Magnesium Infusion for Refractory Non-surgical Pheochromocytoma Crisis

Pheochromocytoma crisis is a rare medical emergency characterized by severe hypertension, shock, and multiorgan failure. Despite its widespread availability, low cost and wide therapeutic index, magnesium sulfate has primarily been utilized as an adrenergic antagonist during pheochromocytoma resection. This case report describes a 57-year-old male with recurrent nonsurgical pheochromocytoma and crisis refractory to adrenergic antagonism. Initiation of magnesium sulfate continuous infusion provided rapid hemodynamic control in the setting of inoperable disease. This case highlights the role and dosing of magnesium sulfate in the management of pheochromocytoma crisis.

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Challenging Thyroid Storm in Pregnancy, Case Report

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.1887 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A923-A924

Author(s):

Zaina Abdelhalim Alamer ◽

Mohammed Alkhatib ◽

Emad Naem ◽

Noor Nabeel M Suleiman ◽

Marwa Gomaa Mokhtar ◽

...

Keyword(s):

Case Report ◽

Liver Function ◽

Calcium Supplementation ◽

Rare Complication ◽

Multiorgan Failure ◽

Medical Emergency ◽

Thyroid Storm ◽

Dilation And Curettage ◽

Definitive Therapy ◽

In Pregnancy

Abstract Background: Thyroid storm is a rare complication of hyperthyroidism. It can lead to life-threatening complications such as Arrhythmias, multiorgan failure and disseminated intravascular coagulation (DIC) (1). In pregnant patients can cause spontaneous abortions, fetal demise (2). Aggressive treatment under critical care settings is needed. Clinical Case: We report a case of 24-year-old Indian female twelve weeks pregnant; background of Graves’ disease for five years, was on carbimazole but she discontinued since she became pregnant. Presented to Hamad general hospital with nausea, vomiting and altered mental status for one day. She was afebrile, normotensive, tachypneic, tachycardiac with heart rate of 150bpm, and confused. Investigations showed supraventricular tachycardia aborted by adenosine and amiodarone, TSH was < 0.01mIU/l(0.3-4.2) and FT4> 100 pmol/L(11.6-21.9),normal baseline liver function and complete blood counts. In the emergency department, she was managed for thyroid storm with hydrocortisone, propranolol, propylthiouracil (PTU), iodine solution and cholestyramine. Then suddenly she deteriorated requiring intubation and vasopressor support under care of Medical Intensive Care Unit (MICU) progressed to multiorgan failure; acute liver injury, acute kidney injury and DIC. So, PTU was stopped and started on plasma exchange followed by total thyroidectomy and tracheostomy. US pelvis showed nonviable fetus, so dilation and curettage were done by obstetric team. Afterwards, she markedly improved except her conscious level and kidney function which required Hemodialysis. MRI brain showed small subdural hematoma treated conservatively and Wernicke encephalopathy treated with thiamine with substantial response and spontaneously breathing. Post thyroidectomy she required calcium supplementation and levothyroxine, liver function and coagulation parameters back to baseline. Conclusion: Thyroid storm in pregnancy is a medical emergency with high mortality rate, it needs high index of suspicion and early aggressive management by a multidisciplinary team. Plasmapheresis may be considered for challenging cases as a bridge for definitive therapy. Thyroidectomy may be the only option in selected cases like our case. References: 1. Karger S, Führer D. Thyreotoxische Krise--ein Update [Thyroid storm--thyrotoxic crisis: an update]. Dtsch Med Wochenschr. 2008 Mar;133(10):479-84. German. doi: 10.1055/s-2008-1046737. PMID: 18302101. 2. Ma Y, Li H, Liu J, Lin X, Liu H. Impending thyroid storm in a pregnant woman with undiagnosed hyperthyroidism: A case report and literature review. Medicine (Baltimore). 2018;97(3):e9606. doi:10.1097/MD.0000000000009606

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Terlipressin-induced ischaemic skin necrosis

BMJ Case Reports ◽

10.1136/bcr-2019-233089 ◽

2020 ◽

Vol 13 (1) ◽

pp. e233089 ◽

Cited By ~ 1

Author(s):

Anand V Kulkarni ◽

Pramod Kumar ◽

Nagaraj P Rao ◽

Nageshwar Reddy

Keyword(s):

Continuous Infusion ◽

Skin Necrosis ◽

Multiorgan Failure ◽

Kidney Injury ◽

Meld Score ◽

Medical Emergency ◽

Variceal Bleed ◽

Male Patients ◽

Complications Of Cirrhosis ◽

End Stage

Terlipressin is a commonly used drug in hepatology practice for the two most serious complications of cirrhosis, that is, acute oesophageal variceal bleed and hepatorenal syndrome. Acute-on-chronic liver failure (ACLF) is a medical emergency and is frequently associated with acute kidney injury (AKI). Two male patients with alcohol-induced ACLF with high MELD (Model for End-Stage Liver Disease) score presented with AKI. Both were treated with terlipressin infusion. There was no response to terlipressin in these sick patients, and further both patients developed ischaemic skin necrosis and succumbed to multiorgan failure. Continuous infusion of terlipressin is superior to bolus dosing, but we noted that continuous infusion might as well be associated with severe adverse effects in patients with a high MELD score. More extensive prospective studies, including patients with high MELD score, are required to ascertain the safety of terlipressin.

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Treatment of class II furcation defects with autogenous bone graft associated with Bichat’s fat pad: case report

RSBO ◽

10.21726/rsbo.v1i2.412 ◽

2017 ◽

Vol 1 (2) ◽

pp. 114

Author(s):

Priscila Alves Teixeira ◽

Carmen L. Mueller Storrer ◽

Felipe Rychuv Santos ◽

Aline Monise Sebastiani ◽

Tatiana Miranda Deliberador

Keyword(s):

Case Report ◽

Bone Graft ◽

Low Cost ◽

Class Ii ◽

Autogenous Bone Graft ◽

Surgical Reconstruction ◽

Autogenous Bone ◽

Fat Pad ◽

Furcation Defects ◽

Maxillary Tuberosity

The periodontal treatment of teeth with furcation defect is clinically challenging. In cases of class II furcation defects, the regenerative surgery shows low morbidity and good prognosis when correctly indicated. The aim of the presentstudy is to report a treatment option for class II furcation defect through autogenous bone graft associated with the Bichat’s fat pad. Case report: A 59-year-old female patient was diagnosed with class II furcation defect in the left mandibular first molar. The treatment comprised surgical reconstruction of the defect with a combination of maxillary tuberosity bone graft and Bichat’s fat pad. The clinical and radiographic follow-up of 180 days showed bone formation inthe furcation area and absence of probing depth. Conclusion: An association of autogenous graft form the maxillary tuberosity with a Bichat’s fat pad proved to be a safe, low cost, and effective therapy for the regenerative treatment of class II furcation.

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Multiorgan failure due to hemophagocytic syndrome: A case report

Cases Journal ◽

10.1186/1757-1626-1-209 ◽

2008 ◽

Vol 1 (1) ◽

Cited By ~ 2

Author(s):

Juan Mayordomo-Colunga ◽

Corsino Rey ◽

Soledad González ◽

Andrés Concha

Keyword(s):

Case Report ◽

Hemophagocytic Syndrome ◽

Multiorgan Failure

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Midazolam for treatment of refractory neonatal seizures: a case report

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x1994000200019 ◽

1994 ◽

Vol 52 (2) ◽

pp. 260-262 ◽

Cited By ~ 7

Author(s):

José Luiz Dias Gherpelli ◽

Francisco José C. Luccas ◽

Israel Roitman ◽

Eduardo Juan Troster

Keyword(s):

Case Report ◽

Status Epilepticus ◽

Continuous Infusion ◽

Seizure Control ◽

Neonatal Period ◽

Hyaline Membrane Disease ◽

Water Soluble ◽

Neonatal Seizures ◽

Hyaline Membrane ◽

Ischemic Encephalopathy

Midazolam is a short-acting water soluble benzodiazepine that has been used with an increasing frequency in the last years. Although there are reports on its use in status epilepticus, there is none in the neonatal period. A pre-term (35 w) AGA newborn infant with a severe hypoxic-ischemic encephalopathy secondary to grade ED hyaline membrane disease developed status epilepticus in the first 6 hours of life and was successfully treated with midazolam after phenobarbital and phenytoin failed to achieve seizure control. Dosage schedule was 0.2 mg/kg IV, followed by continuous infusion of 0.025 mg/kg/h. Midazolam is an effective drug for neonatal status epilepticus and more experience should accumulate before it can be routinely employed in the neonatal period. This case shows that it is a possible option before using more dangerous drugs, such as thionembutal.

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The relevance of a fast and early diagnosis of necrotizing fasciitis in the Emergency Department: a case report

Italian Journal of Medicine ◽

10.4081/itjm.2016.671 ◽

2016 ◽

Vol 10 ◽

Author(s):

Marianna Gregorio ◽

Antonio Villa

Keyword(s):

Diabetes Mellitus ◽

Emergency Department ◽

Case Report ◽

Early Diagnosis ◽

Necrotizing Fasciitis ◽

Multiorgan Failure ◽

Left Thigh ◽

Popliteal Fossa ◽

Leg Pain ◽

Movement Limitation

We report a case of necrotizing fasciitis in an 84 year-old man affected by diabetes mellitus. The patient was admitted in the Emergency Department of our hospital because of an acute and strong left leg pain that began almost 8 hours before admission. The left leg had an increased size and a movement limitation, with a hard haemathoma in the left thigh with subcutaneous crepitus. The lesion became worse and larger rapidly, with a wide extension from the back to the popliteal fossa. An antimicrobial therapy was immediately started with morphine for pain. A surgical debridment was performed, but the patient died for multiorgan failure. Necrotizing fasciitis is a rare and mortal disease, the early diagnosis is a challenge for the Emergency Department where patients are admitted and assessed primarly.

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Traumatic Acinetobacter Baumannii Meningitis Without Neuro surgical Intervention– A Rare Case Report

Journal of Anaesthesia and Critical Care Reports ◽

10.13107/jaccr.2021.v07i01.170 ◽

2021 ◽

Vol 7 (1) ◽

Keyword(s):

Cerebrospinal Fluid ◽

Case Report ◽

Acinetobacter Baumannii ◽

Surgical Intervention ◽

Medical Emergency ◽

Acute Bacterial Meningitis ◽

Elderly Male ◽

Rare Case Report ◽

Acute Meningitis ◽

Cerebrospinal Fluid Otorrhea

Acute bacterial meningitis is a medical emergency that warrants an early diagnosis and aggressive therapy. Despite the availability of potent newer antibiotics, the mortality caused by acute meningitis and its complication remains high in India, ranging from 16% to 32%. The aim of this case report is to present the isolation of Acinetobacter baumannii from cerebrospinal fluid(CSF) of an elderly male following trauma without any neurosurgical intervention and without any evident cerebrospinal fluid otorrhea or rhinorrhea. Keywords: CSF; Acinetobacter; Colistin; Intraventricular.

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CVDentus bur for epithelial abrasion in the treatment of melanin pigmentation: case report

RSBO ◽

10.21726/rsbo.v1i3.490 ◽

2018 ◽

Vol 1 (3) ◽

pp. 186

Author(s):

Katiane Vieira Menezes Leite ◽

Patrícia Oliveira de Souza ◽

Jussania Fonseca da Paz ◽

Ana Beatriz Franco Fernandes ◽

Leonardo Fernandes da Cunha ◽

...

Keyword(s):

Case Report ◽

Low Cost ◽

Melanin Pigmentation ◽

Alternative Approach ◽

Safe Technique ◽

Dark Color ◽

One Year ◽

Fast Procedure ◽

Interesting Alternative

Introduction: The gingival melanin hyperpigmentation (GMH) is resulted from an abnormal deposition of melanin, but it is not a pathology. However, GMH is an esthetic problem for some people. Some alternatives of treatment for this situation exist. The epithelial abrasion has been an interesting alternative because it has a satisfactory esthetic outcome, is a fast procedure, of easy execution, and low cost. Recently, tips adapted in ultrasound (CVDentus) can bean alternative approach. Objective: To report a clinical case of GMH treated by the technique of the epithelial abrasion with association of instrument adapted in ultrasound. Case report: Patient aged 28 years, melanoderm, sought treatment due to esthetic dissatisfaction because of intense dark color in the maxillary gingiva. The GMH removal was proposed through the technique of the epithelialabrasion CVD bur. Conclusion: The technique of epithelial abrasion using CVD bur was effective in removing GMH at one-year follow-up showing to be easy and safe technique.

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Flushing of an intravenous catheter

Biochemia Medica ◽

10.11613/bm.2019.031001 ◽

2019 ◽

Vol 29 (3) ◽

pp. 614-618

Author(s):

Rutger C.C. Hengeveld ◽

Bianca E. Olofsen ◽

Edmée C. van Dongen-Lases ◽

Peter A. Leenhouts ◽

Victor F.H.A. Hakkenberg van Gaasbeek ◽

...

Keyword(s):

Emergency Department ◽

Renal Function ◽

Case Report ◽

Sodium Chloride ◽

Continuous Infusion ◽

Intravenous Catheter ◽

Blood Samples ◽

Close Proximity ◽

Laboratory Results ◽

Life Threatening

Introduction: Phlebotomy is an error-prone process in which mistakes are difficult to reveal. This case report describes the effect on laboratory results originating from a blood sample collected in close proximity to an intravenous catheter. Materials and methods: A 69-year-old male patient was referred to the Emergency department where pneumonia was suspected. Phlebotomy was performed to collect blood samples to assess electrolytes, renal function, liver function, infection and haematological parameters. Results: The laboratory analysis showed reduced potassium and calcium concentrations. To prevent life-threatening cardiac failure the clinician decided to correct those electrolytes. Remarkably, the electrocardiogram showed no abnormalities corresponding to hypokalaemia and hypocalcaemia. This observation, in combination with an overall increase in laboratory parameters with the exception of sodium and chloride, led to the suspicion of a preanalytical error. Retrospectively, an intravenous catheter was inserted in close proximity of the puncture place but no continuous infusion was started prior to phlebotomy. However, the intravenous catheter was flushed with sodium chloride. Since potential other causes were excluded, the flushing of the intravenous catheter with sodium chloride prior to phlebotomy was the most probable cause for the deviating laboratory results and subsequently for the unnecessary potassium and calcium suppletion. Conclusion: This case underlines the importance of caution in the interpretation of laboratory results obtained from specimens that are collected in the proximity of an intravenous catheter, even in the absence of continuous infusion.

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