scholarly journals Bowel Ischemia from Heat Stroke: A Rare Presentation of an Uncommon Complication

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Umair Masood ◽  
Anuj Sharma ◽  
Wajihuddin Syed ◽  
Divey Manocha
Keyword(s):  
Heat Stroke ◽  
Kidney Injury ◽  
Bowel Ischemia ◽  
Ascending Colon ◽  
Rare Presentation ◽  
Early Presentation ◽  
Adequate Hydration ◽  
Unique Aspect ◽  
Bowel Movements ◽  
Uncommon Complication

A healthy 27-year-old female presented to the hospital after she collapsed an hour into her first marathon run on a hot humid day. On presentation, she was hyperthermic, encephalopathic, tachycardic, and hypotensive. On admission, she was found to have lactic acidosis, rhabdomyolysis, and acute kidney injury and was treated with cold normal saline and cooling blankets. She subsequently started having abdominal pain and bloody bowel movements. Computed tomography of the abdomen revealed ascending colon thickening. Furthermore, her lab findings showed transaminitis and elevated coagulation parameters. Due to the acute hypotensive state from the heat stroke, patient had developed bowel ischemia, ischemic hepatitis, and disseminated intravascular coagulation, all of which are uncommon complications of heat stroke. She was managed aggressively with intravenous fluid hydration with resolution of her symptoms over the course of 4 days. In addition to the uncommon complications, early presentation of this bowel ischemia despite adequate hydration in such a healthy individual is another unique aspect of the case.

scholarly journals Survival from paraquat induced renal impairment in a 17 years old male

2021 ◽  
Vol 8 (2) ◽  
pp. 300
Author(s):  
Medo M. Kuotsu ◽  
N. Biplab Singh ◽  
Nyamnyei Konyak ◽  
Vikie-o Khruomo ◽  
Senjele Kath ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Treatment Options ◽  
Fatal Outcome ◽  
Radical Scavenging ◽  
Case Fatality ◽  
Kidney Injury ◽  
Organ Damage ◽  
Paraquat Poisoning ◽  
Adequate Hydration ◽  
Life Threatening

N, N’-dimethyl-4, 4’-bipyridinium dichloride (paraquat) is a herbicide commonly used in India that leads to fatal outcome on ingestion. Paraquat interferes in the intracellular electron transfer systems inhibiting the reduction of NADP to NADPH resulting in accumulation of superoxide radical causing lipid cell membranes destruction leading to various organ damage. Life threatening effects such as acute kidney injury as paraquat elimination is mainly by kidney, acute respiratory distress syndrome and multi-organ failure are the causes of mortality in paraquat poisoning. There is no specific antidotes for paraquat poisoning so prevention and aggressive decontamination remains the mainstay of management in case of exposure or ingestion. Paraquat poisoning presentation may vary in cases depending on the amount of paraquat consumed and thus the outcome. Here we report a case of a 17 years old male who presented with acute kidney injury following ingestion of paraquat in a suicidal attempt. In our case, induced vomiting of the stomach content readily after ingestion of the poison, early haemodialysis, use of immunosuppression such as methylprednisolone, cyclophosphamide and antioxidants such as acetylcysteine, Vitamin C and Vitamin E as free radical scavenging agent , supportive measures such as adequate hydration and antibiotics might have helped in the patient’s survival. The case fatality remains very high in paraquat poisoning till date owing to lack of effective treatment options.

scholarly journals Comparison of Rapid Hydration and Standard Hydration Prior to Ifosfamide Administration in Pediatric Patients: A Safety and Efficacy Study

2020 ◽  
Vol 25 (3) ◽  
pp. 246-250
Author(s):  
Aubrie Eaton ◽  
Tosha Egelund ◽  
John Ng
Keyword(s):  
Pediatric Patients ◽  
Hemorrhagic Cystitis ◽  
Kidney Injury ◽  
Urine Specific Gravity ◽  
Hydration Status ◽  
Time To Initiation ◽  
Adequate Hydration ◽  
Administration Time ◽  
Secondary Endpoints ◽  
Chemotherapy Initiation

OBJECTIVES Adequate hydration status prior to chemotherapy initiation prevents nephrotoxicity in patients receiving potentially nephrotoxic regimens. The purpose of this study was to evaluate the time to initiation of ifosfamide administration between patients receiving standard 6-hour pre-hydration versus 1-hour rapid pre-hydration. METHODS A retrospective study was conducted to determine the primary endpoint of time to ifosfamide administration. Patients 1 to 21 years of age who received ifosfamide with standard 6-hour pre-hydration (125 mL/m2/hr for 6 hours) between September 2017 and January 2018 or 1-hour rapid pre-hydration (750 mL/m2/hr for 1 hour) between September 2018 and March 2019 were included. Secondary endpoints included the incidence of hemorrhagic cystitis, incidence of acute kidney injury (AKI), urine specific gravity, amount of time that ifosfamide was delayed from the originally scheduled administration time, the number of times ifosfamide was delayed greater than 4 hours from the originally scheduled administration time, and length of stay. RESULTS A total of 128 patients were included; 68 patients received standard 6-hour pre-hydration and 60 patients received 1-hour rapid pre-hydration prior to ifosfamide administration. Time to ifosfamide administration was reduced from an average of 9.3 hours to 2.4 hours (p < 0.0001). There was no incidence of hemorrhagic cystitis or AKI in either group. CONCLUSIONS The 1-hour rapid pre-hydration protocol significantly reduced the time to ifosfamide administration without an increase in adverse effects.

scholarly journals Paradoxical Herniation following Decompressive Craniectomy in the Subacute Setting

2016 ◽  
Vol 2016 ◽  
pp. 1-3
Author(s):  
Alex P. Michael ◽  
Jose Espinosa
Keyword(s):  
Medical Treatment ◽  
Intracranial Hypertension ◽  
Treatment Option ◽  
Decompressive Craniectomy ◽  
Supine Position ◽  
Unique Case ◽  
Adequate Hydration ◽  
Standard Medical Treatment ◽  
Uncommon Complication

Decompressive craniectomy is reserved for extreme cases of intracranial hypertension. An uncommon complication known as paradoxical herniation has been documented within weeks to months following surgery. Here we present a unique case within days of surgery. Since standard medical treatment for intracranial hypertension will exacerbate paradoxical herniation, any abrupt neurological changes following decompressive craniectomy should be carefully investigated. Immediate treatment for paradoxical herniation is placement of the patient in the supine position with adequate hydration. Cranioplasty is the ultimate treatment option.

Hyperglycaemic crisis secondary to emphysematous pyelonephritis

2021 ◽  
Vol 14 (8) ◽  
pp. e242617
Author(s):  
Katie Liston ◽  
Rustom P Manecksha ◽  
Conor P Woods
Keyword(s):  
Kidney Injury ◽  
Glycated Haemoglobin ◽  
Generation Cephalosporin ◽  
Rare Presentation ◽  
Emphysematous Pyelonephritis ◽  
Intravenous Insulin ◽  
Intravenous Antibiotics ◽  
New Diagnosis

A 49-year-old woman presented to the emergency department acutely unwell. Initial investigations revealed hyperglycaemia, ketosis and an acute kidney injury precipitated by urosepsis. She was found to have a new diagnosis of diabetes mellitus (type 2) with a glycated haemoglobin (HbA1c) of 156 mmol/mol. CT imaging of the abdomen and pelvis revealed unilateral emphysematous pyelonephritis (EPN), radiologically classified as stage 3 severity with gas extending beyond the renal collecting system. Escherichia coli was grown on blood and urine cultures. This was sensitive to second-generation cephalosporin cefuroxime. The patient was managed with fluid resuscitation, intravenous antibiotics and renal system decompression with urinary catheter insertion. She was commenced on an intravenous insulin infusion for hyperglycaemic crisis. This case illustrates a rare presentation of hyperglycaemic crisis precipitated by EPN in a patient without a previously known diagnosis of diabetes, successfully treated with medical management alone. Close clinical and radiological follow-up was arranged to monitor the need for future nephrectomy.

scholarly journals A Rare Presentation of Hypermagnesemia Associated with Acute Kidney Injury due to Hypercalcemia

2019 ◽  
Vol 58 (8) ◽  
pp. 1123-1126 ◽  
Author(s):  
Taro Horino ◽  
Osamu Ichii ◽  
Yoshio Terada
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Rare Presentation

Thrombocytopenia as a predictor of severe acute kidney injury in patients with heat stroke

Renal Failure ◽  
2015 ◽  
Vol 37 (5) ◽  
pp. 877-881 ◽  
Author(s):  
Heng Fan ◽  
Yu Zhao ◽  
Jian-Hua Zhu ◽  
Fu-Chun Song ◽  
Ji-Hui Ye ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Heat Stroke ◽  
Kidney Injury

scholarly journals A Rare Presentation of AKI: Gastric Infiltration of the Bladder Wall

2011 ◽  
Vol 2011 ◽  
pp. 1-4
Author(s):  
Sandipani Sandilya ◽  
Ladan Golestaneh
Keyword(s):  
Gastric Cancer ◽  
Renal Failure ◽  
Peritoneal Carcinomatosis ◽  
Bladder Wall ◽  
Kidney Injury ◽  
Tumor Infiltration ◽  
Ureteral Stents ◽  
Imaging Studies ◽  
Rare Presentation ◽  
Obstructive Renal Failure

We describe the case of a man who presented with back pain and acute kidney injury and was found to have bilateral ureteral obstruction, which initially corrected with ureteral stents. Imaging studies showed thickening of the bladder. Shortly thereafter, he developed obstructive jaundice, pancreatitis, recurrence of renal failure, and was diagnosed with advanced gastric cancer after a laparotomy revealed peritoneal carcinomatosis. The patient deteriorated rapidly after diagnosis. While peritoneal carcinomatosis, ureteral metastases, and extrinsic ureteral compression have been recognized in gastric cancer, obstructive renal failure due to tumor infiltration of the bladder wall is seldom described. We present this case as an unusual cause of acute renal failure and presentation of gastric cancer.

scholarly journals Acute Kidney Injury, Immune Thrombocytopenic Purpura, and the Infection That Binds Them Together: Disseminated Histoplasmosis

2017 ◽  
Vol 5 (4) ◽  
pp. 232470961774619
Author(s):  
Pooja Sethi ◽  
Jennifer Treece ◽  
Chidinma Onweni ◽  
Vandana Pai ◽  
Sowminya Arikapudi ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Immune Thrombocytopenic Purpura ◽  
Opportunistic Infections ◽  
Immunocompromised Patient ◽  
Kidney Injury ◽  
The United States ◽  
Rare Presentation ◽  
Thrombocytopenic Purpura ◽  
Disseminated Histoplasmosis ◽  
Immunodeficiency Virus

Untreated human immunodeficiency virus (HIV) can be complicated by opportunistic infections, including disseminated histoplasmosis (DH). Although endemic to portions of the United States and usually benign, DH can rarely act as an opportunistic infection in immunocompromised patients presenting with uncommon complications such as acute kidney injury and idiopathic thrombocytopenic purpura. We report a rare presentation of DH presenting with acute kidney injury and immune thrombocytopenic purpura in an immunocompromised patient with HIV.

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