Volume 6

Alcohol Related Non-traumatic Rhabdomyolysis and Compartment Syndrome

Case Reports, Volume 6, Issue 1, Pages 1 - 48 (2007)

Abstract

Rhabdomyolysis is a serious and life-threatening condition in which skeletal muscle is damaged, commonly resulting in acute renal failure. The causes of this clinical entity can be traumatic and non-traumatic. In the latter group, alcohol is the commonest cause. This report describes the case of a 25 year old man who presented with rhabdomyolysis leading to acute renal failure after an alcohol binge. He presented with painful legs and lower extremity compartment syndrome. The patient recovered with surgical fasciotomy and renal support. This case illustrates the importance of early recognition and treatment of alcohol related non-traumatic rhabdomyolysis and compartment syndrome.

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Severe Thyrotoxicosis (Thyroid Storm) With Liver Failure

Case Reports, Volume 6, Issue 1, Pages 1 - 48 (2007)

Abstract

Thyroid storm is a severe form of thyrotoxicosis. It is an uncommon condition but can be life-threatening. Most often it is seen in patients with a background history of thyroid disease and most cases are complicated with multi-organ involvement, mainly respiratory, cardiovascular, hepatic and renal. The association of severe thyrotoxicosis with severe hepatic dysfunction has been rarely reported. This case describes a 34-year-old male without a known prior history of thyroid disease who presented with severe liver failure.

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Jaundice, Renal Failure and Pulmonary Haemorrhage in a Canal Boat Owner

Case Reports, Volume 6, Issue 1, Pages 1 - 48 (2007)

Abstract

Leptospirosis is a rare notifiable disease with three major clinical manifestations: subclinical disease, a self limiting illness (90% cases) and Weil’s disease, a fulminant, life-threatening condition with renal and hepatic failure, haemorrhagic pneumonitis and cardiovascular collapse. Diagnosis is by the detection of IgM antibodies to leptospira produced 7 to 14 days after the onset of illness. It is important for acute physicians to consider this condition in their initial differential diagnosis since early treatment reduces the severity and duration of symptoms and hospital stay. A history of environmental or occupational exposure to animals or potentially infected water should raise suspicions of leptospirosis.

This article aims to remind clinicians of the diagnosis and management of this condition. The typical symptoms and signs are illustrated by a recent case which presented to our department.

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The Diagnostic Assessment of Suspected Pulmonary Embolism on the Acute Medical Take: An Evidence Based Guide

Clinical Reviews, Volume 6, Issue 1, Pages 1 - 48 (2007)

Abstract

Pulmonary Embolism is a common cardiopulmonary illness with an age and sex adjusted incidence of around 117 cases per 100 000 person years. The clinical presentation is extremely heterogeneous and non specific. Risk factors for venous thromboembolism are well established. When combined with presenting features and investigations. a multimodality algorithm has led to significant changes in the diagnostic approach of suspected PE. While the best combination of tests for any individual patient remains the subject of controversy this article aims to rationalise the acute physician’s approach to diagnosis and use of available investigations.

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A Review of the Evaluation and Management of Syncope in the Acute Medical Unit

Clinical Reviews, Volume 6, Issue 1, Pages 1 - 48 (2007)

Abstract

Syncope is a common acute presentation and frequently results in hospitalisation. Cardiac syncope is potentially life threatening. The diagnosis and management of syncope demands a careful history, witness account wherever possible, and a comprehensive assessment. This, in combination with routine investigations, will provide an answer in a significant percentage of patients.

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Management of Suspected Avian (H5N1) Influenza in a Non-pandemic Setting

Clinical Reviews, Volume 6, Issue 1, Pages 1 - 48 (2007)

Abstract

Avian (H5N1) influenza has been responsible for millions of wild bird and poultry deaths throughout the world. Sporadic human cases with a high mortality have occurred, almost exclusively in association with very close contact with sick, dying or dead birds. Appropriate management of suspected cases requires their prompt recognition via attention to travel and bird-exposure history. The early isolation, diagnosis and treatment of suspected cases as well as prompt involvement of the health protection unit should enable patients to be optimally managed with minimum risk to health care staff.

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The Management of Diabetic Ketoacidosis

Clinical Reviews, Volume 6, Issue 1, Pages 1 - 48 (2007)

Abstract

This article reviews the management of diabetic ketoacidosis (DKA) in adults with a focus on the three basic principles of treatment: intravenous fluid therapy, intravenous insulin administration and potassium replacement. The recommendations are modelled on the national guidance for the management of DKA in children. We highlight the importance of being alert to signs of life-threatening complications of the condition such as cerebral oedema and adult respiratory distress syndrome (ARDS). We also discuss the use of near-patient testing of capillary beta-hydroxybutyrate (b-OHB) using a ketone meter as an aid to managing and preventing DKA.

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