Caffeine poisoning successfully treated by venoarterial extracorporeal membrane oxygenation and emergency hemodialysis.

BACKGROUND: Caffeine overdose can cause life-threatening circulatory failure, neurological abnormalities, and ventricular fibrillation. We report the case of a patient with caffeine poisoning who was successfully treated with early hemodialysis and venoarterial extracorporeal membrane oxygenation. CASE PRESENTATION: A 43-year-old man who had ingested pills containing 20 g caffeine was transported to the hospital 100 min after ingestion. Hemodynamic collapse and refractory arrhythmia were most likely the potential complications. The patient developed ventricular fibrillation when placed in the left lateral decubitus position. Return of spontaneous circulation with defibrillation and introduction of venoarterial extracorporeal membrane oxygenation were followed by emergency dialysis, which led to rapid improvement in the clinical findings. CONCLUSION: Acute caffeine poisoning in a patient who developed an arrhythmia was successfully treated using an indwelling arterial and venous sheath followed by venoarterial extracorporeal membrane oxygenation.

Splenic mass of uncertain etiology in a 15-year-old male patient: a case report.

BACKGROUND: There are few reports on spleen masses, and solitary splenic abscesses with abdominal pain have not been reported in younger age groups. We report a case of a splenic mass of uncertain etiology in a 15-year-old boy. CASE PRESENTATION: A 15-year-old boy visited the emergency department with abdominal pain. Abdominal ultrasonography revealed a thin-walled multilobular splenic cyst. Computed tomography revealed a cystic shadow and a septate structure in the spleen. Magnetic resonance imaging examination revealed a high-signal region on the T2-weighted image. The neutrophil ratio in the white blood cell count of 8,330/µL was high (80%), and splenic abscess could not be ruled out. Thus, therapy with 2 g/day fosfomycin was initiated. Abdominal pain disappeared on day 3 of hospital stay, and the patient was discharged on day 8. CONCLUSION: Antibiotic therapy can be effective against very acute onset splenic abscesses, although surgical treatment is usually carried out.

Membranous tracheal stenosis in a patient with anorexia nervosa and self-induced vomiting- challenges in securing the airway.

We report a rare case of acquired membranous tracheal stenosis in a patient with anorexia nervosa and a history of self-induced vomiting, but without a history of tracheal intubation or tracheostomy. A 50-year-old woman presented with difficulty in breathing and swallowing, self-expectoration, and impaired consciousness due to acute benzodiazepine intoxication. Bronchoscopic examination was performed after tracheotomy and placement of a tracheostomy tube failed to secure her respiratory tract and ventilation continued to deteriorate. A flap-like membranous structure was identified on the posterior tracheal wall, obstructing the tracheostomy tube. Physical compression of the membranous structure improved ventilation. Bronchoscopic examination is generally recommended prior to performing tracheostomy in patients suspected to have post-intubation tracheal obstruction. Based on our findings, we suggest that these examinations should also be performed in patients with conditions associated with chronic irritation of the respiratory tract, including those with a prolonged history of self-induced vomiting.