1/10. Monitoring of cerebral oxygen saturation with a jugular bulb catheter after near-drowning and respiratory failure.We report on monitoring oxygen saturation with a jugular bulb fiber-optical catheter in an 18-month-old girl after fresh water near-drowning followed by acute respiratory failure. The first measured cerebral oxygen saturation was 22% despite normal values for arterial and central venous oxygen saturation. After conventional therapy had failed to improve cerebral oxygen saturation, we started veno-venous extracorporeal membrane oxygenation. Normal levels of cerebral oxygen saturation were achieved after six hours. The girl was extubated after seven days and discharged after twenty-five days in good general condition and without obvious evidence of neurological damage. We believe that in this case of near-drowning, monitoring cerebral oxygen saturation with a jugular bulb catheter was important for surveillance of cerebral hypoxia.- - - - - - - - - - ranking = 1keywords = water (Clic here for more details about this article) |
2/10. amyotrophic lateral sclerosis associated with the syndrome of inappropriate secretion of antidiuretic hormone.A 71-year-old female with amyotrophic lateral sclerosis (ALS) developed the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) during respiratory failure due to atrophy of the respiratory muscles. serum sodium concentration fell to 116 mEq/l and then returned to the normal range after water restriction and respiratory care. This is considered to be the first case report of ALS associated with SIADH.- - - - - - - - - - ranking = 1keywords = water (Clic here for more details about this article) |
3/10. A non-fatal case of sodium toxicity.A non-fatal case of sodium toxicity in a six-year-old boy is presented. hypernatremia is the clinical term for an excessive concentration of sodium relative to water in the body. The diagnosis of hypernatremia was made at serum sodium (Na( )) concentrations exceeding 150 mEq/L, and few people have been reported to survive concentrations greater than 160 mEq/L. This case involves a six-year-old boy who was taken to the hospital following a seizure attack, and lab analyses revealed serum sodium (Na( )) levels of 234 mEq/L and serum chloride (Cl(-)) levels of 205 mEq/L. Clinical tests ruled out diabetes insipidus, dehydration, renal pathology, and other primary causes of hypernatremia. The child's purported history of pica, and the lab results indicating corresponding increases in levels of serum sodium (Na( )) and serum (Cl(-)), led to a diagnosis of acute sodium toxicity by ingestion of sodium chloride. A search of the boy's house led to the discovery of rock salt in the cabinet and a container of table salt. Extrapolating from the serum sodium (Na( )) level, it was estimated that the child had ingested approximately four tablespoons of rock salt, leading to the acute toxicity. A literature search revealed that the serum sodium (Na( )) concentration in the present report was the highest documented level of sodium in a living person.- - - - - - - - - - ranking = 1keywords = water (Clic here for more details about this article) |
4/10. Lethal inhalation exposure during maintenance operation of a hydrogen fluoride liquefying tank.calcium sulfate adheres to the inside of liquefying pipes during the production of liquefied hydrogen fluoride. It is regularly washed away with water jets every six months. Two days before the operation, the pipes were experimentally washed down with water and the safety of the operation was confirmed with acidic washing fluid (pH 5). A 65-year-old man was severely sprayed on his face just after the start of the operation. He died half an hour later from acute respiratory failure. High serum concentrations of ionized fluoride indicated massive exposure to hydrofluoric acid (HFA). Pathological findings revealed severe bilateral pulmonary congestion and edema. It was hypothesized that calcium sulfate hardened with the water during the experimental washing and caused some blockages in the pipes. Consequently, choking of the pipes caused the HFA to collect and the washing fluid ran back. Weak HFA is not pungent to skin and mucous membranes. Therefore, it was suggested that a low concentration of HFA was inhaled directly into the peripheral respiratory tracts. No risk management against HFA exposure was in place during the operation. It is especially important to take thorough safety measures against inhalation of HFA. It is also essential that there are no stoppages of the pipes before the operation.- - - - - - - - - - ranking = 3keywords = water (Clic here for more details about this article) |
5/10. A case of myxoedema coma successfully treated by low dose oral triiodothyronine.Myxoedema coma is fortunately rare and is probably rarer in a warm climate such as australia. It carries a high mortality rate. Its correct management is still a controversial issue. A case of severe myxoedema coma who was successfully treated is described. Thyroid hormone was replaced in the form of triiodothyronine given orally in doses of 20-40 microng/day. There was an improvement in body temperature within six hours of the first dose; this was accompanied by a brisk fall in serum CPK and cholesterol with a rapid rise of plasma T3 into the euthyroid range. There was a defect in water excretion which was rapidly reversed as renal function returned to normal. review of the literature suggests that low dose oral therapy with T3 is a satisfactory form of initial management.- - - - - - - - - - ranking = 1keywords = water (Clic here for more details about this article) |
6/10. Hydrocarbon contact injuries.Cutaneous injury caused by exposure to gasoline and other hydrocarbons is a clinical entity with potentially life-threatening effects. We report four cases of such injury. One patient developed full-thickness skin loss following gasoline immersion, and another developed severe systemic complications following contact with a carburetor cleaning solvent. Initial therapy should consist of removal of solvent-containing clothing and extensive lavage or soaking with water, followed by wound care that is generally similar to that used in the treatment of partial-thickness burns. In most cases this includes debridement, topical antimicrobial agents, and dressing changes. Severe pulmonary, cardiovascular, neurologic, renal, and hepatic complications may accompany hydrocarbon absorption, particularly in cases involving gasolines containing lead additives. Therefore immediate surgical debridement should be considered if there is suspicion of continued absorption of toxic compounds from the wound.- - - - - - - - - - ranking = 1keywords = water (Clic here for more details about this article) |
7/10. survival after free falls of 59 metres into water from the Sydney Harbour Bridge, 1930-1982.Between 1930 and 1982, 92 persons fell from the Sydney Harbour Bridge into the water, 59 metres below. The major problem among survivors was pulmonary trauma, often with severe respiratory failure. The position of impact influenced survival, the feet-first vertical position being the most favourable. mortality rate from the fall was 85%. Rapid clinical assessment of victims, especially with reference to pulmonary injury, and prompt institution of ventilatory support, where required, may reverse respiratory failure. Intra-abdominal injuries, spinal column or central nervous system involvement and peripheral fractures should all be suspected.- - - - - - - - - - ranking = 5keywords = water (Clic here for more details about this article) |
8/10. Accidental administration of Syntometrine in adult dosage to the newborn.The clinical course is described of an infant who accidentally received an adult dose of Syntometrine (synthetic oxytocin ergometrine) at delivery. The infant soon became ill with convulsions and ventilatory failure, and later with water intoxication. Similar reported cases are reviewed and recommendations are given for the management of future cases.- - - - - - - - - - ranking = 1keywords = water (Clic here for more details about this article) |
9/10. Noncardiogenic pulmonary edema associated with accidental hypothermia.The pulmonary system may be significantly affected by hypothermia. The association between NCPE and hypothermia is controversial. A 59-year-old man with mild hypothermia presented with NCPE after passive external rewarming following accidental immersion in water. The patient's course was uneventful after 48 h, allowing immediate withdrawal of assisted ventilation and supplemental oxygen.- - - - - - - - - - ranking = 1keywords = water (Clic here for more details about this article) |
10/10. Pulmonary function in patients with multiple trauma and associated severe head injury.1) Sodium and water balance and pulmonary function studies were obtained in five patients with multiple injuries, including pulmonary contusion, plus severe intracranial trauma. All patients received dexamethasone, 4-6 every 6 hours during the 72-hour study period after injury. 2) Results were compared with those from 14 previously reported patients without head injury; none had received corticosteroids. 3) Study patients with head injury achieved negative water balance and almost-zero sodium balance within 72 hours of injury be excreting a high-volume, low-sodium urine. Despite elevated alveolar-arterial oxygen gradients and low-normal pulmonary compliance initially, there was progressive improvement and no patient developed post-traumatic pulmonary insufficiency. 4) The data suggest that the "negative" effects of major intracranial trauma on the kidney, heart, and lung are cancelled by dexamethasone, or that corticosteroids protect pulmonary function in the patient with multiple injuries and prevent post-traumatic pulmonary insufficiency, perhaps through their effect on the kidney leading to rapid restoration of sodium and water balance.- - - - - - - - - - ranking = 3keywords = water (Clic here for more details about this article) |
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