Volume 12, Issue 2, Pages 65 – 124 (2013)

Correspondence

Correspondence, Volume 12, Issue 2, Pages 65 - 124 (2013)

We read with interest the article by Rogers et al in the recent edition of Acute Medicine, regarding the evaluation and management of adrenal failure. It was noted that the investigation and diagnosis of adrenal failure during pregnancy was not discussed; we feel this is an important omission, which was highlighted recently by a young woman who presented to our medical take, two weeks post-partum following her first pregnancy with clinical features in keeping with an Addisonian crisis.

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Problem Based Review: The Patient with Acute Monoarthritis

Trainee Section, Volume 12, Issue 2, Pages 65 - 124 (2013)

Acute monoarthritis is a common medical emergency with wide differential diagnosis. Common underlying causes include trauma, septic arthritis, crystal induced arthritis (gout and pseudogout), and reactive arthritis. Of these, septic arthritis is the diagnosis not to miss because of its association with significant morbidity and mortality. Precise diagnosis of the underlying cause of monoarthritis relies on a good history, physical examination findings, and results of focussed investigations. In this article, a practical approach to diagnosis and initial management of patients presenting with acute monoarthritis is described with the aid of a case vignette.

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Problem Based Review: The patient with a Pyrexia of Unknown Origin

Trainee Section, Volume 12, Issue 2, Pages 65 - 124 (2013)

Pyrexia of unknown origin (PUO) is a frequent presentation to the Acute Medical Unit, and is a source of significant morbidity, both the psychological burden of an uncertain diagnosis and prognosis and untreated complications of the underlying pathology. We present a problem based review of the management of PUO, illustrated by a patient who recently presented to our unit with fever and systemic malaise after returning from abroad and in whom no cause could be found for more than two months. We describe a structured approach making use of complex modern techniques such as Positron Emission Tomography-Computed Tomography (PET-CT) which ultimately provided the diagnosis for our patient.

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Trainee update – May 2013

Trainee Section, Volume 12, Issue 2, Pages 65 - 124 (2013)

We are delighted to introduce Ruth Johnson and Nerys Conway who have been elected as your new SAM trainee representatives. Kirk and Amy have completed their training but Kirk will continue in an advisory role until October when his official term concludes, to allow time for handover and to ensure continuity. If you want to get in touch or need any help or advice we can be contacted on our usual email address of: traineerep@acutemedicine.org.uk.

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A Case of Newly Diagnosed Primary Hypothyroidism with Deteriorating Consciousness that did not Respond to Thyroxine – What Else should be Considered?

Case Reports, Volume 12, Issue 2, Pages 65 - 124 (2013)

Abstract

We present an unusual case of a 60 year old male who was noted to have primary hypothyroidism and decreased consciousness which did not respond to Levothyroxine. Further investigations revealed a diagnosis of Hashimoto’s Encephalopathy which responded well to steroids. We describe the case in detail and discuss the available relevant literature on this topic.

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A Case of Newly Diagnosed Primary Hypothyroidism with Deteriorating Consciousness that did not Respond to Thyroxine – What Else should be Considered? Read More

Infectious Mononucleosis Hepatitis – An Unwelcome Present for Father Christmas

Case Reports, Volume 12, Issue 2, Pages 65 - 124 (2013)

Abstract

We describe a case of infectious mononucleosis (IM) hepatitis occurring in an elderly thespian, who had recently played the role of ‘Father Christmas’. We discuss the importance of differing clinical manifestations in older and younger age groups, the changing epidemiology of Epstein Barr (EB) infection within the United Kingdom and the role of different virology tests in establishing a diagnosis. Raised awareness of this changing pattern of disease could prevent unnecessary investigation and consequent potential iatrogenic complications.

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An Unusual Complication of Cocaine Toxicity

Case Reports, Volume 12, Issue 2, Pages 65 - 124 (2013)

Abstract

A 25-year man presented to the Accident and Emergency Department complaining of dizziness and shortness of breath after taking 70 grams of cocaine over 10 hours. He said a friend had noticed that his skin had turned dark blue. On examination the patient was severely centrally and peripherally cyanosed. His pulse oximeter oxygen saturations were 88% on air. An arterial blood gas showed a methaemoglobin level of 45.6%. The patient was diagnosed with cocaineinduced methaemoglobinaemia and given methyl thioninium chloride (methylene blue). He made an uneventful recovery.

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Elemental Mercury Toxicity due to Aspiration following Intentional Massive Ingestion

Case Reports, Volume 12, Issue 2, Pages 65 - 124 (2013)

Abstract

Deliberate poisoning with intentional ingestion of elemental mercury is reported not to result in systemic toxicity due to minimal absorption from the gastrointestinal tract. We report a case of a 43 year old male who intentionally ingested 200ml elemental mercury which resulted in abdominal pain and vomiting. The patient subsequently aspirated globules of mercury which was confirmed on chest x-ray and his blood mercury levels were markedly raised. He was treated with chelating agents and managed in a negative pressure room to reduce the risk of staff being exposed to exhaled mercury vapour from the patient.

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Selected abstracts from the Society for Acute Medicine Spring Meeting

Research Audit and Clinical Practice, Volume 12, Issue 2, Pages 65 - 124 (2013)

9th -10th May 2013, Hilton Hotel, Coventry

Over 200 abstracts were submitted to this year’s Society for Acute Medicine spring meeting which was held in the Hilton hotel, Coventry on 9-10 May 2013. Around 60 were accepted presented as posters, and 6 as oral presentations. The abstracts for the oral presentations are published here, while the poster abstracts are available on the Society for Acute Medicine website (www.acutemedicine.org.uk)

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