ABSTRACT
We present a unique case of a 42-year-old gentleman with alcohol use disorder who developed osmotic demyelination syndrome (ODS) despite appropriate hyponatremia correction. This patient initially presented with severe hyponatremia (Na 97 mEq/L) due to beer potomania, which was corrected gradually over eight days, resulting in no observed neurological deficits upon discharge. However, he was readmitted with respiratory failure from aspiration pneumonia, leading to endotracheal intubation. Laboratory findings revealed a sodium level of 134 mEq/L and serum osmolality (293 mOsm/kg). The patient had neurological exam findings of spontaneous eye opening with left gaze preference and decreased power â in all extremities. Following extubation, he experienced a relapse with evolving subacute central pontine myelinolysis and bulbar weakness necessitating reintubation. Subsequently, five sessions of plasmapheresis were conducted, resulting in stable clinical findings. Despite remaining non-verbal, the patient demonstrated gradual neurological motor improvement, progressing from 1/5 power in all extremities to 4/5 on the right side and 3/5 on the left side. He was discharged with ventilator support, tracheostomy, and PEG tube placement to a long-term care facility. This case underscores the importance of vigilant monitoring in high-risk individuals following hyponatremia treatment because ODS presentation can be delayed.
ABSTRACT
Heterotopic pregnancy is the simultaneous existence of intrauterine and extrauterine gestation. It is usually seen in women at risk for ectopic pregnancy or those undergoing fertility treatments. The incidence has dramatically risen to 1 in 3900 of pregnancies via assisted reproductive techniques or ovulation induction, compared to 1 in 30000 of spontaneous conception. Besides this, history of pelvic inflammatory disease (PID), tubal damage, pelvic surgery and prior tubal surgery can increase its risk. Here we present a case of heterotopic pregnancy which was diagnosedafter ectopic gestation ruptured along with compromised intrauterine gestation and maternal condition. Earlier diagnosis before this life-threatening event could have saved the intrauterine fetus. Keywords: Extrauterine pregnancy; heterotopic pregnancy; ruptured ectopic.