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Hypernatremia due to urea-induced osmotic diuresis: Physiology at the bedside
Sonali Vadi, Kenneth YimIndian Journal of Critical Care Medicine 2018 22(9):664-669
Hypernatremia secondary to urea-induced solute diuresis is due to the renal excretion of electrolyte-free water. This concept is explained here step-wise physiologically with the help of a clinical vignette.
Source: Indian Journal of Critical Care Medicine - September 17, 2018 Category: Intensive Care Authors: Sonali Vadi Kenneth Yim Source Type: research
Hepatitis a virus-induced severe hemolysis complicated by severe Glucose-6-Phosphate Dehydrogenase deficiency
Dhruva Sharma, Omender Singh, Deven Juneja, Amit Goel, Suneel Kumar Garg, Shashank ShekharIndian Journal of Critical Care Medicine 2018 22(9):670-673
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an x-linked recessive genetic disorder with mutation in the G6PD gene. Defect in the enzyme G6PD causes red blood cells (RBCs) to breakdown prematurely causing hemolytic anemia. Hemolytic anemia is also a known hematological complication associated with viral hepatitis. In such patients, hemolysis may be more severe if there is any secondary injury to RBC in the form of membrane defect, oxidative stress, or enzyme defici...
Source: Indian Journal of Critical Care Medicine - September 17, 2018 Category: Intensive Care Authors: Dhruva Sharma Omender Singh Deven Juneja Amit Goel Suneel Kumar Garg Shashank Shekhar Source Type: research
Severe hypokalemia mimicking brain death
Asif Ali Hitawala, Piyush Garg, Abhay Jain, Ashish NaharIndian Journal of Critical Care Medicine 2018 22(9):674-677
We discuss a case of a 20-year-old female who presented with history of fever, vomiting, and decreased oral intake for 10 days followed by one episode of generalized tonic–clonic seizure and altered sensorium for 5–6 h. On arrival in the emergency room, she had Glasgow Coma Scale 3 (E1V1M1), both pupils fixed and dilated, low blood pressure, low oxygen saturation, and few gasping breaths. She appeared to be brain dead and was assumed to have a very poor prognosis. Investigations rev...
Source: Indian Journal of Critical Care Medicine - September 17, 2018 Category: Intensive Care Authors: Asif Ali Hitawala Piyush Garg Abhay Jain Ashish Nahar Source Type: research
A rare case of localized tetanus
We present case of a 55-year-old male farmer, presented with an injury to the left toe. A surgical wound exploration and washout with administration of human tetanus immunoglobulin and tetanus toxoid were given as treatment with antibiotic support. This case report points out the importance of the early recognition of a rare form of this fatal infectious disease, which may present with prodromal symptoms before the generalized form shows its clinical effects. Successful management includes prompt diagnosis, neutralization of circulating toxin and elimination of C. tetani infection, control of spasms, maintenance of the air...
Source: Indian Journal of Critical Care Medicine - September 17, 2018 Category: Intensive Care Authors: Deepak S Sharma Mit B Shah Source Type: research
Speech and swallowing function outcome following early tracheostomy in patients who underwent neurosurgical intervention
Pralay Shankar Ghosh, Sukanya Naskar, Afzal AzimIndian Journal of Critical Care Medicine 2018 22(9):683-683
Source: Indian Journal of Critical Care Medicine - September 17, 2018 Category: Intensive Care Authors: Pralay Shankar Ghosh Sukanya Naskar Afzal Azim Source Type: research
Echographic comparison of optic nerve sheath diameter between both eyes
Maddalena De Bernardo, Ilaria De PascaleIndian Journal of Critical Care Medicine 2018 22(9):684-684
Source: Indian Journal of Critical Care Medicine - September 17, 2018 Category: Intensive Care Authors: Maddalena De Bernardo Ilaria De Pascale Source Type: research
Organ donation rate in brain-dead patients in a tertiary referral center
Shivakumar Mutnal, Pradeep Rangappa, Ipe Jacob, Karthik RaoIndian Journal of Critical Care Medicine 2018 22(9):685-686
Source: Indian Journal of Critical Care Medicine - September 17, 2018 Category: Intensive Care Authors: Shivakumar Mutnal Pradeep Rangappa Ipe Jacob Karthik Rao Source Type: research
Timing of renal replacement therapy in acute kidney injury: Shedding new light on an old controversy
Helmut SchifflIndian Journal of Critical Care Medicine 2018 22(10):730-732Critically ill patients with severe acute kidney injury (AKI-D) require renal replacement therapy (RRT) increasingly. However, the optimal timing of initiation of RRT for non-life-threatening indications of AKI remains unknown. There is a debate as to whether different philosophies of RRT initiation (early vs. delayed) confer a survival benefit. Lowering the threshold for RRT initiation, however, inevitably leads to more critically ill patients receiving unnecessary RRT. The relevant proportion of nonprogressing early stage AKI patients with spontane...
Source: Indian Journal of Critical Care Medicine - October 17, 2018 Category: Intensive Care Authors: Helmut Schiffl Source Type: research
Diagnostic usefulness of serum albumin as a predictor of diabetic ketoacidosis
Conclusions: Serum albumin levels may predict the occurrence of ketosis in diabetic patients.
Source: Indian Journal of Critical Care Medicine - October 17, 2018 Category: Intensive Care Authors: Jayagowri Karthikeyan Sujatha Rajaragupathy Source Type: research
Bilateral phrenic nerve palsy in a diabetic causing respiratory failure
We presented a 64-year-old male who was a case of type 2 DM for >6 years. He presented with orthopnea and respiratory failure secondary to bilateral phrenic neuropathy and resultant diaphragmatic palsy. Clinical examination, ultrasound, and nerve conduction studies confirmed the bilateral involvement of the phrenic nerves. Phrenic neuropathy may be an important, albeit a rare complication of diabetes, and hence, diaphragmatic dysfunction associated with diabetic phrenic neuropathy should be considered in any patient with unexplained breathlessness, orthopnea, and respiratory failure.
Source: Indian Journal of Critical Care Medicine - October 17, 2018 Category: Intensive Care Authors: Robert Da Costa Pezad Doctor Kaustubh Mahajan Vidyadhara G Lakkappan Source Type: research
Calming the electrical storm: Use of stellate ganglion block and thoracic epidural in intractable ventricular tachycardia
Supriya D'souza, Shalini Saksena, Manju ButaniIndian Journal of Critical Care Medicine 2018 22(10):743-745Imbalances in the autonomic nervous system contribute to ventricular tachyarrhythmias. Sympatholysis with thoracic epidural analgesia or a stellate ganglion block attenuates myocardial excitability and the proarrhythmic effects of sympathetic hyperactivity.
Source: Indian Journal of Critical Care Medicine - October 17, 2018 Category: Intensive Care Authors: Supriya D ' souza Shalini Saksena Manju Butani Source Type: research
Refractory status asthmaticus: A case for unconventional therapies
We present successful use of Extracorporeal Membrane Oxygenation and isoflurane in a child with Refractory Status Asthmaticus.
Source: Indian Journal of Critical Care Medicine - October 17, 2018 Category: Intensive Care Authors: Rohit Vohra Anil Sachdev Dhiren Gupta Neeraj Gupta Suresh Gupta Source Type: research
Artesunate-induced severe autoimmune hemolytic anemia in complicated malaria
Sarvinder Singh, Santosh Kumar Singh, Ajai Kumar Tentu, Anshu Kumar, Bhaskar Shahbabu, Vani Singh, Nidhi SinghIndian Journal of Critical Care Medicine 2018 22(10):753-756Autoimmune hemolytic anemia (AIHA) is a very rare cause of anemia in a case of malaria and drug-induced AIHA is even rarer. A 50-year old patient with a history of fever for 8 days was diagnosed with a case of complicated malaria with mixed infection having initial parasite index of 45%. He showed good response on initial therapy with artesunate (parasite count reduced to <1%) but his haemoglobin (Hb) continued to drop from...
Source: Indian Journal of Critical Care Medicine - October 17, 2018 Category: Intensive Care Authors: Sarvinder Singh Santosh Kumar Singh Ajai Kumar Tentu Anshu Kumar Bhaskar Shahbabu Vani Singh Nidhi Singh Source Type: research
& #8220;BROAD effect: Bradycardia in obstructive airway disease & #8221;An unusual phenomenon: A case report
We present one such case that was also a treatment challenge for us. Recurrent bradycardia in COPD, with repeatability on discontinuation of Non Invasive Ventilation (NIV) is an extremely rare condition with not much reports/studies in the medical literature. The mechanisms leading to such an event are poorly understood. To the best of our knowledge, it's the first case to be reported from India.
Source: Indian Journal of Critical Care Medicine - October 17, 2018 Category: Intensive Care Authors: Vikas Sikri Vinay Singhal Sandeep Chopra Source Type: research
Targeting the venous confluence of pirogoff for central venous cannulation insertion, when internal jugular vein cannulation is difficult: A three-step approach
Deepanshu Dhiman, Vikas Saini, Sameer Sethi, Tanvir SamraIndian Journal of Critical Care Medicine 2018 22(10):760-761
Source: Indian Journal of Critical Care Medicine - October 17, 2018 Category: Intensive Care Authors: Deepanshu Dhiman Vikas Saini Sameer Sethi Tanvir Samra Source Type: research
