procedure, we should not forget the potentially lethal complications, especially cardiac erosion. Therefore, we should carefully evaluate the risk of erosion before surgery, and careful lifelong follow-up is needed.

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Death of unknown cause? Post-mortem diagnosis of fulminant course of an EBV-associated secondary hemophagocytic lymphohistiocytosis

memo - Magazine of European Medical Oncology ◽

10.1007/s12254-021-00701-9 ◽

2021 ◽

Author(s):

Josia Fauser ◽

Stefan Köck ◽

Eberhard Gunsilius ◽

Andreas Chott ◽

Andreas Peer ◽

...

Keyword(s):

Immune Response ◽

Case Report ◽

Macrophage Activation ◽

Post Mortem ◽

Life Threatening ◽

Appropriate Therapy ◽

Diagnostic Work ◽

Work Up ◽

Diagnostic Work Up ◽

Secondary Hemophagocytic Lymphohistiocytosis

SummaryHLH is a life-threatening disease, which is characterized by a dysregulated immune response with uncontrolled T cell and macrophage activation. The often fulminant course of the disease needs a fast diagnostic work-up to initiate as soon as possible the appropriate therapy. We present herein the case of a 71-year-old patient with rapidly progressive hyperinflammatory syndrome, which post mortem resulted in the diagnosis of EBV-associated HLH. With this case report, we intend to highlight the relevance of the HScore in the diagnosis of HLH, to create a greater awareness for EBV as a trigger of HLH, and to demonstrate the importance of treating EBV-associated HLH as early as possible.

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A life‐threatening dental implant: A case report

Clinical Implant Dentistry and Related Research ◽

10.1111/cid.13010 ◽

2021 ◽

Author(s):

Marco Dalle Carbonare ◽

Elizabeth Yeung ◽

Juveria Siddiqui ◽

Naga Kandasamy ◽

Kathleen Fan

Keyword(s):

Case Report ◽

Dental Implant ◽

Life Threatening

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A case of neck abscess caused by rare hypervirulent Klebsiella pneumoniae, capsular type K20 and sequence type 420

Annals of Clinical Microbiology and Antimicrobials ◽

10.1186/s12941-021-00453-8 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

John Alexander McHardy ◽

Vathshalan Selvaganeshapillai ◽

Priya Khanna ◽

Ashley Michael Whittington ◽

Jane Turton ◽

...

Keyword(s):

Public Health ◽

Case Report ◽

Antimicrobial Resistance ◽

Klebsiella Pneumoniae ◽

East Asia ◽

South East Asia ◽

Neck Abscess ◽

Global Challenge ◽

Life Threatening ◽

The Uk

Abstract Background This case report describes a neck abscess caused by a strain of Hypervirulent Klebsiella pneumoniae in a middle aged man with diabetes without a history of travel to East and South East Asia. This case report is of notable significance as Hypervirulent Klebsiella pneumoniae neck abscesses are rarely seen in the UK and are very infrequently documented in individuals who have not first travelled to the high prevalence areas of East and South East Asia. Case presentation This case report describes a 53 year old diabetic man who contracted a Hypervirulent Klebsiella pneumoniae neck abscess which led to the development of sepsis. Klebsiella pneumoniae was cultured from blood cultures and fluid aspirated from the abscess grew the pathogen with same antimicrobial susceptibility. Hypervirulence was demonstrated after the samples were analysed, at the Antimicrobial Resistance and Healthcare Associated Infections Reference Unit Public Health England Colindale, and found to contain the K20 (rmp)A and rmpA2 virulence genes. Discussion Hypervirulent Klebsiella pneumoniae is a Gram-negative, encapsulated, non-motile bacillus notable for its ability to metastatically spread and cause potentially life threatening infections in otherwise healthy adults, but especially in those with diabetes. Genes responsible for the production of hyperviscous mucoid polysaccharide capsules and siderophores, such as those isolated in this case, enable the bacteria to more efficiently evade the hosts immune system and disseminate and invade surrounding and distant tissues. Data from Public Health England shows Hypervirulent Klebsiella pneumoniae are rare in the UK. A review of current literature also showed Hypervirulent Klebsiella pneumoniae almost exclusively occur in those who have traveled to East and South East Asia. Conclusions This case reported a rare Hypervirulent Klebsiella pneumoniae neck abscess outside of, and without travel to, East and South East Asia. This raises concerns about future, potentially life threatening, Hypervirulent Klebsiella pneumoniae infections becoming more widespread without the need for endemic travel. This concern is further exacerbated by the growing global challenge of antimicrobial resistance.

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