scholarly journals Severe lactic acidosis from acute cyanide poisoning after intentional amygdalin ingestion in a teenager

2020 ◽  
Vol 16 (3) ◽  
Author(s):  
Jack Green
Keyword(s):  
Lactic Acidosis ◽  
Signs And Symptoms ◽  
Altered Mental Status ◽  
The United States ◽  
Oral Route ◽  
Rare Entity ◽  
Cyanide Poisoning ◽  
Bedside Clinician ◽  
History Of ◽  
History Of Depression

Cyanide poisoning via the oral route is a remarkably rare entity in the United States. Though acute toxicity from this poison may present with classic signs and symptoms (smell of bitter almonds on breath and cherry-red skin), these signs are frequently not clinically observed in the intoxicated patient, making it low on the routine differential diagnosis leading to both diagnostic and therapeutic challenges for the bedside clinician. This is a case of a 17-yearold male with a history of depression who presented to the Emergency Room (ER) with altered mental status, abdominal pain, and emesis. A severely elevated and worrisome lactic acidosis triggered the ER’s septic shock bundle and algorithm, but further investigation ultimately led to the unifying diagnosis of intentional cyanide poisoning.

Hickam’s dictum, Occam’s razor, and Crabtree’s bludgeon: a case of renal failure and a clavicular mass

Diagnosis ◽  
2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Simone Blaser ◽  
Verity Schaye ◽  
John Hwang ◽  
Patrick Cocks ◽  
David Kudlowitz
Keyword(s):  
Renal Failure ◽  
Disease Process ◽  
Signs And Symptoms ◽  
The United States ◽  
Normocytic Anemia ◽  
Analytic Thinking ◽  
Occam’S Razor ◽  
History Of ◽  
Atypical Presentations ◽  
Occam's Razor

Abstract Objectives Our discussant’s thoughtful consideration of the patient’s case allows for review of three maxims of medicine: Occam’s razor (the simplest diagnosis is the most likely to be correct), Hickam’s dictum (multiple disease entities are more likely than one), and Crabtree’s bludgeon (the tendency to make data fit to an explanation we hold dear). Case presentation A 66-year-old woman with a history of hypertension presented to our hospital one day after arrival to the United States from Guinea with chronic daily vomiting, unintentional weight loss and progressive shoulder pain. Her labs are notable for renal failure, nephrotic range proteinuria and normocytic anemia while her shoulder X-ray shows osseous resorption in the lateral right clavicle. Multiple myeloma became the team’s working diagnosis; however, a subsequent shoulder biopsy was consistent with follicular thyroid carcinoma. Imaging suggested the patient’s renal failure was more likely a result of a chronic, unrelated process. Conclusions It is tempting to bludgeon diagnostic possibilities into Occam’s razor. Presumption that a patient’s signs and symptoms are connected by one disease process often puts us at a cognitive advantage. However, atypical presentations, multiple disease processes, and unique populations often lend themselves more to Hickam’s dictum than to Occam’s razor. Diagnostic aids include performing a metacognitive checklist, engaging analytic thinking, and acknowledging the imperfections of these axioms.

scholarly journals 714. Invasive Fungal Infection Caused by Curvularia Species in a Patient with Intranasal Drug Use: A Case Report

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S456-S457
Author(s):  
Bakri Kulla ◽  
Jason Pham ◽  
McKenna Johnson
Keyword(s):  
Case Report ◽  
Head And Neck ◽  
Mental Status ◽  
Sphenoid Sinus ◽  
Altered Mental Status ◽  
The United States ◽  
Fungal Sinusitis ◽  
Invasive Fungal Sinusitis ◽  
History Of ◽  
Curvularia Species

Abstract Background Invasive fungal infections (IFIs) are uncommon infections that account for approximately 27.2/100,000 cases per year in the United States. One form of IFI is chronic invasive fungal sinusitis (CIFS). If untreated, invasion into neighboring structures may cause altered mental status, seizures, strokes, proptosis, and intracranial complications. Case Report An afebrile 43-year-old female with a history of polysubstance abuse presented to the ED due to altered mental status, left sided facial droop, right sided hemiparesis, and slurred speech. The patient was somnolent but arousable to stimuli and appeared acutely ill. The patient’s mother reported a history of cocaine abuse, which was confirmed on urine toxicology. A CT head and neck with contrast revealed subacute basal ganglia lacunar infarcts and a left sphenoid opacity with scattered hyperintensities and erosive changes [Figure 2]. One month prior, she had been diagnosed with a left superior pole kidney mass and a left-sided enlarged periaortic lymph node containing multiple noncaseating granulomas and GMS stains positive for fungal hyphae [Figure 1]. The patient underwent nasal endoscopy with tissue biopsy. Tissue showed necrotizing invasive fungal sinusitis with granuloma formation and foreign-body giant cell reaction. Fungal speciation of the tissue culture showed Curvularia species was placed on IV voriconazole. While the infection stabilized, her neurologic deficits did not significantly improve. She was discharged to inpatient rehabilitation. Figure 1. Coronal and axial view of left upper pole kidney mass with perinephric fat stranding. Figure 2. MRI brain CTA Head and Neck with contrast in axial plane showing multifocal infarcts likely represent complications of fungal basilar meningitis secondary to the left sphenoid sinus disease. Imaging also shows irregular erosive change at the anterior aspect of the sella turcica, through the planum sphenoidale, and bony defect of the sphenoid sinus. Methods Results Conclusion Intranasal use of cocaine causes vasoconstriction to elicit sinonasal tissue ischemia. With extended use, chronic mucosal inflammation can occur that can result in sinonasal osteocartilaginous necrosis and potential for infection. CIFS is infrequently diagnosed and its indolent nature with progression over weeks or months can make diagnosis and treatment difficult. The most frequent fungal species identified are the Aspergillus species, but Curvularia species have been found as well. CT and MRI scanning can be suggestive, but are not sufficiently specific or sensitive. The main forms of interventional modalities include surgical debridement and antifungal therapy to maximize survival Disclosures All Authors: No reported disclosures

Depression and self-reported memory problems in adult-onset cancer survivors.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 9586-9586
Author(s):  
Pascal Jean-Pierre ◽  
Paul Winters
Keyword(s):  
United States ◽  
Cancer Survivors ◽  
The United States ◽  
Adult Onset ◽  
Memory Impairments ◽  
Memory Problems ◽  
History Of ◽  
Nationally Representative ◽  
Brain Insults ◽  
History Of Depression

9586 Background: Memory impairments are debilitating adverse effects of cancer and its treatments. Depression may predispose or exacerbate memory problems. We examined the relationship between depression and memory problems in adult-onset cancer survivors. Methods: We included data from individuals who completed the National Health and Nutrition Examination Survey, a nationally representative, stratified, multistage probability sample of the civilian, non-institutionalized population of the United States from 2005 to 2010. We excluded individuals with a history of brain cancer or stroke since these conditions are expected to cause cognitive problems because of direct brain insults. We determined the prevalence of depression and its relationship to memory problems in cancer survivors by weighting our results proportionally. We controlled for demographic predictors of memory problems. Results: The sample included 14249 adults (6875 men and 7274 women) age 20 years and older. There were 6959 Whites, 2792 Blacks, 3903 Hispanics, and 589 other race/multiracial. Overall, individuals in the United States with a history of depression were 8.4 times more likely to report memory problems (Odds Ratio (OR), 8.406; 95%CI, 6.73 to 10.64). We further explored the depression-memory relationship in a subsample of cancer survivors. Adjusting for age, sex, race-ethnicity, education, income, and general health, cancer survivors with a history of depression were approximately 5 times more likely to report memory problems (N=1283; OR, 4.921; 95%CI, 2.141 to 11.313) than those without a history of depression. Other predictors of memory problems were age (≥ 60 years old, OR = 4.756, 95%CI, 1.957 to 11.560) and lower income (OR, 3.721; 95%CI, 1.951 to 7.098). Conclusions: The likelihood of memory problems is higher in cancer survivors with a history of depression. Future studies are needed to systematically delineate the depression-memory problems relationship, and to inform the development of interventions to treat these conditions for cancer survivors.

scholarly journals A Case Report of Steroid Responsive Nivolumab-Induced Encephalitis

2017 ◽  
Vol 24 (5) ◽  
pp. 107327481772906 ◽  
Author(s):  
Kaja Richard ◽  
Jacqueline Weslow ◽  
Stephanie L. Porcella ◽  
Sowmya Nanjappa
Keyword(s):  
Mental Status ◽  
Checkpoint Inhibitors ◽  
Early Recognition ◽  
Signs And Symptoms ◽  
Altered Mental Status ◽  
Oral Steroid ◽  
Gradual Improvement ◽  
Stage 4 ◽  
History Of ◽  
Intravenous Steroids

Nivolumab (Opdivo) approval for the treatment of non-small cell lung cancer (NSCLC) prompts recognition of its future use in various cancers. Although rare, occurring in 1% to 3% of treated cases, nivolumab along with other immune checkpoint inhibitors are associated with immune-related encephalitis. With its prospective use, nivolumab-induced encephalitis illustrates the necessity of early recognition and successful management to decrease morbidity and mortality. We describe a treated case of nivolumab-induced encephalitis. A 74-year-old male with a history of stage 4 squamous NSCLC presenting with insidious altered mental status following his first dose of nivolumab. After an extensive workup that proved negative, the patient received intravenous steroids with gradual improvement of mental status. Patient subsequently returned to baseline and was discharged with oral steroid taper. Nivolumab-induced encephalitis is a diagnosis of exclusion with nonspecific signs and symptoms. Immediate recognition of patients prescribed nivolumab chemotherapy could potentially prevent fatal complications of neurotoxicity.

Factors associated with self-reported history of depression diagnosis among cancer survivors aged 18 years and over in the United States

2018 ◽  
Vol 27 (8) ◽  
pp. 2039-2044 ◽  
Author(s):  
Gemechu B. Gerbi ◽  
Stranjae Ivory ◽  
Elaine Archie-Booker ◽  
Mechelle D. Claridy ◽  
Stephanie Miles-Richardson
Keyword(s):  
United States ◽  
Cancer Survivors ◽  
The United States ◽  
Depression Diagnosis ◽  
Factors Associated ◽  
History Of ◽  
History Of Depression

STUDIES ON WESTERN EQUINE ENCEPHALITIS ASSOCIATED WITH WILD DUCKS IN SASKATCHEWAN

1961 ◽  
Vol 7 (3) ◽  
pp. 295-302 ◽  
Author(s):  
A. N. Burton ◽  
R. Connell ◽  
J. G. Rempel ◽  
J. B. Gollop
Keyword(s):  
United States ◽  
Natural History ◽  
The United States ◽  
Oral Route ◽  
Wild Birds ◽  
Infected Mosquito ◽  
Bird Population ◽  
Previous Infection ◽  
History Of ◽  
Western Equine Encephalitis

It has been shown by many workers in the United States that wild birds are associated with the natural history of Western equine encephalitis (WEE). They have also demonstrated that birds can be infected with WEE virus through the bite of an infected mosquito. Wild ducks of many species make up a large part of the bird population to be found in Saskatchewan from April to November each year. By using the neutralization technique, we have found that WEE antibodies are present in the blood of many wild ducks, indicating previous infection with the virus. Further studies carried out at this laboratory showed that wild ducks can be infected with the virus by the oral route, suggesting another possible means by which birds could be naturally infected.

scholarly journals U.S. Case Report of Cerebral Phaeohyphomycosis Caused by Ramichloridium obovoideum (R. mackenziei): Criteria for Identification, Therapy, and Review of Other Known Dematiaceous Neurotropic Taxa

1998 ◽  
Vol 36 (3) ◽  
pp. 708-715 ◽  
Author(s):  
Deanna A. Sutton ◽  
Malcolm Slifkin ◽  
Robert Yakulis ◽  
Michael G. Rinaldi
Keyword(s):  
Middle East ◽  
Signs And Symptoms ◽  
Excisional Biopsy ◽  
Mass Effect ◽  
The United States ◽  
Subcortical Region ◽  
Clinical Mycology ◽  
History Of ◽  
Brain Abscesses ◽  
The Right

We report a case of cerebral phaeohyphomycosis in a 36-year-old male caused by the neurotropic fungus Ramichloridium obovoideum (Matushima) de Hoog 1977 (Ramichloridium mackenziei Campbell et Al-Hedaithy 1993). This man resided in the Middle East, where the fungus appears to be endemic and, possibly, geographically restricted, since all previous reports of brain abscesses due to this organism have been for patients indigenous to this area. As a servant of the Saudi Arabian royal family, he appeared in the United States seeking treatment for chronic weight loss, fatigue, decreased memory, and a more recent 2-week history of right-hand weakness which worsened to involve the entire right upper extremity. On the day prior to his admission, he had a focal motor seizure with rotation of the head and eyes to the right, followed by secondary generalization. A computerized tomogram showed a ring-enhancing hypodense lesion in the left parietal subcortical region with associated edema and mass effect. Diagnosis of a fungal etiology was made following a parietal craniotomy and excisional biopsy by observation of septate, dematiaceous hyphal elements 2 to 3 μm in width on hematoxylin-and-eosin-stained sections from within areas of inflammation and necrosis. Culture of the excised material grew out a dematiaceous mould which was subsequently identified as R. obovoideum. At two months postsurgery and with a regimen of 200 mg of itraconazole twice a day, the patient was doing well and returned to Saudi Arabia. His condition subsequently deteriorated, however, and following a 7-month course of itraconzole, he expired. We use this case to alert clinicians and personnel in clinical mycology laboratories of the pathogenicity of this organism and its potential occurrence in patients with central nervous system signs and symptoms who have resided in the Middle East and to review and/or compare R. obovoideum with other neurotropic, dematiaceous taxa and similar nonneurotropic, dematiaceous species.

scholarly journals Type 2 Diabetes Decompensation as the Clinical Presentation of Thyroid Storm – Cause or Consequence?

2017 ◽  
Vol 13 (02) ◽  
pp. 99 ◽  
Author(s):  
Ana Margarida Monteiro ◽  
Cláudia Matta-Coelho ◽  
Vera Fernandes ◽  
Olinda Marques ◽  
◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Signs And Symptoms ◽  
Altered Mental Status ◽  
Neurological Status ◽  
Thyroid Storm ◽  
Good Glycemic Control ◽  
Adequate Treatment ◽  
Intercurrent Illness ◽  
History Of

This case study aims to discuss the unusual forms of hyperthyroidism presentation, the nonspecific symptoms and precipitating events. A 70-year-old male was taken to the emergency department for hyperglycaemia, nausea, vomiting and altered mental status with a week of evolution. He had a past medical history of type 2 diabetes, hypertension and dyslipidemia. He had no history of any recent intercurrent illness or infection. At the emergency room, besides hyperglycaemia, ketonemia and slightly elevated C-reactive protein, the basic laboratory panel workup was normal, as was the head computed tomography. He was admitted for metabolic compensation and to study the altered neurological status. During hospitalisation, despite the good glycemic control, he had no improvements in neurological status. At day four of hospitalisation, thyrotoxicosis with thyroid storm criteria was diagnosed. He started on adequate treatment with complete clinical recovery. The associated morbidity and mortality of thyroid storm requires immediate recognition and treatment. Elderly patients are frequently misdiagnosed or diagnosed later due to fewer and less pronounced signs and symptoms.

D-lactic acidosis presenting as metabolic encephalopathy in a patient with short bowel syndrome

2021 ◽  
Vol 14 (5) ◽  
pp. e241102
Author(s):  
Ciarán McHale ◽  
Eoin Keating ◽  
Helen O'Donovan ◽  
Eoin Slattery
Keyword(s):  
Lactic Acidosis ◽  
Short Bowel Syndrome ◽  
Management Strategies ◽  
Bacterial Overgrowth ◽  
Signs And Symptoms ◽  
Small Intestinal Bacterial Overgrowth ◽  
Metabolic Encephalopathy ◽  
Short Bowel ◽  
Current Therapies ◽  
History Of

We present a case of D-lactic acidosis presenting as a metabolic encephalopathy secondary to small intestinal bacterial overgrowth. This patient had a known history of short bowel syndrome. Of note, this case required the alteration of treatment to promote a sustained clinical and biochemical improvement. We discuss the pathophysiological mechanisms thought to be involved. We also review the current therapies as well as potential future strategies. This case highlights the importance of the prompt clinical recognition of signs and symptoms as well as the rapid initiation of management strategies to ameliorate this condition.

Focus on Smoke Inhalation—The Most Common Cause of Acute Cyanide Poisoning

2006 ◽  
Vol 21 (S2) ◽  
pp. s49-s55 ◽  
Author(s):  
Marc Eckstein ◽  
Paul M. Maniscalco
Keyword(s):  
Treatment Options ◽  
Signs And Symptoms ◽  
The United States ◽  
Morbidity And Mortality ◽  
Smoke Inhalation ◽  
Closed Space ◽  
Cyanide Poisoning ◽  
Cyanide Antidote ◽  
Prehospital Management ◽  
Fire Smoke

AbstractThe contribution of smoke inhalation to cyanide-attributed morbidity and mortality arguably surpasses all other sources of acute cyanide poisoning. Research establishes that cyanide exposure is: (1) to be expected in those exposed to smoke in closed-space fires; (2) cyanide poisoning is an important cause of incapacitation and death in smoke-inhalation victims; and (3) that cyanide can act independently of, and perhaps synergistically with, carbon monoxide to cause morbidity and mortality. Effective prehospital management of smoke inhalation-associated cyanide poisoning is inhibited by: (1) a lack of awareness of fire smoke as an important cause of cyanide toxicity; (2) the absence of a rapidly returnable diagnostic test to facilitate its recognition; and (3) in the United States, the current unavailability of a cyanide antidote that can be used empirically with confidence outside of hospitals. Addressing the challenges of the prehospital management of smoke inhalation-associated cyanide poisoning entails: (1) enhancing the awareness of the problem among prehospital responders; (2) improving the ability to recognize cyanide poisoning on the basis of signs and symptoms; and (3) expanding the treatment options that are useful in the prehospital setting.

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