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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Category: Case reports (Page 1 of 23)

Late-onset sick sinus syndrome after carbon monoxide poisoning

Abstract

Carbon monoxide (CO) is a known, potent poisonous gas that causes hypoxaemia because of its high affinity for haemoglobin. It also induces inflammatory responses that cause tissue injury, particularly to the nervous and cardiovascular systems. Here we present a case of late-onset sick sinus syndrome (SSS) after CO poisoning. Arrhythmia during the acute phase has been recorded in the literature, but to the best of our knowledge, this is the first report of late-onset SSS. Late-onset neuropathy after CO poisoning is well known, and it seems that a similar mechanism develops in cardiac conduction after CO poisoning. This report highlights the importance of follow-up for arrhythmia after CO poisoning.

Key words: sick sinus syndrome, carbon monoxide poisoning, arrhythmia, neurologic injury, cardiac injury

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Levodopa-carbidopa-entacapone overdose presenting as altered mental status, xanthoderma, and yellowish sclera

Abstract

Levodopa-carbidopa-entacapone is a single combination drug consisting of levodopa (aromatic amino acid), carbidopa (dopa-decarboxylase inhibitor), and entacapone (catechol-O-methyltransferase inhibitor). The Food and Drug Administration approved levodopa-carbidopa-entacapone in 2003, as treatment for idiopathic Parkinson’s disease in patients experiencing signs and symptoms of wearing-off. Although various adverse drug reactions of levodopa-carbidopa-entacapone have been recorded, there has been no reported case of levodopa-carbidopa-entacapone overdose. We report the first case of signs and symptoms of an overdose of levodopa-carbidopa-entacapone (levodopa: 3000 mg; carbidopa: 750 mg; entacapone: 6000 mg) in a suicide attempt, presenting as altered mentality, xanthoderma, and yellowish sclera without hyperbilirubinemia.

Key words: levodopa-carbidopa-entacapone, Parkinson’s disease, drug overdose, xanthoderma, yellowish sclera, toxicology

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Psoas abscess as the first manifestation of Crohn’s disease – case report

Abstract

A case of 16-year-old female with secondary psoas abscess as the complication of the Crohn’s disease was analysed. Her pre-hospital, long lasting, non-specific symptoms led to ultrasound (US) and radiologic imaging confirming the diagnosis. The antibiotic treatment was insufficient and worsening of the patient’s condition required surgical treatment including descendent colectomy, abscess drainage and negative pressure wound therapy (NPWT). In spite of numerous complications the condition of the child gradually improved and she was discharged from the hospital on the 71st postoperative day. Two years after the colectomy, the occlusion of her colostomy was performed.

Key words: child, Crohn’s disease, psoas abscess

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Abdominal stab wound with damage to the abdominal aorta and the left lobe of the liver – case report

Abstract

A case of a 26-year-old man with an abdominal stab wound damaging the abdominal aorta and the left lobe of the liver is presented here. The patient was diagnosed and operated on after an emergency admission. The patient was discharged from the Surgical Ward 10 days after surgery in good general condition and was referred to the out-patient clinic.

Key words: abdominal stab wounds, liver, abdominal aorta

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Treatment of non-oliguric hyperkalaemia with inhaled salbutamol in premature infants with severe respiratory distress syndrome

Abstract

Non-oliguric hyperkalaemia (NOHK) in neonates is defined as a plasma potassium level > 6.5 mmol/L in the presence of urine output ≥ 1 mL/kg/h during the first 72 hours of life. It is characterized by a rapid rise of serum potassium to excessively high values, a high risk of cardiac arrhythmias and no occurrence after 72 hours of birth. NOHK commonly occurs in premature neonates, especially in those with a gestational age <28 weeks, with only a few reports of this entity in moderate or late preterm neonates. The effectiveness and safety of different treatments for NOHK is uncertain and currently there is no firm treatment recommendation. We describe the case of a moderately premature neonate (32+ 2 weeks gestation), with severe neonatal respiratory distress syndrome, who developed NOHK that was treated with inhaled salbutamol. When salbutamol is used for the treatment of NOHK, an initial paradoxical rise in potassium levels should always be taken into account to avoid cardiac arrhythmias.

Key words: non-oliguric hyperkalaemia, premature, infants, salbutamol, hyperkalaemia

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