Melatonin-induced symptomatic bradycardia in an otherwise healthy male: a case report.

Melatonin, a pineal gland hormone closely associated with the circadian rhythm, has been trending over the past years as an over-the-counter medication to aid with sleep disturbances. Although generally believed to be safe, recent studies show negative inotropic and chronotropic effects on the heart rate and blood pressure in humans. Several studies suggested that melatonin induces cardiac vagal tone and affects heart rate and mean arterial pressure. Limited literature is currently available on the effects of melatonin beyond its sleep function. We present a case of a healthy 22-year-old male who visited the emergency department reporting palpitations and dizziness following the ingestion of 20 mg of melatonin. Subsequent examinations revealed marked bradycardia. Fortunately, the patient experienced spontaneous resolution of the bradycardia without necessitating intervention after a few hours of observation, and he was observed and discharged.

Acute massive posterior stroke with tonsillar herniation in a scuba diver.

A transient female passenger in her 40s presented to the emergency department (ED) exhibiting drowsiness post-scuba diving. Despite normal initial vitals, she reported dizziness, sleepiness, and occipital headache. A computed tomography (CT) scan showed a severe posterior circulation acute infarction affecting various brain regions, resulting in significant mass effects and complications like 4th ventricle compression, cerebellar tonsillar herniation, and hydrocephalus. Extensive diagnostic tests, blood workup, and stroke evaluations revealed normal findings, except for an incidental patent foramen ovale (PFO). Collaboration with neurosurgery led to her transfer for life-saving extraventricular drain (EVD) insertion and posterior fossa decompression. Treatment included right-side EVD insertion, suboccipital craniectomy, and foramen magnum decompression. Postoperatively, she was extubated the next day, alert, without focal neurological deficits. Upon EVD removal, a repeat CT head scan showed regression of mass effect. She was discharged home safely after 16 days, fully ambulating.

Euglycemic diabetic ketoacidosis in a pregnant woman.

Background: Euglycemic diabetic ketoacidosis (EDKA) carries serious risks for mortality and morbidity for both the mother and the baby, and it is essential to recognize it early and start immediate treatment. Case Presentation: We present a case of EDKA in a 28-week pregnant woman known to have type 1 diabetes. She was found to have severe acidosis with a blood sugar level of 10.6 mmol/L (190.8 mg/dL) and normal anion gap. She was found to have EDKA, which was confirmed later with a depressed venous pH and bicarbonate level and an increased serum ketone level. The patient's acidosis was not improving significantly with 0.05 units/kg/h of insulin infusion, so a full dose of 0.1 unit/kg/h of insulin infusion was started following a full diabetic ketoacidosis (DKA) protocol regardless of her blood sugar level. The patient showed gradual improvement and was discharged home after 4 days, with follow-up with endocrinology and obstetrics. Conclusion: In conclusion, EDKA is a critical complication of diabetes, especially in pregnant women. Therefore, it is crucial to treat it early and potentially consider following a full DKA protocol using 0.1 unit/kg/h insulin infusion instead of 0.05 unit/kg/h.