A Case Report of Delirium Induced by Herbal Laxative Senna

2021 ◽  
Vol 11 (6) ◽  
pp. 231-233
Author(s):  
Nimitha K J ◽  
Porimita Chutia ◽  
Pooja Misal
Keyword(s):  
Case Report ◽  
Serum Sodium ◽  
Elderly Population ◽  
Oral Intake ◽  
Mental Illnesses ◽  
Electrolyte Imbalance ◽  
Normal Limits ◽  
Icd 10 ◽  
Current Scenario ◽  
History Of

Constipation is one major complaint in elderly population. It may be due to physiological and anatomical reasons of aging, but it can be also due chronic medical and mental illnesses and due to use of multiple medications. Constipation itself is a precipitating factor for delirium. Drugs used for constipation can also be the culprit. A 64-year-old female who had a history of hypertension and chronic constipation presented with symptoms of confused and altered behavior, decreased oral intake, decreased sleep. On history taking it was known that she was using Herbal medication containing senna glycoside and other compounds since 8-9months. On examination she had signs of dehydration, disoriented and attention was impaired. On investigation her serum sodium was 122.6 mmol/ and other investigations were within normal limits. She was diagnosed as a case of Delirium according to ICD-10 criteria. Her dehydration was corrected by giving intravenous fluids and serum sodium level was corrected using salt capsules 2 tablets thrice daily. For disturbed sleep she was prescribed Tab Melatonin 10mg at bedtime and constipation was treated with per rectal enema and syrup lactulose 30ml at bedtime. Patient improved in 1 week time. Senna a herbal laxative used to treat constipation. It can alter intestinal electrolyte transportation and irritates intestinal mucosa. It is due to increased peristalsis and increased defecation and even diarrhea Prolonged use can cause dehydration, electrolyte imbalance and delirium. Senna, an over-the-counter laxative with FDA approval is a matter of concern in the current scenario. This case report warns into the judicious use of laxatives containing senna in elderly population. Key words: Delirium, Herbal Laxative, Senna, Constipation.

scholarly journals Acute Iodine Toxicity from a Suspected Oral Methamphetamine Ingestion

2014 ◽  
Vol 7 ◽  
pp. CCRep.S20086 ◽  
Author(s):  
Marilyn N. Bulloch
Keyword(s):  
Case Report ◽  
Gastrointestinal Symptoms ◽  
Liver Function Tests ◽  
Oral Ingestion ◽  
Methamphetamine Abuse ◽  
Normal Limits ◽  
Naturally Occurring ◽  
History Of ◽  
Systemic Symptoms ◽  
Iodine Toxicity

Background Iodine is a naturally occurring element commercially available alone or in a multitude of products. Iodine crystals and iodine tincture are used in the production of methamphetamine. Although rarely fatal, iodine toxicity from oral ingestion can produce distressing gastrointestinal symptoms and systemic symptoms, such as hypotension and tachycardia, from subsequent hypovolemia. Objective The objective of this case report is to describe a case of iodine toxicity from suspected oral methamphetamine ingestion. Case Report A male in his early 20′s presented with gastrointestinal symptoms, chills, fever, tachycardia, and tachypnea after orally ingesting a substance suspected to be methamphetamine. The patient had elevated levels of serum creatinine, liver function tests, and bands on arrival, which returned to within normal limits by day 4 of admission. Based on the patient's narrow anion gap, halogen levels were ordered on day 3 and indicated iodine toxicity. This is thought to be the first documented case of iodine toxicity secondary to suspected oral methamphetamine abuse. Conclusion Considering that the incidence of methamphetamine abuse is expected to continue to rise, clinicians should be aware of potential iodine toxicity in a patient with a history of methamphetamine abuse.

Valsalva retinopathy associated with intranasal cocaine abuse: A case report

2018 ◽  
Vol 29 (3) ◽  
pp. NP5-NP8 ◽  
Author(s):  
Evdoxia-Maria A Karasavvidou ◽  
Georgios P Athanasopoulos ◽  
Anastasios G Konstas ◽  
Eleni A Tsirampidou ◽  
Paris G Tranos
Keyword(s):  
Visual Acuity ◽  
Case Report ◽  
Cocaine Abuse ◽  
Posterior Pole ◽  
Normal Limits ◽  
Valsalva Retinopathy ◽  
Intranasal Cocaine ◽  
Treatment Measures ◽  
History Of ◽  
Field Defect

Introduction: The purpose of this report is to describe a case of Valsalva retinopathy in an intranasal cocaine user. Case report: A 49-year-old male presented with a history of sudden loss of vision and inferior visual field defect in his left eye. Clinical evaluation of the affected eye showed best corrected visual acuity of 20/25 and fundus examination revealed a preretinal hemorrhage superior to the disk with multiple intraretinal hemorrhages in and around the posterior pole. On further questioning, the patient revealed intranasal cocaine use the day before the onset of his visual symptoms. Blood tests were requested to exclude blood dyscrasias or predisposition to vascular occlusive disorders and no further treatment measures were taken. The patient was reviewed a month later when his hemorrhages had completely resolved and his visual acuity had improved to 20/20. His blood results were within normal limits. Conclusion: Although never been reported before, Valsalva retinopathy can be associated with intranasal cocaine abuse and should be considered in the differential diagnosis of visual reduction in such population.

Brief psychotic disorder with delusion content related to the COVID-19 outbreak

Psychiatriki ◽  
2021 ◽  
Author(s):  
Kyriaki Marouda ◽  
Leonidas Mantonakis ◽  
Konstantinos Kollias
Keyword(s):  
Case Report ◽  
Psychotic Disorder ◽  
Psychiatric Symptoms ◽  
Stressful Life Event ◽  
Psychological Impact ◽  
Strong Relationship ◽  
Brief Psychotic Disorder ◽  
Icd 10 ◽  
History Of

The COVID-19 outbreak has affected millions of people globally and it also has a huge psychological impact. The objective of this case report is to outline the possible effect of the COVID-19 pandemic to the content of delusions in patients with psychosis. Α 34-year-old male with no history of mental disorder, involuntarily hospitalized due to agitation and aggression towards others, experienced grandiose delusions, referential delusions and delusions of passivity. The content of all his delusions was related to the COVID-19 pandemic. His symptoms were not proven to be caused by any physical condition or substance use disorder. He was prescribed olanzapine 10mg bd and lorazepam 2,5mg td and demonstrated significant improvement with a complete subsidence of his symptoms within a week. He was discharged after a total of 13 days with an ICD-10 diagnosis of brief psychotic disorder. At his 6 months follow-up, he reported no psychiatric symptoms. Existing literature indicates a strong relationship between life experiences and the content of delusions. This case report highlights how the stressful life event of the COVID-19 outbreak affected the content of our patient’s delusions.

scholarly journals Atypical presentation of central pontine myelinolysis in hyperglycemia

2017 ◽  
Vol 2017 ◽  
Author(s):  
Swapna Talluri ◽  
Raghu Charumathi ◽  
Muhammad Khan ◽  
Kerri Kissell
Keyword(s):  
Case Report ◽  
Blood Glucose ◽  
Serum Sodium ◽  
Central Pontine Myelinolysis ◽  
Blood Glucose Control ◽  
Clinical Suspicion ◽  
Serum Osmolality ◽  
Pontine Myelinolysis ◽  
History Of ◽  
Central Pontine

Summary Central pontine myelinolysis (CPM) usually occurs with rapid correction of severe chronic hyponatremia. Despite the pronounced fluctuations in serum osmolality, CPM is rarely seen in diabetics. This is a case report of CPM associated with hyperglycemia. A 45-year-old non-smoking and non-alcoholic African American male with past medical history of type 2 diabetes, hypertension, stage V chronic kidney disease and hypothyroidism presented with a two-week history of intermittent episodes of gait imbalance, slurred speech and inappropriate laughter. Physical examination including complete neurological assessment and fundoscopic examination were unremarkable. Laboratory evaluation was significant for serum sodium: 140 mmol/L, potassium: 3.9 mmol/L, serum glucose: 178 mg/dL and serum osmolality: 317 mosmol/kg. His ambulatory blood sugars fluctuated between 100 and 600 mg/dL in the six weeks prior to presentation, without any significant or rapid changes in his corrected serum sodium or other electrolyte levels. MRI brain demonstrated a symmetric lesion in the central pons with increased signal intensity on T2- and diffusion-weighted images. After neurological consultation and MRI confirmation, the patient was diagnosed with CPM secondary to hyperosmolar hyperglycemia. Eight-week follow-up with neurology was notable for near-complete resolution of symptoms. This case report highlights the importance of adequate blood glucose control in diabetics. Physicians should be aware of complications like CPM, which can present atypically in diabetics and is only diagnosed in the presence of a high index of clinical suspicion. Learning points: Despite the pronounced fluctuations in serum osmolality, central pontine myelinolysis (CPM) is rarely seen in diabetics. This case report of CPM associated with hyperglycemia highlights the importance of adequate blood glucose control in diabetics. Physicians should be aware of complications like CPM in diabetics. CPM can present atypically in diabetics and is only diagnosed in the presence of a high index of clinical suspicion.

scholarly journals A 38 Years Old Man with ANCA Negative Wegener’s Granulomatosis Vasculitis with Type 2 Diabetes Mellitus and Electrolyte Imbalance: A Case Report

2021 ◽  
Vol 12 (2) ◽  
pp. 309-313
Author(s):  
Bryan Arief Aji Rudita ◽  
Yulyani Werdiningsih ◽  
Arief Nurudhin ◽  
Nurhasan Agung Prabowo ◽  
Zainal Arifin Adnan
Keyword(s):  
Case Report ◽  
Wegener’S Granulomatosis ◽  
Rare Case ◽  
Clinical Symptoms ◽  
Wegener's Granulomatosis ◽  
Electrolyte Imbalance ◽  
Saddle Nose ◽  
Normal Limits ◽  
The Face ◽  
Hands And Feet

A B S T R A C TBackground: Wegener's granulomatosis is a very rare long-term systemicdisorder, in which granuloma formation occurs and inflammation of bloodvessels (vasculitis). The cause of disorder is not yet known, but geneticfactors are thought to play an important role. Clinical symptoms are oftensimilar to other disorders, making diagnosis difficult. However, earlydiagnosis is very important in order to provide effective management.Objective: Diagnosis and management in a rare case of Wegener’sgranulomatosis vasculitis, especially it was found with other comorbidities.Methods: This case report showed a-38-years-old-man that came to theemergency room of Dr Moewardi Hospital with complaints of swellingaccompanied by redness and stiff on the face, hands and feet that worseningsince 7 days ago. He also complained of fever fluctuating, nasal congestionaccompanied by clear discharge and sometimes hearing loss in the rightear. Since the last 3 months, he was often experience similar complaints.History of diabetes was recognized by the patient for 5 years, but he did notregularly take medication. Results: In this case, examination of vital signswithin normal limits. Physical examination revealed a saddle nose with cleardischarge, swelling and redness around the face, hands and feet. Laboratorytests showed hemoglobin 12.9 g/dl, HbA1c 8.4%, sodium level 128 mmol/L,potassium level 3.1 mmol/L, calcium level 1.12 mmol/L. The Anti -Neutrophil Cytoplasmic Antibodies (ANCAs) and Anti Nuclear Antibody(ANA) Indirect Immunofluorescence (IF) method were negative.Electrocardiogram and chest x-ray examination within normal limits.Histopathological examination revealed epidermal atrophy and multiplegranulomas of the dermis. The patient underwent treatment for 10 dayswith tappering-off dose steroid, immunosuppressants, insulin, calcium,and potassium preparations therapy. Conclusions: Wegener’sgranulomatosis vasculitis is a rare case. Prompt and accurate diagnosis andmanagement will prevent poor progression of them, especially it was foundwith other comorbidities.

scholarly journals Mayer-Rokitansky-Kuster-Hauser Syndrome (MRKH) Patients Treated with Laparoscopic Neovaginal with The Davydov Procedure with Epidural Anesthesia: A Case Report

2021 ◽  
Vol 2 (1) ◽  
pp. 184-189
Author(s):  
Hadrians Kesuma Putra ◽  
Amir Fauzi ◽  
Ratih Krisna ◽  
Aerul Chakra Alibasya ◽  
Aidyl Fitrisyah ◽  
...  
Keyword(s):  
Case Report ◽  
Septal Defect ◽  
Operative Management ◽  
Surrogate Mothers ◽  
Case Presentation ◽  
Mrkh Syndrome ◽  
Normal Limits ◽  
Uterine Transplantation ◽  
History Of ◽  
Selection Of

Introduction. MRKH syndrome is characterized by incomplete or absent of vaginal and uterine agenesis. Currently there are no official guidelines on the management of MRKH syndrome. This case report is about the operative management in MRKH patients by neovaginal with laparoscopic Davydov procedure. Case presentation. A 26-year-old woman admitted that she had never had a period, the patient admitted that her breasts began to grow at the age of 13, and the patient was planning to get married, and refused to take further planning. The patient then came back to the RSMH urogynecology clinic after marriage, from the examination it was found that the pubic hole was ± 0.5 cm deep, speculum examination could not be done, the uterus could not be palpable from the rectal toucher. From the ultrasound examination, it was found that both ovaries were within normal limits and suspected uterine hypoplasia. Hormone tests were within normal limits, with the following values: LH 27.01 mIU / mL, FSH 57.08 mIU / mL, Estradiol 10 pg / mL, Prolactin 5.94 ng / mL. Patients with a history of atrial septal defect (ASD) and ventricular septal defect (VSD) Conclusion. Treatment of MRKH syndrome patients is usually complex and requires multidisciplinary counseling, therapy, and management, so it is hoped that it can help patients to make a functional vagina. Further research and collaboration from various multidisciplinary make pregnancy in patients with MRKH syndrome, not impossible, along with current technological and scientific developments, the selection of surrogate mothers, and uterine transplantation is an option.

scholarly journals A RARE CASE REPORT ON MYXOEDEMA COMA

2021 ◽  
pp. 1-3
Author(s):  
SHANTHI B ◽  
MARY CHANDRIKA A
Keyword(s):  
Case Report ◽  
Female Patient ◽  
Rare Case ◽  
Previous History ◽  
Altered Mental Status ◽  
Electrolyte Imbalance ◽  
Rare Case Report ◽  
Life Threatening ◽  
History Of ◽  
Life Threatening Complication

Myxoedema coma is a sporadic life-threatening complication of severe hypothyroidism with high mortality. Altered mental status and hypothermia are the main symptoms of myxoedema coma. Apart from that, hypoxia, bradycardia, hypotension, anemia, and hyponatremia would be present. Few patients present comatose with severe myxoedema. Presenting coma may mislead the diagnosis of this condition. A female patient presented with fever, breathlessness, and disorientation was admitted. First diagnosed to have electrolyte imbalance and treatment was started accordingly. The patient did not show much of an improvement, and it took a day to identify the presence of severe hypothyroidism. Treating hypothyroidism resulted in an advance in the patient condition. Patients’ previous history of hypothyroidism was not informed during admission. It is always tough to diagnose myxoedema coma when the patients’ previous history of hypothyroidism is unknown. Hence, it is still essential to have hypothyroidism in mind while treating patients with comatose. This case has been reported to alert physicians in diagnosing myxoedema coma patients and to proceed with the treatment at the earliest.

scholarly journals Hepatobiliary Manifistations of COVID-19 in Sickle Cell Disease: A Case Report

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 33-34
Author(s):  
Badria M. Alghamdi ◽  
Ohoud F. Kashari
Keyword(s):  
Case Report ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Laboratory Finding ◽  
Oral Intake ◽  
Cell Disease ◽  
Gastrointestinal Manifestations ◽  
Biliary Sludge ◽  
History Of ◽  
Poor Oral Intake

Hepatobiliary manifestation of COVID-19 in Sickle Cell Disease: A Case report. Background and aim: SARS-CoV-2 belongs to the Coronaviridae family, and the virus began spreading worldwide in late December 2019. It mainly affects the respiratory system. However, some studies have shown an increasing number of patients reporting gastrointestinal manifestations associated with COVID-19. There is little clinical experience of COVID-19 patients with sickle cell disease (SCD) especially in our country, and most reported cases presented with acute chest syndrome (ACS). Sickle cell hepatopathy is common and ranges from benign hyperbilirubinemia and biliary sludge to overt liver failure, but it is unclear how this is affected by COVID-19. Case presentation: We report a case of a 5-year-old Saudi, non-obese female who was diagnosed as sickle B+ thalassemia (HbS: 71.9%, HbA 1.4%, HbA2: 6 & HbF: 20.7%) and was on hydroxyurea, folic acid, and vitamin D. The child came to our Emergency Department on 28/7/2020 with a one-week history of generalized abdominal pain related to the food ingestion and associated with vomiting and diarrhea. There is a history of jaundice, dark urine, and clay-like stool. There was no documented fever, history of cough, or respiratory distress. There was a history of contact with Covid-19 patient. On clinical examination, the child was vitally stable but jaundiced. She was in pain with tenderness over the right part of the abdomen but no organomegaly; other systematic examinations were normal. Her initial laboratory finding showed elevated liver enzyme (ALT: 148U/L, AST: 89U/L, GGT:150U/L, ALP:149U/L) with direct hyperbilirubinemia (total bilirubin 4.5mg/dl and direct bilirubin 2.6 mg/dl), high reticulocyte, and stable hemoglobin (10 mg/dl). She had a normal leukocyte count, platelet count, inflammatory markers, and pancreatic enzymes. Her abdominal U/S showed no hepatic focal lesions detected with normal size liver and no evidence of intrahepatic bile duct dilatation. In addition, the common bile duct and the portal vein were not dilated. The gallbladder showed normal wall thickening and was partially filled with sludge without stones (Figure 1). The child was kept on diet restriction and treated with maintenance intravenous fluid (IVF) and paracetamol. Hydroxyurea was stopped. Her gastrointestinal manifestations improved, and the liver enzymes subsided within days (Figure 2). After four days, the child was discharged home. Two days later, she was readmitted with poor oral intake and generalized upper limb pain (vaso-occlusive crisis). There was no clinical finding on examination. Her laboratory finding was acceptable, and she was started on IVF and analgesia. On 8/8/2020, she was discharged in very good clinical condition. Conclusions: It is clear that COVID-19 has significant impact on SCD. Poor oral intake that associated with viral infection can cause biliary sludge and Close follow-up is essential for those patients. Further studies are needed to support this finding. Disclosures No relevant conflicts of interest to declare.

scholarly journals Impact of comorbidities on risk of angioedema without urticaria in elderly patients

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Andrzej Bożek ◽  
Magdalena Zając
Keyword(s):  
Elderly Population ◽  
The Elderly ◽  
Inclusion Criteria ◽  
Hashimoto’S Disease ◽  
Detailed Medical History ◽  
Icd 10 ◽  
History Of ◽  
Hashimoto's Disease ◽  
Low Levels ◽  
Potential Factors

Abstract Background Angioedema without urticaria (AWU) is a disease found in the elderly population but is still poorly studied. The aim of this study was to investigate potential factors, especially comorbidities, that may affect the induction of angioedema without urticaria in patients over 60 years of age. Methods This was an observational, retrospective study of 242 patients with a diagnosis of AWU and 263 controls. The inclusion criteria were as follows: at least one episode of confirmed AWU based on the ICD-10 code (T78.3) that required treatment in the last 15 years (2004–2019); age above 60 years; detailed medical history of comorbidities; and details regarding the use of drugs at that time. Serum functional and quantitative C1 inhibitor assays were performed, and serum C4 was measured. Comorbidities were grouped into the following panels: autoimmune, cancer, cardiac, metabolic, respiratory and allergic, liver failure and renal failure. Individual diseases were checked according to ICD code and treatment. Results In 1 (0.4%) patient, hereditary angioedema was confirmed. Decreased levels of C1INH were observed in 4 (1.65%) patients, dysfunction of C1INH was observed in 5 (1.76%) patients, and low levels of C4 were observed in 9 (3.71%) patients in the study group. The multiple logistic regression model revealed that patients with hyperuricemia or Hashimoto’s disease had a significantly higher chance of angioedema (OR = 3.21, 95% CI 2.92–3.66, p = 0.002; OR = 1.78 95% CI 1.37–2.21, p = 0.034, respectively). Conclusion The obtained results may indicate a significant influence of hyperuricemia or Hashimoto’s disease on angioedema manifestations.

scholarly journals Managing an Acute and Chronic Periprosthetic Infection

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Cristian Barrientos ◽  
Maximiliano Barahona ◽  
Rodrigo Olivares
Keyword(s):  
Staphylococcus Aureus ◽  
Case Report ◽  
Chronic Infection ◽  
Periprosthetic Infection ◽  
Coagulase Negative Staphylococci ◽  
Normal Limits ◽  
History Of ◽  
One Year ◽  
First Time ◽  
Periprosthetic Infections

A case report of a 65-year-old female with a history of right total hip arthroplasty (THA) in 2007 and left THA in 2009 was presented. She consulted with our institution for the first time, on December 2013, for right hip pain and fistula on the THA incision. It was managed as a chronic infection, so a two-stage revision was performed. First-time intraoperative cultures were positive for Staphylococcus aureus (3/5) and Proteus mirabilis (2/5). Three weeks after the second half of the review, it evolved with acute fever and pain in relation to right hip. No antibiotics were used, arthrocentesis was performed, and a coagulase-negative staphylococci multisensible was isolated at the 5th day. Since the germ was different from the first revision, it was decided to perform a one-stage revision. One year after the first review, the patient has no local signs of infection and presents ESV and RPC in normal limits. The indication and management of periprosthetic infections are discussed.

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