A Probable Association of Aseptic Meningoencephalitis, Complicated With Cerebral Salt Wasting Syndrome Following COVID-19 Vaccination: A Case Report.

Coronavirus disease-19 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) occurred worldwide, and it affected millions of people around the world and killed millions of lives without a definitive treatment. During this challenging time, vaccine production has been hugely carried out leading to the invention of many vaccines against COVID-19. As any vaccine can have some side effects, COVID-19 vaccines also need surveillance and reporting side effects worldwide. Currently, more than 10 vaccines are available against SARS-CoV-2 infection globally. There are many neurological complications reported by SARS-CoV-2 vaccines. There are some reported neurological complications, such as ischemic stroke, Guillain-Barré syndrome, transverse myelitis, Bell's palsy, cerebral venous sinus thrombosis, optic neuritis, meningoencephalitis, small fiber neuropathy, and Tolosa-Hunt syndrome. We present a case of an elderly man who presented with fever, fits, hyponatremia, and polyuria following COVID-19 vaccination and was found to have cerebral salt wasting (CSW) with the exclusion of other causes.

Starvation Ketoacidosis in a Young Healthy Female After Prolonged Religious Fasting.

Ketone bodies are important energy sources for the body and are produced by the liver when the body is in a deficiency state of glucose, which is used in the peripheral tissues to provide energy. There are several ketone bodies that are produced by the liver, of which two are important: acetoacetate and beta-hydroxybutyrate. Even though ketone bodies are always present in the body, they are minimal when a person is not fasting. Ketone bodies are produced by the oxidation of fatty acids to fulfill the metabolic needs of tissues, especially the brain. The biochemical reactions of forming ketone bodies are triggered by a lack of insulin and an elevated glucagon level in the blood. Both cause unopposed lipolysis and free fatty acid oxidation resulting in the production of ketone bodies and eventually high anion gap metabolic acidosis. We present a case of young healthy female who presented with euglycemic ketoacidosis after involving prolonged fasting for her religious ceremony. She also physically exerted quite more during her fasting. With a detailed history and excluding other possibilities, we made the diagnosis of starvation ketoacidosis. She improved well with the treatment and established her pre-morbid condition in our review.