Methadone-Induced Polymorphic Ventricular Tachycardia Complicated by Takotsubo Cardiomyopathy in a Malnourished Patient

Takotsubo cardiomyopathy (TC) is a syndrome characterized by acute and transient regional systolic myocardial dysfunction. TC often mimics myocardial infarction without obstructive coronary disease. We present a case of a 48-year-old woman who developed TC following the onset of polymorphic ventricular tachycardia in the setting of methadone intoxication.

Left Lower Lung Collapse in a Patient Undergoing Endoscopic Procedure

ASA closed claims from 2000 to 2009 have shown that adverse respiratory events are more common in nonoperating room locations like endoscopy suite than in the operating room (44% v/s 20%). Here, we report a case of lung atelectasis which resulted in hypoxemia in a malnourished patient undergoing endoscopic procedure. It is crucial to identify the high-risk patients and monitor them appropriately in the postoperative phase. Continuous capnometry may offer additional benefit by identifying hypercapnia, hypoventilation at the earliest in the recovery area, thus preventing serious complications.

Refeeding syndrome : physiological background and practical management

Refeeding problems have been recognised since the the liberation of starved communities under siege. The main clinical problems may relate to hypophosphataemia, hypomagnesaemia and hypokalaemia with a risk of sudden death; thiamine deficiency with the risk of Wernike’s encephalopathy/Korsakoff psychosis and sodium/water retention. The problems are greatest with oral/enteral feeding and especially with carbohydrate due to it increasing plasma insulin and thus glucose entry into cells. It is difficult to predict patients at risk of refeeding problems so there must be a high clinical suspicion on refeeding any malnourished patient (including any who have had no or very little nutrition for over 5days). Generous vitamin and electrolyte supplementation may be given while monitoring closely and increasing the calorie intake reasonably rapidly from 10 to 20 kcal/kg/24 hours. Often patients in this category are not hungry, but over the course of a few days, the restoration of their appetite is an indication that the risks of refeeding have been managed and it is now safe to increase the feed aiming for repletion. If problems do occur, the feed should be slowed to the previous day’s amount, reduced further or rarely stopped while fluid and electrolyte issues are corrected.

Osteoporosis recovery in severe anorexia nervosa: a case report

Background Osteoporosis represents a common and severe complication in patients with anorexia nervosa (AN) that normally persists despite weight restoration and the resumption of regular menses. The condition may result in significant pain, injury, and disability. Case presentation We report the only published case of a complete return to normal bone density following many years of severe osteoporosis in a severely malnourished patient with AN. We describe a patient with severe and enduring AN whose osteoporosis, with resultant fractures, was completely reversed. Available patient records, imaging, and laboratory data were evaluated. Conclusions This case represents a common yet often improperly treated complication of AN. It demonstrates the potential important clinical role that targeted medicines coupled with a multifaceted supplementation and lifestyle interventions, may have for some very malnourished patients with AN. Medications, in the treatment of osteoporosis in patients with severe AN, may decrease fracture risk, enhance overall bone density, and contribute to an improved quality of life.

The influence of nutritional status on complications after major intra abdominal Surgery.

Background: Malnutrition is an impairment of health resulting from a deficiency or imbalance of nutrients, are associated with alteration in cellular physiology and organ function, which are of importance for the surgical patients. Protein energy malnutrition is a known clinical problem in hospital has an important role on post operative outcome so that necessary measures can be taken to improve nutritional status of these patients and improve post operative outcome. Objective: The objectives of this study are to assess the relation of nutritional status with post operative complications following major intra-abdominal surgery and to find out the complications in a malnourished patient. Method: This is prospective descriptive Study. The sample for the study constituted 100 randomly selected of major intra abdominal surgery age ≥12 yrs which was admitted the surgical word of SSMC& Mitford Hospital, Dhaka from May 2010 to October 2010 as a case of elective abdominal surgery.Result: Higher Prevelence of malnourished was found among elective surgical patient that about 48-57%. Regearding pattern of post operative complication among malnourished patent pulmonary complication 15.3% (Average 11%) Wound infection 17% (Average 12%) Brust abdomen 2.8% (Average 4.1%) Excess duration of Hospital Stay in melnutrited group than the Nutritionally Sound gorup was about 11 days.Conclusion: There is significant number of surgical patient suffering from diferent type of Nutritional imbalance. Due attention should be given to improve nutritional status of a patient before any major intrabdominal surgery.TAJ 2014; 27(2): 6-10