scholarly journals A compulsive act of excess water intake leading to hyponatraemia and rhabdomyolysis: a case report

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
Sudheera Fernando ◽  
Francisca Sivagnanam ◽  
Devarajan Rathish
Keyword(s):  
Water Intake ◽  
Clonic Seizure ◽  
Case Presentation ◽  
Psychiatric Illnesses ◽  
Ureteric Calculus ◽  
Anticholinergic Medications ◽  
Excess Water ◽  
Severe Hyponatraemia ◽  
Level Of Consciousness ◽  
Recovery Of Consciousness

Abstract Background Primary polydipsia is commonly seen in patients with psychiatric illnesses. Excess water intake is also seen in patient with anorexia and anticholinergic medications. We report a patient who had hyponatraemia and rhabdomyolysis after consuming excess water for ureteric calculus. Case presentation A healthy middle-aged male presented with an episode of generalized tonic-clonic seizure and reduced level of consciousness preceded by consumption of excess water. He was recently diagnosed to have a ureteric calculus and was advised to consume plenty of water. On examination, he was disoriented in place, person and time. Except for the generalized diminished reflexes, other neurological and systemic examinations were normal. He had severe hyponatraemia, mild hypokalaemia and myoglobulinuria. His serum creatinine phosphokinase and aspartate aminotransferase were markedly elevated. The diagnosis of rhabdomyolysis in the setting of acute water intoxication was made. Optimum fluid and electrolyte management achieved a dramatic recovery of consciousness, hyponatraemia and rhabdomyolysis. Discussion The patient has had excess water intake due to a compulsive act in the background fear of ureteric calculus. Such act could lead to severe hyponatraemia and rhabdomyolysis. Therefore, future similar acts could be prevented by proper medical advice. Further, emergency physicians should be vigilant for rhabdomyolysis in patients with hyponatraemia or hypokalaemia.

Acute effect of excess water intake on blood pressure in healthy Individuals

2014 ◽  
Vol 1 (4) ◽  
pp. 496-499
Author(s):  
Buchineni Madhavulu ◽  
Pathapati Rama Mohan ◽  
, Devaraju Sreebhushan Raju
Keyword(s):  
Blood Pressure ◽  
Water Intake ◽  
Acute Effect ◽  
Healthy Individuals ◽  
Excess Water

scholarly journals Tacrolimus-induced neurotoxicity from bipolar disorder to status epilepticus under the therapeutic serum level: a case report

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Bora Jin ◽  
Ga Yeon Kim ◽  
Sang-Myung Cheon
Keyword(s):  
Adverse Events ◽  
Therapeutic Range ◽  
Solid Organ Transplantation ◽  
Brain Magnetic Resonance Imaging ◽  
Solid Organ ◽  
Therapeutic Level ◽  
Hyperintense Lesion ◽  
Case Presentation ◽  
Delta Waves ◽  
Level Of Consciousness

Abstract Background Tacrolimus is a macrolide immunosuppressant widely used to prevent rejection after solid organ transplantation. In general, adverse events of tacrolimus occur more often as the concentration of tacrolimus in the blood increases. We report the case of a 39-year-old man who developed a variety of adverse events despite in the therapeutic level of tacrolimus in the blood. Case presentation A 39-year-old man underwent liver transplantation for liver cirrhosis due to alcoholic liver disease. The postoperative immunosuppressant consisted of tacrolimus (5 mg) and mycophenolate (500 mg) twice daily. Five months after taking tacrolimus, he presented with talkativeness, which gradually worsened. Brain magnetic resonance imaging performed 10 months after tacrolimus administration revealed a hyperintense lesion affecting the middle of the pontine tegmentum on T2WI. The blood concentration of tacrolimus was 7.2 ng/mL (therapeutic range 5–20 ng/mL). After 21 months, he exhibited postural tremor in both the hands. Twenty-four months after taking tacrolimus, he showed drowsy mentality, intention tremor, and dysdiadochokinesia. Electroencephalography presented generalized high-voltage rhythmic delta waves; therefore, tacrolimus was discontinued in suspicion of tacrolimus-induced neurotoxicity, and anticonvulsive treatment was started. The level of consciousness gradually improved, and the patient was able to walk independently with mild ataxia. Conclusion This case shows that tacrolimus-induced neurotoxicity can occur even at normal concentrations. Therefore, if a patient taking tacrolimus exhibits psychiatric or neurologic symptoms, neurotoxicity should be considered even when the blood tacrolimus is within the therapeutic range.

scholarly journals RECOVERY OF CONSCIOUSNESS: OPPORTUNITIES FOR NEUROPSYCHOLOGICAL ASSESSMENT AND REHABILITATION

2021 ◽  
pp. 102-128
Author(s):  
Ekaterina V. Fufaeva ◽  
Yuri V. Mikadze ◽  
Anastasiia N. Cherkasova ◽  
Maria S. Kovyazina ◽  
Maria E. Baulina ◽  
...  
Keyword(s):  
Neuropsychological Assessment ◽  
Brain Lesions ◽  
Disorders Of Consciousness ◽  
Diagnostic Tools ◽  
Clinical Psychologist ◽  
Neuropsychological Rehabilitation ◽  
Rehabilitation System ◽  
Level Of Consciousness ◽  
Practical Guidelines ◽  
Recovery Of Consciousness

Relevance. Neuropsychological rehabilitation and assessment are the priority tasks in practice of a clinical psychologist. The modern rehabilitation system can be considered as a partnership between patients, their families and different specialists participating in the rehabilitation process. The existing approaches to neurorehabilitation are aimed at the earliest possible intervention. It`s of particular importance for patients with disorders of consciousness, whose number has been increasing in connection with the development of medicine in recent decades. This leads to the need to develop tools for specialized neuropsychological assessment and methods of neuropsychological rehabilitation of patients in the early stages of recovery of consciousness. Objective. To summarize neuropsychological diagnostic and rehabilitation experience of working with patients with disorders of consciousness after brain lesions. Methods. We analyze practical guidelines, applied research and our own hands-on experience of working with patients with disorders of consciousness after brain lesions. Results. Based on the analysis, the recommended diagnostic tools are formulated that can be used to identify the current level of consciousness and to assess various parameters of psychic activity of patients with disorders of consciousness. In addition, the main directions and neuropsychological methods of rehabilitation work recommended for recovery of consciousness and continuing to be developed now are highlighted. Conclusion. A new diagnostic and rehabilitation material is presented, which is recommended for use in neuropsychological practice by practicing clinical psychologists with patients with disorders of consciousness after brain lesions.

Psychogenic polydipsia: A case report

2017 ◽  
Vol 41 (S1) ◽  
pp. S681-S682
Author(s):  
G. Erzin ◽  
K. ozdel ◽  
H. Karadağ
Keyword(s):  
Anxiety Disorder ◽  
Water Intake ◽  
Vital Signs ◽  
Fluid Restriction ◽  
Test Results ◽  
Psychogenic Polydipsia ◽  
Excess Water ◽  
Competing Interest ◽  
Married Female ◽  
Excessive Thirst

IntroductionPsychogenic or primary polydipsia characterized by excessive thirst and compulsive water drinking is a common problem among psychiatric populations, affecting 6% to 20% of patients. It is frequent in chronic psychiatric diseases, particularly schizophrenia. We report a patient with excessive thirst and diagnosed as PIP syndrome.CaseA 54-year-old, married, female patient had normal vital signs. She has excessive water intake (10–12 L/day). She did not have edema, signs of dehydration or fever. The neurological examination, CT, MRI, and EEG was normal. The laboratory tests were normal. She had started using sertraline 100 mg, 7 months ago due to anxiety disorder. There is not any disease except the anxiety disorder, which is in remission due to the treatment. A total of, 2 μg desmopressin I.M. is applied in fluid restriction test. The urine density is determined as 1.008 mg/dL initially, 1.011 mg/dL one hour later, and 1.013 mg/dL two hours later in the urinary test. The diagnosis is psychogenic polydipsia (primary) according to patient history, the clinical examination, and the test results. The patient is recommended to continue the sertraline 100 mg treatment, and also assigned with fluid restriction behaviour.ConclusionSince excess water intake periods are correlated with psychotic exacerbations; psychosis and polydipsia might have similar physiopathologic mechanisms. Polydipsia might be due to anti-cholinergic side effect of some psychiatric drugs. The physiopathology of the polydipsia and polyuria is not totally enlightened in the psychiatric disorders. In some cases, the fluid intake occurs completely voluntary. Therefore, we decided to present this case.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Cyclical haematological changes in a case of hypopituitarism

2021 ◽  
Vol 14 (8) ◽  
pp. e243421
Author(s):  
Rahul Nema ◽  
Abhinav Sengupta ◽  
Arvind Kumar ◽  
Naveet Wig
Keyword(s):  
Clinical Symptoms ◽  
Clonic Seizure ◽  
Appetite Loss ◽  
Cyclical Fluctuations ◽  
Severe Hyponatraemia ◽  
Secondary Hypothyroidism ◽  
Long Time ◽  
History Of ◽  
Multiple Blood ◽  
Haematological Changes

A 40-year-old woman presented to our emergency department in an altered state following a generalised tonic-clonic seizure. On regaining consciousness, she gave a history of bleeding tendencies and menorrhagia, fatigue, nausea, vomiting and appetite loss for a long time. She had received multiple blood transfusions in the last 10 years. Investigations revealed severe hyponatraemia, transaminitis and pancytopenia, which showed cyclical fluctuations in the hospital. Hyponatraemia was attributed to a central cause owing to secondary hypothyroidism and hypocortisolism on evaluation. A diagnosis of cyclical thrombocytopenia was made by logging the trends of blood cell lines and applying the Lomb-Scargle test. Liver biopsy showed features of transfusion hemosiderosis explaining transaminitis. All of the haematological abnormalities and clinical symptoms resolved on thyroxine and corticosteroid replacement, suggesting causal association hypopituitarism with cyclical thrombocytopenia

Spice plants induced psychosis-case presentation

2011 ◽  
Vol 26 (S2) ◽  
pp. 30-30 ◽  
Author(s):  
H. Nagy ◽  
L. Buftea ◽  
L. Domokos ◽  
A. Mihai
Keyword(s):  
Emergency Service ◽  
Salvia Divinorum ◽  
Psychotic Episode ◽  
Psychoactive Substance ◽  
Psychoactive Substances ◽  
Psychomotor Agitation ◽  
Case Presentation ◽  
Psychiatric Illnesses ◽  
Psychoactive Substance Use

Spice shops, selling ethnobotanical plants like Salvia divinorum, Mitragina speciosa, Amanita muscaria and others, have become very numerous in Romania, first of all because they are legal, second of all because more and more young people are tempted to experiment new sensations. These plants can cause different psychiatric illnesses and associating theme with alcohol or drugs can also be fatal.Our objective was to present the case of a 25 year old male patient consulted at emergency service, and admitted in our department, presenting psychomotor agitation, anxiety and the specific elements of a psychotic episode, delusions and hallucinations, after smoking a cigarette with sage and night-shade.The symptomatology remitted rapidly, after approximately 12 hours, revealing the complications of psychoactive substance use.ConclusionsThis case shows the importance of knowledge of psychiatrists concerning the psychoactive substances of ethnobotanical plants, because of their legality and easy procuration possibility. We consider that the role of psychiatrists in mediatizing the side effects of these plants is very important.

scholarly journals Hypermagnesemia in a 20-month-old healthy girl caused by the use of a laxative: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Kotaro Araki ◽  
Yuhei Kawashima ◽  
Miyuki Magota ◽  
Norio Shishida
Keyword(s):  
Emergency Department ◽  
Renal Function ◽  
Renal Dysfunction ◽  
Impaired Renal Function ◽  
Muscle Tone ◽  
Case Presentation ◽  
Cardiac Side Effects ◽  
Level Of Consciousness ◽  
Tendon Reflexes

Abstract Background Hypermagnesemia can be a fatal condition and should be diagnosed early on. Most reports of hypermagnesemia have been of adults with impaired renal function. We describe the case of a pediatric patient without renal dysfunction who developed severe hypermagnesemia. Case presentation A healthy 20-month-old Asian girl presented to our emergency department with episodes of vomiting and a reduced level of consciousness. The neurological examination showed a symmetric decrease in muscle tone, and the deep tendon reflexes were decreased. On admission, her magnesium (Mg) level was 11.0 mg/dL after receiving magnesium oxide for 4 days because of constipation. She was immediately administered calcium gluconate infusion (3.9 mEq), and then was continuously infused with it (0.23 mEq/h) as a Mg antagonist to cardiac side effects. She was kept hydrated with 0.9% sodium chloride to maintain good urine output to excrete the Mg. The level of the serum Mg decreased to 2.4 mg/dL, enabling her to regain consciousness. During 5 years of follow-up, she was neurologically well, without the recurrence of hypermagnesemia. Conclusions Even in the absence of significant renal dysfunction, the prescription of a laxative containing Mg for constipation can result in severe hypermagnesemia. In addition, the symptoms of hypermagnesemia are nonspecific, and early diagnosis is difficult unless it is actively suspected.

scholarly journals Calcified brain metastatic adenocarcinoma: A case report and review of the literature

2018 ◽  
Vol 32 (1) ◽  
pp. 57-61
Author(s):  
Eshagh Bahrami ◽  
Morteza Taheri ◽  
Mohsen Benam
Keyword(s):  
Brain Metastasis ◽  
Histopathological Examination ◽  
Occipital Lobe ◽  
Clonic Seizure ◽  
Brain Parenchyma ◽  
Metastatic Adenocarcinoma ◽  
Case Presentation ◽  
Rim Enhancement ◽  
Autopsy Specimens ◽  
The Right

Introduction Calcification in brain metastasis occurs rarely so it is reported in approximately 1% of surgical and 6.6% of autopsy specimens. Here we report a new case of brain metastasis with calcification. Case presentation A 44-year-old woman presented with a generalized tonic–clonic seizure with no neurological deficit on physical examination. Brain imaging demonstrated a hyperdense lesion on computed tomography scan and hyposignal and rim enhancement on T1, T2 and T1 with gadolinium injection sequence images in the right parieto-occipital lobe. Intraoperatively, there was a well-defined solid homogenous calcified mass within brain parenchyma. The lesion that resembled a meningioma was totally resected. The histopathological examination revealed metastatic adenocarcinoma. Conclusion Metastatic brain lesions should be in the differential diagnosis of a solitary calcified brain mass, although it occurs rarely. It is important to differentiate it radiologically from intralesional haemorrhage.

scholarly journals Spontaneous Intracerebral Hemorrhage and Delayed Cerebral Vasospasm in a Patient with COVID-19 Infection

2021 ◽  
Vol 8 (3) ◽  
Author(s):  
Björn Sommer ◽  
Christoph Maurer ◽  
Ansgar Berlis ◽  
Ehab Shiban
Keyword(s):  
Intracerebral Hemorrhage ◽  
Cerebral Vasospasm ◽  
Neurological Impairment ◽  
Clonic Seizure ◽  
Transluminal Angioplasty ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Case Presentation ◽  
Delayed Cerebral Vasospasm ◽  
First Case ◽  
Short Period

Introduction: The SARS-CoV-2 may cause vasculitis and thromboembolic events. We report on an unusual case of spontaneous intracerebral hemorrhage and delayed cerebral vasospasms in a patient with COVID-19. Case Presentation: A 65-year-old male was transferred to the emergency department due to a short period of unconsciousness. Twenty-two hours prior to presentation, the patient had a 39.5°C fever with breathing difficulties. Initial COVID-19 PCR was positive. While conscious and without any neurological impairment, a large right frontal intracerebral hemorrhage (ICH) was detected. A preoperative angiogram showed no pathological blood vessels or vasospasm. The patients had a generalized tonic-clonic seizure due to ICH progression, which led to an immediate microsurgical ICH removal. Thirteen days thereafter, the patient became unconscious again. Angiography revealed severe cerebral vasospasm (CV) that required repetitive percutaneous transluminal angioplasty (PTA) and intra-arterial nimodipine treatment. Conclusions: We present the first case of ICH and delayed vasospasm associated with COVID-19. In these patients, combined maximum surgical and endovascular therapy is needed.

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