1/9. pancytopenia, hyperglycemia, shock, coma, rhabdomyolysis, and pancreatitis associated with acetaminophen poisoning.It is well recognized that acetaminophen overdose can cause severe hepatic injury. However, extra-hepatic manifestations may also develop following inappropriate use or ingestion of large amounts of acetaminophen. We present a 44-y-o female who manifested coma, metabolic acidosis, shock, hypothermia, hyperglycemia, rhabdomyolysis, hepatotoxicity, and renal insufficiency after suicidal ingestion of an unknown amount of acetaminophen. Although her consciousness and hemodynamic status gradually improved after treatment with N-acetylcysteine and other supportive measures, she was found to have pancytopenia, pancreatitis and hepatorenal failure during the hospitalization and eventually died 18 d post-admission. review of relevant literature reports and the clinical findings in our patient suggests that direct toxic effects mediated by acetaminophen or its metabolites were most likely responsible for most of the observed clinical features.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
2/9. death from hypovolemic shock caused by perforation of duodenal ulcer in a patient with angiosarcoma of the scalp.We report a case of an 86-year-old woman with angiosarcoma on the scalp, who died from hypovolemic shock caused by perforation of a duodenal ulcer. A purple-red macule was first noticed on her left temporal scalp, and over a 1-month period this macule rapidly grew to a 6 cm purple-red indurated plaque with hematomas. The diagnosis of angiosarcoma was made based on the clinical features and histopathological finding of the lesional skin. Perilesional injections of recombinant interleukin 2 (rIL-2) were followed by surgical resection of the lesion and graft repair. However, 5 months later, new hematomas appeared and increased in number and size to cover her cheek, left temporal scalp and around the grafted area. Electron-beam radiotherapy showed only a temporary effect and the skin lesions with spontaneous severe bleeding extended rapidly again toward a wide region of the left half of the scalp and cheek. The patient died of hypovolemic shock after acute abdominal pain with intestinal hemorrhage. The surgical pathology revealed the presence of a perforated duodenal ulcer which might have been the direct cause of hypovolemic shock.- - - - - - - - - - ranking = 1.2keywords = coma (Clic here for more details about this article) |
3/9. Pyrimidifen intoxication.We present a case of lethal ingestion of pyrimidifen, a new insecticide with an unclear mode of action. The primary manifestations were coma and circulatory shock, leading to irreversible multiorgan failure. Pyrimidifen was detected in the patient's blood, urine, brain tissue, and gastric content samples. Minimal structural homology exists between pyrimidifen and organochlorines. Currently, no antidote is available, and therapy is primarily supportive.- - - - - - - - - - ranking = 0.2keywords = coma (Clic here for more details about this article) |
4/9. Recognition of hypotensive shock on abdominal computed tomography.A comatose patient on a ventilator suffered circulatory collapse while undergoing abdominal computed tomography. The computed tomography findings are presented, and the means for prompt recognition of this catastrophe are discussed.- - - - - - - - - - ranking = 0.2keywords = coma (Clic here for more details about this article) |
5/9. Systemic hypotension and glaucomatous changes.We undertook a prospective study to determine the frequency of development of glaucomatous disk or field changes in a series of patients who had survived at least one episode of shock with poor peripheral tissue perfusion. In 18 patients with 26 distinct episodes of shock we were unable to demonstrate any glaucomatous disk or field changes.- - - - - - - - - - ranking = 1.2keywords = coma (Clic here for more details about this article) |
6/9. shock, metabolic acidosis, and coma following ibuprofen overdose in a child.OBJECTIVE: To report a child who developed shock, loss of consciousness, and metabolic acidosis following an ibuprofen overdose. CASE SUMMARY: A 6-year-old boy with no prior medical problems ingested approximately thirty 200-mg tablets of ibuprofen. The patient developed shock, coma, and metabolic acidosis. He was treated successfully with intubation and mechanical ventilation, fluid resuscitation, and decontamination with activated charcoal. The patient was discharged without any clinical sequelae. DISCUSSION: Serious adverse complications following ibuprofen overdose have been reported rarely in children. We reviewed literature pertaining to the etiology, pharmacology, pathophysiology, and management of complications following ibuprofen overdoses, as well as other case reports. CONCLUSIONS: coma, metabolic acidosis, and shock were noted in a child who ingested a large quantity of ibuprofen. These complications have been described rarely in children. We attribute his favorable clinical outcome to early and aggressive intervention consisting of tracheal intubation, fluid resuscitation, and decontamination with activated charcoal. Although ibuprofen overdoses are usually benign, healthcare professionals should be aware of the various potentially serious complications that may occur.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
7/9. Two cases of lethal complications following ultrasound-guided percutaneous fine-needle biopsy of the liver.Two cases with lethal complications are reported among 1750 ultrasound (US)-guided percutaneous fine-needle liver biopsies performed in our department. The first patient had angiosarcoma of the liver which was not suspected after computed tomography (CT) and US studies had been performed. The other patient had hepatocellular carcinoma in advanced hepatic cirrhosis. death was due to bleeding in both cases. Pre-procedure laboratory tests did not reveal the existence of major bleeding disorders in either case. Normal liver tissue was interposed in the needle track between the liver capsule and the lesions which were targeted.- - - - - - - - - - ranking = 0.2keywords = coma (Clic here for more details about this article) |
8/9. The CVC removal distress syndrome: an unappreciated complication of central venous catheter removal.The removal of a central venous catheter (CVC) can be complicated by rare but potentially life-threatening neurocardiopulmonary distress. The clinical courses of eight patients who had CVC removal complications are reviewed. Seven patients had catheter removal from the right internal jugular vein, and one from the right subclavian vein. The complications occurred after complete removal of the catheter (four patients), after guidewire replacement for catheter change (three patients), and after detachment of the hemostasis side port of the Swan introducer during sheath removal (one patient). Each of them had more than one complication. The major complications were: neurologic paresis or coma (four patients), respiratory failure (four patients), and shock (two patients). One patient died of pulmonary sepsis. The overall mortality rate was 12.5 per cent. Guidelines for safe removal of central venous catheters are proposed. Possible mechanisms of the complications are discussed. We refer to the observed complications as the CVC removal distress syndrome.- - - - - - - - - - ranking = 0.2keywords = coma (Clic here for more details about this article) |
9/9. Hypoglycaemic shock: normal or abnormal response to injury?We report a case of hypoglycaemic shock which occurred in a patient 18 h after injury. The patient was involved in a road traffic accident and sustained multiple rib fractures and bruising in the (R) lumbar region. Eleven hours after his last meal he developed sudden weakness, profuse sweating, air hunger, thirst, disorientation and suddenly lapsed into coma 18 h after admission. Administration of 50 ml of 50% dextrose resulted in immediate restoration of consciousness. This case shows that this complication can occur in trauma patients even though the metabolic response to trauma is usually assumed to be hyperglycaemic.- - - - - - - - - - ranking = 0.2keywords = coma (Clic here for more details about this article) |