Case Reports in Critical Care最新文献

Noncardiogenic pulmonary edema has been reported as a rare adverse reaction of hydrochlorothiazide. Symptoms can develop acutely after medication ingestion, and patients may present acutely ill. The mechanism by which hydrochlorothiazide causes pulmonary edema remains unknown and is considered idiosyncratic. Prompt supportive care and discontinuation of the medication is necessary to prevent and manage such a complication. This case report describes a patient who developed noncardiogenic pulmonary edema after taking a combination pill of hydrochlorothiazide-losartan.

Fever is common in the ICU, with infectious causes accounting for only half of febrile episodes. This case examines a young male who developed high-grade fevers and pulmonary infiltrates unresponsive to broad-spectrum antibiotics. Examination revealed hepatosplenomegaly, hypertriglyceridemia, anemia, and thrombocytopenia, suggestive of hemophagocytic lymphohistiocytosis (HLH). Meeting 5 of 8 HLH criteria, high-dose steroids were administered, resulting in clinical improvement. HLH, with a high mortality risk, demands early recognition, complicated by nonspecific symptoms. This case highlights the rare manifestation of ARDS in HLH, adding diagnostic challenges in critical care settings.

Cerebral malaria is the most severe complication of Plasmodium falciparum infection. Left untreated, it is universally fatal. Coma is the clinical hallmark, emerging between the first and third days of fever. Adults typically present with mild cerebral edema, usually with a more favorable prognosis compared to the pediatric population. We present a case of a 48-year-old man with a recent travel to Angola who presented comatose on the second day of a febrile illness with clinical signs of cerebral herniation and diffuse cerebral edema and cerebellar tonsil ectopia on cranioencephalic computed tomography. He had a missed diagnosis on a first visit to the emergency department 2 days prior. The diagnosis of cerebral malaria was confirmed after the identification of the parasite in peripheral blood. He was admitted to an intensive care unit; however, progression to brain death was inevitable within a few hours. Malaria affects 5% of the world's population. In Portugal, it has an incidence of 0.01 in every 1000 inhabitants, and all cases are imported. Despite its rarity in a nonendemic country, its severity alerts to the consideration of this syndrome in the etiologic workup of coma. The early recognition of the diagnosis is of major importance for the establishment of definitive treatment, as its timely administration has a crucial impact on the outcome.

This report describes a 34-year-old male admitted to the medical intensive care unit (ICU) who sustained cardiac arrest while in prone positioning. Prone position CPR was initiated, and the utilization of point-of-care ultrasound (POCUS) during CPR was necessary to assess compression quality. Specifically, the popliteal was observed using POCUS to gauge the adequacy of compressions and subsequent perfusion during prone position CPR. This approach provides insight into assessing the effectiveness of chest compressions in a challenging prone position, potentially improving outcomes in similar cases. Further research and application of POCUS in this context may enhance the quality of CPR and patient care during cardiac arrest events in prone positioning.

Background: Hidradenitis suppurativa (HS) is a painful relapsing inflammatory disease characterized with subcutaneous nodules, abscesses, tunnels, and deforming scars. We present a case of HS complicated with amyloidosis who was admitted with sepsis and acute renal failure. Case Report: A 53-year-old male patient with a history of HS and amyloidosis was accepted to the intensive care unit suffering from acute kidney failure and sepsis symptoms. He was receiving adalimumab during admission. He received hemodialysis and piperacillin-tazobactam antibiotherapy. After 15 days of hospitalization, his sepsis was treated, but he was taken to a routine hemodialysis programme. Conclusion: In the presence of amyloidosis with intervenient infections, the risk of chronic renal failure in HS cases can be kept in mind even if the patient is receiving TNF inhibitors.

Introduction: In pulmonary embolism (PE), when used for catheter-directed thrombolysis (CDT), low-dose alteplase is associated with good outcomes. Tenecteplase has been only used as intravenous for this indication. In the context of our national economic crisis where alteplase was unavailable, we describe our experience with tenecteplase CDT. Case: A 73-year-old male, hypertensive and smoker with COPD, presented to the ED with intermediate high-risk PE.(ED) with intermediate high-risk PE. Heparin infusion was initiated. A few hours later, the patient developed atrial fibrillation (AF) for which amiodarone infusion was started. Also, a left femoral and popliteal vein thrombosis was also confirmed by the lower extremity duplex. As the patient remained dyspneic with unstable vital signs, the decision was to perform a CDT. In the absence of alteplase, tenecteplase was used at 0.5 mg/h over 30 h, for a total of 15 mg. Result: Twenty-four hours after tenecteplase initiation, dyspnea and vital signs had significantly improved. Oxygen support was gradually dropping to finally stop. Being on concomitant heparin infusion, the patient had a mild blood oozing at the femoral vein site of entry; however, this did not require any transfusion or discontinuation of heparin. The patient regained his baseline physical and mental functions and was discharged on enoxaparin and amiodarone tablet. Discussion: This is the first experience describing the use of tenecteplase as part of CDT in a patient with acute intermediate high-risk PE. The combination to therapeutic heparin infusion, already described in different clinical scenarios with intravenous tenecteplase, was safe and well tolerated Conclusion: CDT with tenecteplase was, for the first time, safely and effectively used in an intermediate high-risk PE patient. However, more studies are needed to confirm and establish these findings.

Paroxysmal sympathetic hyperactivity (PSH) syndrome is a potentially life-threatening complication after traumatic brain injuries that results from a massive release of catecholamines in the brain. Fat embolism syndrome (FES) is a complication of long bone fractures that results in cerebral or pulmonary fat emboli. We describe PSH in the setting of cerebral FES in an adolescent female following polytrauma secondary to a motor vehicle collision to highlight the importance of rapid diagnosis and treatment of this rare complication.

Sodium valproate overdose leads to CNS depression, cerebral oedema, and severe metabolic acidosis in cases of severe toxicity. Extracorporeal removal, specifically through intermittent haemodialysis, is recommended, though not always tolerated by or accessible to haemodynamically unstable patients in intensive care units. We present a case of a male in his mid-twenties presenting following a massive, intentional overdose of 13 g of sodium valproate over 7 hours, with an initial valproate blood concentration of 975 μg/ml (normal 50-100 μg/ml). He was hypoxic and severely acidotic on arrival and was given fluids and L-carnitine according to TOXBASE guidelines. This resulted in only marginal improvement to his acidosis. Once transferred to our intensive care unit, the patient was started on inotropic support followed by continuous venovenous hemofiltration (CVVHDF) at the maximum effluent rate of 60 ml/kg/hr. Due to his persisting metabolic acidosis and worsening hyperlacataemia, dual CVVHDF was started by adding another filter in series after 26 hours, increasing the maximum effluent rate to 96 ml/kg/hr. The patient remained on dual CVVHDF for 31 hours, during which his acidosis and lactate showed considerable improvement, and he was subsequently stepped down to single-filter CVVHDF for a further 20 hours until complete resolution of his acidosis. This case report recognises dual CVVHDF as a viable salvage therapy for severe sodium valproate overdose by facilitating the achievement of a higher effluent flow rate compared to what can be accomplished with single-filter CVVHDF.