scholarly journals Severe hypercalcemia associated with hypophosphatemia in very premature infants: a case report

2021 ◽  
Vol 47 (1) ◽  
Author(s):  
Nicola Improda ◽  
Francesca Mazzeo ◽  
Alessandro Rossi ◽  
Claudia Rossi ◽  
Francesco Paolo Improda ◽  
...  
Keyword(s):  
Intrauterine Growth Retardation ◽  
High Energy ◽  
Case Presentation ◽  
Intrauterine Growth ◽  
Severe Hypercalcemia ◽  
Threatening Condition ◽  
Life Threatening ◽  
Female Baby ◽  
Very Premature Infants ◽  
Intrauterine Malnutrition

Abstract Background Severe hypercalcemia is rare in newborns; even though often asymptomatic, it may have important sequelae. Hypophosphatemia can occur in infants experiencing intrauterine malnutrition, sepsis and early high-energy parenteral nutrition (PN) and can cause severe hypercalcemia through an unknown mechanism. Monitoring and supplementation of phosphate (PO4) and calcium (Ca) in the first week of life in preterm infants are still debated. Case presentation We report on a female baby born at 29 weeks’ gestation with intrauterine growth retardation (IUGR) experiencing sustained severe hypercalcemia (up to 24 mg/dl corrected Ca) due to hypophosphatemia while on phosphorus-free PN. Hypercalcemia did not improve after hyperhydration and furosemide but responded to infusion of PO4. Eventually, the infant experienced symptomatic hypocalcaemia (ionized Ca 3.4 mg/dl), likely exacerbated by contemporary infusion of albumin. Subsequently, a normalization of both parathyroid hormone (PTH) and alkaline phosphatase (ALP) was observed. Conclusions Although severe hypercalcemia is extremely rare in neonates, clinicians should be aware of the possible occurrence of this life-threatening condition in infants with or at risk to develop hypophosphatemia. Hypophosphatemic hypercalcemia can only be managed with infusion of PO4, with strict monitoring of Ca and PO4 concentrations.

scholarly journals Successful treatment of pulmonary mucormycosis caused by Rhizopus microsporus with posaconazole

2021 ◽  
Vol 26 (1) ◽  
Author(s):  
F. Yuan ◽  
J. Chen ◽  
F. Liu ◽  
Y. C. Dang ◽  
Q. T. Kong ◽  
...  
Keyword(s):  
Fungal Culture ◽  
Rhizopus Microsporus ◽  
Pulmonary Tissue ◽  
Case Presentation ◽  
Common Cause ◽  
Pulmonary Mucormycosis ◽  
Threatening Condition ◽  
Life Threatening ◽  
One Year

Abstract Background Mucormycosis is a rare fungal infection occurring chiefly in the lung or the rhino-orbital-cerebral compartment, particularly in patients with immunodeficiency or diabetes mellitus. Among Mucorales fungi, Rhizopus spp. are the most common cause of mucormycosis. Case presentation We report a case of pulmonary mucormycosis caused by Rhizopus microsporus in a young patient with diabetes but no other apparent risk factors. The diagnosis mainly relied on clinical manifestation, positive pulmonary tissue biopsy, and fungal culture. The patient was successfully treated with posaconazole oral suspension and remains asymptomatic at one-year follow-up. Conclusions Pulmonary mucormycosis is a life-threatening condition and posaconazole is an effective treatment for pulmonary mucormycosis caused by Rhizopus microspores.

EARLY DETECTION OF FAT EMBOLISM SYNDROME IN TRAUMATOLOGY (LITERATURE REVIEW)

2021 ◽  
pp. 23-30
Author(s):  
MAKSIM D. OSIPOV
Keyword(s):  
Early Detection ◽  
Literature Review ◽  
Fat Embolism ◽  
High Energy ◽  
Severe Condition ◽  
Fat Embolism Syndrome ◽  
Embolism Syndrome ◽  
Threatening Condition ◽  
Life Threatening ◽  
The Many

Fat embolism syndrome is one of the many complications in traumatology, which carries a serious danger due to the difficult diagnosis at the early stages of its development. In many medical sources, fat embolism syndrome is described as a severe condition characterized by obturation of blood vessels by embolus, which are represented by fat droplets larger than 7-9 microns. Fat embolism is usually caused by trauma, accompanied by crushing of tissues. This is especially common in fractures of the tubular bones as a result of high-energy trauma. As exemplified in the medical literature about 6-7 % of isolated fractures and 37 % of combined injuries lead to the appearance of fat embolism syndrome. Much more often, fat embolism develops in open fractures, and the frequency of its occurrence increases with a combination of open and closed fractures. Due to the fact that fat embolism is a life-threatening condition, early detection of this pathology is necessary. The purpose of this literature review is to study the pathogenesis of fat embolism, as well as the possibilities, problems and methods of early diagnosis of this pathology in trauma practice...

Successful Treatment of Pulmonary Mucormycosis Caused by Rhizopus Microsporus With Posaconazole

2021 ◽  
Author(s):  
Fan Yuan ◽  
Jun Chen ◽  
Fang Liu ◽  
Yongchao Dang ◽  
Qingtao Kong ◽  
...  
Keyword(s):  
Fungal Culture ◽  
Rhizopus Microsporus ◽  
Pulmonary Tissue ◽  
Case Presentation ◽  
Common Cause ◽  
Pulmonary Mucormycosis ◽  
Threatening Condition ◽  
Life Threatening ◽  
One Year

Abstract Background: Mucormycosis is a rare fungal infection occurring chiefly in the lung or the rhino-orbital-cerebral compartment, particularly in patients with immunodeficiency or diabetes mellitus. Among Mucorales fungi, Rhizopus spp. are the most common cause of mucormycosis. Case presentation: We report the case of pulmonary mucormycosis caused by Rhizopus microsporus in a young patient with diabetes but no other apparent risk factors. The diagnosis has mainly relied on clinical manifestation, positive pulmonary tissue biopsy, and fungal culture. The patient was successfully treated with posaconazole oral suspension and remains asymptomatic at one-year follow-up.Conclusions: Pulmonary mucormycosis is a life-threatening condition and based on direct microscopy, histopathology, and culture for the diagnosis.

Congenital Absence of the Pancreas and Intrauterine Growth Retardation

PEDIATRICS ◽  
1979 ◽  
Vol 64 (2) ◽  
pp. 255-257
Author(s):  
James A. Lemons ◽  
Robert Ridenour ◽  
Edmund N. Orsini
Keyword(s):  
Intrauterine Growth Retardation ◽  
Fetal Distress ◽  
Pancreatic Tissue ◽  
Postmortem Examination ◽  
Fetal Life ◽  
Case Presentation ◽  
Intrauterine Growth ◽  
Uncomplicated Pregnancy ◽  
Emergency Cesarean ◽  
Radiologic Evidence

Recent investigations support the concept that insulin is a primary growth hormone during fetal life. The importance of insulin in fetal development is illustrated by the following case presentation, a severely growth-retarded infant who possessed no detectable pancreatic tissue at postmortem examination. CASE REPORT Patient B.G.C. was born following an uncomplicated pregnancy to a 19-year-old gravida 1, para 0, abortus 1 mother by emergency Cesarean section for fetal distress. The baby weighed 1,350 gm with Apgar scores of 2 at one minute, 2 at five minutes, and 4 at ten minutes, requiring immediate intubation and ventilation. Gestational age was 41 weeks by dates, 36 to 37 weeks by clinical examination, and greater than 36 weeks by radiologic evidence of teeth calcification.1

Thyroid storm after choking

2018 ◽  
Vol 31 (8) ◽  
pp. 933-936 ◽  
Author(s):  
Ana L. Creo ◽  
Bryan C. Cannon ◽  
Siobhan T. Pittock
Keyword(s):  
Adolescent Girl ◽  
Pediatric Patients ◽  
Medical Attention ◽  
Thyroid Storm ◽  
Neck Swelling ◽  
Case Presentation ◽  
Cat Scan ◽  
Threatening Condition ◽  
Life Threatening ◽  
Hyperthyroid Patients

Abstract Background: A thyroid storm (TS) is a rare, but life-threatening condition in hyperthyroid patients. Mortality in adult TS patients may be as high as 10%. Typically, a trigger precipitates the storm in hyperthyroid patients. Case presentation: We report the case of an adolescent girl with untreated hyperthyroidism who developed fulminant TS after a significant choking episode. Initially, she was found to have neck swelling and tachycardia leading providers to suspect infection. She deteriorated after a CAT Scan (CT) was performed with iodine contrast, potentially worsening storm symptoms. Here, we describe the case, the treatment strategy and propose a treatment modification for pediatric patients. Conclusions: While many children are found to have minor abnormalities in thyroid studies, this case highlights the critical importance of prompt medical attention for any child with significantly elevated free thyroxine (FT4) levels as morbidity can occur when left untreated.

scholarly journals Anemia That Presented with Desaturation: A Focus on Core Concepts

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Lakshmi Shobhavat ◽  
Antonio D’Costa ◽  
Karthik Shroff
Keyword(s):  
Blood Smear ◽  
Intensive Care Admission ◽  
Case Presentation ◽  
Threatening Condition ◽  
Core Concepts ◽  
Life Threatening ◽  
History Of ◽  
The Common ◽  
Treatable Condition ◽  
Prompt Diagnosis

Background. Methemoglobinemia is a potentially life-threatening condition which presents with cyanosis and characteristic “chocolate-coloured blood.” Although a co-oximetry would give a prompt diagnosis, there have been multiple reports of misdiagnosing this treatable condition—from being diagnosed as sepsis to asthma and even being operated for “ruptured ectopic pregnancy.” Here, we report a case which presented without the classical signs of poisoning and methemoglobinemia—without vomiting, cyanosis, or chocolate-coloured blood. We also discuss the common misconceptions regarding anemia physiology and the pitfalls in diagnosing this condition and warn the reader regarding the reflexive use of antidotes like methylene blue. Case Presentation. A well-grown 3-year old boy presented with an acute history of irritability, cola-coloured urine, and desaturation on examination. The child was pale, with tachypnoea and in failure. Blood smear was suggestive of severe hemolytic anemia. Methemoglobinemia was diagnosed on co-oximetry. By focussing on physiologic principles of management rather than a specific antidote, the child was discharged home, well and active within 3 days of intensive care admission.

scholarly journals Hypophosphatemia in Refeeding Syndrome in Intrauterine Growth Restricted IUGR Neonates Who are Receiving Nutrition: A Prospective Observational Study

2020 ◽  
pp. 23-29
Author(s):  
Varunashree Chaudhary ◽  
Jayendra R. Gohil ◽  
Shreya A. Patel
Keyword(s):  
Intrauterine Growth Retardation ◽  
Prospective Observational Study ◽  
Venous Blood ◽  
Growth Charts ◽  
Refeeding Syndrome ◽  
Serum Electrolytes ◽  
Intrauterine Growth ◽  
Significant Difference ◽  
Life Threatening ◽  
History Of

Objective: Electrolyte dysregulations particularly hypophosphatemia and hypokalemia following feeds in a starved person is known as refeeding syndrome, which may lead to life-threatening conditions like arrhythmias, heart failure, respiratory and neuromuscular compromise. To evaluate electrolyte dyscrasias following enteral or parenteral feeding, among intrauterine growth retardation (IUGR) neonates ie those who were starved in-utero, compared to non-IUGR neonates this study was planned. Methodology: From March to August 2015, 60 IUGR and non-IUGR neonates who were admitted at birth before starting of nutrition, either by breast milk or electrolyte-free intravenous fluid. An infant was classified as IUGR when his birth weight was <10th percentile according to Fenton or Lubchenco growth charts. Venous blood was collected from intramural babies at zero hours of life or just before starting feeds to determine the basal level of serum electrolytes – phosphorus, magnesium and potassium, and was repeated in the following 48 and 72 hours. Results: There was no significant difference between the two groups based on sex, history of maternal pre-eclampsia and oligohydramnios. At 72 hours after the start of feeding, Hypophosphatemia was significantly more prevalent, in 33.33% of IUGR vs. 2% of the non-IUGR group, [RR-5, p = 0.010]. Hypokalemia 20% IUGR; 1% non-IUGR group, [RR-6, p = 0.103]. Hypomagnesemia 3% IUGR; 2% non-IUGR group, [RR-1.5, p = 0.640]. Combined electrolyte– hypophosphatemia with hypokalemia (6.6%) and hypophosphatemia with Hypomagnesemia (13.3%), were present only in the IUGR group. Hyperglycemia was not present in any neonate.      Conclusions: IUGR neonates are more likely to develop Refeeding syndrome when compared to non-IUGR babies, manifesting as decreased phosphorus, potassium and magnesium levels. Phosphorous should be a part of feeding nutrition in IUGR babies.

scholarly journals Ultrasound-guided non-invasive retraction for strangulated obturator hernia allows elective radical surgery: analysis of 12 cases

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Yuto Maeda ◽  
Osamu Nakahara ◽  
Seiya Saito ◽  
Jiro Nasu ◽  
Hideo Baba
Keyword(s):  
Radical Surgery ◽  
Elective Surgery ◽  
Underlying Disease ◽  
Obturator Hernia ◽  
Case Presentation ◽  
Non Invasive ◽  
Threatening Condition ◽  
Life Threatening ◽  
Perioperative Safety ◽  
Physical Findings

Abstract Background Obturator hernia is a life-threatening condition, requiring emergency intervention due to strangulation, if non-invasive repair for strangulation cannot be complete. Change from emergency surgery to elective surgery using minimal non-invasive options can greatly contribute to perioperative safety and curability of the underlying disease. Case presentation 12 cases of strangulated obturator hernia from April 2013 to February 2020 with male:female patient ratio of 0:12. Reduction under ultrasound guidance was possible amongst 10 out of 12 cases. The average age was 85.3 years (74–97) and average BMI was 17.4 (15.0–20.1). Based on physical findings and CT examination, diagnosis of obturator hernia was made using echo guided non-invasive reduction. Prevention in the intestinal ischemia and perforation was observed in the treated cases. Upon request, elective radical surgery was performed in 7 of these patients after their condition improved and monitored other organs for any signs. Conclusion Attempt to improve the strangulation of obturator hernia under an echo-guided approach could enable elective and safe surgery and is believed to be a diagnostic treatment worth attempting.

scholarly journals Hyperglycaemic hyperosmolar state in an obese prepubertal girl with type 2 diabetes: case report and critical approach to diagnosis and therapy

2021 ◽  
Vol 47 (1) ◽  
Author(s):  
Angelika Mohn ◽  
Nella Polidori ◽  
Valeria Castorani ◽  
Laura Comegna ◽  
Cosimo Giannini ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Elevated Serum ◽  
Serum Glucose ◽  
Critical Approach ◽  
Obese Adults ◽  
Case Presentation ◽  
Threatening Condition ◽  
Life Threatening

Abstract Introduction Isolated Hyperosmolar Hyperglycaemic Syndrome (HHS) is a life-threatening condition characterized by elevated serum glucose concentrations and hyperosmolality without significant ketosis. It is often described in obese adults with unknown Type 2 Diabetes (T2D), rarely in youth. In childhood the most common cause of metabolic glucose related derangement is Diabetic Ketoacidosis (DKA) in Type 1 Diabetes (T1D). Interestingly, both components can be combined with each other, thus the prevalent condition needs to be recognised implying a different therapeutic approach. Case presentation In this case, we report a prepubertal Caucasian obese girl admitted for two episodes of combined HHS/DKA in order to elucidate her clinical course taking into account the current pediatric recommendations based on adult guidelines for HHS. Conclusions The treatment of HHS and even more of HHS/DKA in youth is still controversial as no specific guidelines for children are available especially during the prepubertal age. The description of our case might be helpful and offer relevant points for future consensus.

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