Isopropyl Alcohol Intoxication Treated With Hemodialysis: A Case Report and Short Review.

Isopropyl alcohol (IPA) is a common constituent of rubbing alcohol, household cleaning agents, and antiseptic agents. Ingestion of IPA usually leads to self-resolving mild symptoms in most cases but can result in severe symptoms, including central nervous system depression or hemodynamic instability. Treatment is mainly supportive, and hemodialysis is generally reserved for severe intoxication. Limited data are available on the use of hemodialysis to treat IPA intoxication. We are presenting a case of accidental ingestion of IPA in an elderly female with dementia leading to severe intoxication requiring hemodialysis at relatively non-toxic serum levels of IPA. The patient had a prompt recovery without any post-procedural or hospital-acquired complications.

Association of proton pump inhibitor use and significant hyponatremia-a US population-based case-control study.

Hyponatremia is the most common electrolyte abnormality encountered in clinical practice. Several medications are associated with hyponatremia. Proton pump inhibitors were reported to cause hyponatremia in one large Swedish population-based study and small observational studies or case reports. This article presents the results of a single-center retrospective case-control study based on a US patient population that examined the association between the use of proton pump inhibitors and significant hyponatremia. Cases were 792 hospitalized patients with hyponatremia, extracted from 473,000 patient encounters over 6 years, and matched controls were 774 hospitalized patients with normal serum sodium levels whose risk factors for hyponatremia were comparable to those of the study cases. The results showed that use of proton pump inhibitors for at least 30 days prior to hospital admission was significantly higher in patients with hyponatremia than in patients who had normal serum sodium levels (32.7% vs 23.3%, respectively, odds ratio 1.6, P < 0.001). Also, proton pump inhibitor use was nonsignificantly higher among patients with recurrent hyponatremia in subsequent hospitalizations compared with patients who did not have recurrence of hyponatremia (35.5% vs 30.4%, respectively, odds ratio 1.3, P = 0.13). To our knowledge, no prior US population-based study addressing such an association has been published.

Thinking Beyond Acute Kidney Injury.

Acute kidney injury (AKI) can be a significant clue to solving a puzzling patient presentation. Postrenal AKI should be suspected if imaging shows any degree of hydronephrosis and can be caused by a variety of conditions. Diagnosis of urinary obstruction without significant dilatation of the pelvic-ureteral system requires a higher degree of suspicion, and hence, its identification can become late. In patients without prior cancer screening, the etiology of obstructive uropathy must be broadened to include primary or metastatic malignancy. Clinicians should look beyond the AKI to properly evaluate the etiology of the patient's presentation and symptoms. In this report, we present the case of a middle-aged female with no known past medical history who presented with AKI secondary to malignant retroperitoneal fibrosis as the first manifestation of metastatic breast cancer. Her AKI was associated with acute onset anuria and was found to have nondilated postrenal AKI with no significant abnormalities on renal imaging. Early onset anuria in the setting of AKI, which persists despite fluid resuscitation, can suggest complete urinary tract obstruction even with reassuring results of initial renal images, and in the patient with no history of cancer screening, malignancy should be suspected as a primary cause of obstructive uropathy.

Penile calciphylaxis.

For small lesions, conservative management including local wound care, debridement, and adjustment of renal replacement therapy may suffice. Consulting palliative care is encouraged to help establish goals of care among patient, family, and medical team.

Acute aortic insufficiency due to rupture of an aortic valve commissure.

Myxomatous degeneration generally involves the atrioventricular valves (mitral and tricuspid). Rarely, it may affect the aortic or pulmonary valve. We report a case of an acute severe aortic insufficiency due to a rupture of a commissure of the aortic valve in a patient who had previously undergone mitral valve surgery for myxomatous mitral valve prolapse.