Unique Hospital ICU

19/08/2019

New beginning.......

20/05/2019

15 year male student had a complain of vomitting, dyspnea and low grade fever for 1-2 days , had taken primary treatment but still having a persistent symptoms and admitted for the same complain and diagnosed as a diabetes mellitus with DKA.

Started with IV fluids and HAI infusion and potassium supplementation.

After few hours he had developed both lower limb weakness followed by quadriparesis with neck muscle weakness with normal oxygen saturation

Shifted to unique hospital with quadriparesis in ICU
ABG - HAGMA with RBS aroud 400 , acetone present on higher side and K was 1.6

Started with K supplementation via central access with 40 meq in first 2 hour and then 40 meq in next 4 hour and then 40 meq over next 6 hour and continued according to serum potassium level, evening k was 1.9, Magnesium was also supplemented.

Next day k was 2.2 , pt was moving both upper limb and neck

In a next 12 hour patient was having all four limb movement and mobilised with k of 3.6 and shifted out of the ICU.

Case of HYPOKALEMIC PARALYSIS presented because DKA, vomitting and polyurea and recovered within 24 hour.

The most common electrolyte abnormality in hospitalised patients
* 2% of total body K+ is found in the extracellular space
* K+ homeostatsis largely regulated by the kidney (90% of daily K+ loss)
* rest eliminated via GI tract
* normal K+ = 3.5-5.0mmol/L

SEVERITY
* MILD – 3.0-3.5
* MODERATE – 2.5-3.0
* SEVERE
-> upper GI – vomiting
-> mid GI – fistula
-> lower GI – diarrhoea
-> other – sweat, burns, bleeding, RRT

INVESTIGATIONS
* quantify severity and find cause
* K+
* Mg2+
* Ca2+, phosphate
* ECG: on seen in severe hypokalaemia, U waves, T wave flattening, ST depression -> VT/VF, long QT and Torsades
* digoxin level -> particularly at risk if become hypokalaemic

MANAGEMENT
* replace Mg2+ as facilitates a more rapid correction of hypokalaemia
* non-acute situation – 10-20mmol/hr
* life threatening arrhythmia:
* -> K+ 20mol over 10 min
* -> Mg2+ 10mmol over 10 min

27/04/2019

Post partum
Eclampsia young female

Develop AKI
and respiratory failure
Admitted in periphery and shifted to navasari . Shifted to surat for further management

On ventilator and hemodialysis started

2 d echo normal

The CT Chest was done s/o extensive alveolar consolidation

More than one month on ventilator and dialysis
Given two trial
Of steroid and broad spectrum antibiotics

Repeat ct scan and cxr at one month interval almost same and consolidation increased as compare to last CT

We did bronchoscopy
Sent PAS stain

Report : PAS positive material present
Alveolar macrophages with pas positive material seen

Compatible with
alveolar proteinosis

Pulmonary alveolar proteinosis (PAP) is a rare lung disorder of unknown etiology characterized by alveolar filling with floccular material that stains positive using the periodic acid-Schiff (PAS) method and is derived from surfactant phospholipids and protein components (see the image below). PAP was first described in 1958

The mainstay of PAP treatment for a very long time has been therapeutic whole-lung lavage (WLL). This procedure involves cleaning out one lung at a time with saline while the other lung is fed with oxygen. This procedure, performed under general anesthesia, usually takes from two to five hours.

20/04/2019

14 year child , Male , came with history of fall down in farm while playing , injured in right feet with danger stick through and through cut in lateral aspect of feet.

Patient went to primary care hospital after 7-8 days for complain of tightness of abdomen , inability of open the mouth , severe muscle ache and inability to lie down in supine position

Pt was admitted in periphery for same complain and then next day shifted to unique hospital

Came in Emmergency abdominal muscle spasm , trismus and opisthotonos,
Tachycardia 125/min, SpO2 with room air was 92%, BP 106/65, RS clear and he was irritable.

Pt was admitted in ICU in isolation, Suspecting tetanus clinically and confirmed clinically by Intensivist neurophysician and ID specialist,
Started with midazolam infusion , antibiotic like metrogyl and piptaz, IVF, magnesium sulfate infusion , beclofen and other supportive treatment with continues watch on airway.

Urgent surgical opinion taken with primary debridement of wound was done

Tetanus immune globulin was given 5000unit Intramuscularly

On 8 th day He was improved with abdominal muscle spasm and trismus , conscious and mobilised and shifted out of the ICU.

Duration of illness — Tetanus toxin-induced effects are long lasting because recovery requires the growth of new axonal nerve terminals. The usual duration of clinical tetanus is four to six weeks.

The diagnosis of tetanus is usually obvious and can generally be made based upon typical clinical findings outlined above. Tetanus should especially be suspected when there is a history of an antecedent tetanus-prone injury and a history of inadequate immunization for tetanus. However, tetanus can sometimes be confused with other processes

Case-fatality rates for non-neonatal tetanus in resource-limited countries range from 8 to 50 percent, whereas the majority of patients with tetanus recover when supportive care is available.

Case courtesy to dr Parthiv Desai

18/01/2019

Very unusual case of 2-4 dimethylamine poisoning as a suicidal attempt.

50 year female with alleged history of ingestion of 2-4 dimethylamnie solution at her home as a suicidal attempt , came in emmergency with laboured breathing, hypoxia, bradycardia, hypotension, ECG shows ST-T changes and drowsiness

Pt admitted in icu after resuscitation with adrenalin and ET intubation , her initial ventilator requirement on controlled mode was high with PEEP of 10 and 100% FiO2 , high ionotropic support with noradrenalin and vasopressin , CXR was S/O pulmonary Oedema or ARDS , 2dEcho was global LV hypokinesia with EF of 35-40% ? Myocarditis.ABG shows hypoxia and metabolic acidosis, blood reports are grossly normal , acetylecholinestease normal

she was completely knock down with sedatives and ventilated for 24 hour, forced alkaline dieresis was started and one session of dialysis was done and other supportive measures were given.

On 2 nd day in ICU her CXR shows improvement , hypoxia improved , passed good amount of ursine with negative balance , neurologically she was concious and oriented , decreased ventilators support and gradually put on CPAP, ionotropic support decreased

On 3 rd day in ICU she was extrubated and off O2 support , off ionotrops, CXR much better and pt was mobilised.

2-4 DIMETHYAMINE is a selective and systemic post-emergence herbicide used to control annual and perennial broad-leaved weeds in a range of crops.Not an organophosphate compound

which is available as water based solution causes vomiting, congestion, pulmonary emphysema, CNS congestion, perivascular hemorrhages, severe degeneration of ganglion cells, and death within hours of ingestion

No any specific antidote is available , only supportive treatment of complication

Very few literature is available showing the effective role of forced alkaline diuresis which increases its renal elimination and some role of hemodialysis.
This patient responded very well both the measures.

08/01/2019

22 year young female, unmarried, student , no any Comorbid condition presented with abdominal pain and constipation since 3-4 days with generalised weakness , nausea and abdominal discomfort, she had altered sensorium and irritability started since 2 days

Admitted with normal CBC with hyposmolar hyponatremia NA 112 , and normal serum creatinine and urine output, CSF and CT brain and CXR Was normal

She was Intubated on next day because of drowsiness and hypoventilation.
Her urinary porphobillinogen sent which came positive and she was diagnosed as AIP( acute intermittent porphyria )

Carbohydrate loading with 10% dextrose started with 300 gm of glucose orally , with maintaining proper hydration and sodium level Na 140 on day 4.
Avoiding precipitating drugs and other factors.

On day 4 with medical management she was neurologically concious and oriented , weaned off from ventilator and mobilised.
Treatment is inj HEMIN 3-4 mg/kg single daily dose for 4 days and liver transplantation in future.

Unique hospital ICU is highly thankful to dr anil patel sir for giving his special expertise to diagnose this case

02/01/2019

02/01/2019

ISurviveICU

45 years male came with fever, breathless and cough.

CXR was suggestive of bilateral lower lobe infiltration. Blood count was in favor of viral etiology.

he was too restless and needs NIV support to maintain saturation. Patient was intubated on next day due to worsening lung conditions.

patient was treated as per ARDS protocol. His H1N1 was negative.

He was ventilated for nine days and weaned on 10th day
as we all know now a days viral pneumonia with ARDs has not very good prognosis on ventilator. I thank my all ICU staff for managing this patient in a great manner and with responsibility.

Dr Khushbu Vaghasiya
Junior Intensivist
Unique Hospital