We report a patient with hyperosmolar non-ketotic hyperglycaemia who presented with chorea and septic arthritis on his knee. The chorea resolved completely and quickly with correction of the metabolic disturbance, only to return just as quickly when his metabolic disturbance subsequently deteriorated as a result of overwhelming septicaemia, suggesting coexisting cerebral ischaemia, although the basis of focal neurological sign in non-ketotic hyperglycaemia remains controversial.
Leptospirosis adalah salah satu penyakit yang endemik di Malaysia. Ia mempunyai pelbagai manifestasi klinikal bermula daripada yang ringan sehingga yang boleh membawa maut. Kami melaporkan sebuah kes tentang seorang lelaki berumur 56 tahun dengan pelbagai masalah kesihatan terdahulu, dengan sejarah tidak sihat kerana demam, batuk dan sakit perut selama dua hari. Pesakit datang ke Jabatan Kecemasan dalam keadaan tidak sedarkan diri dengan Pulseless Electrical Activity (PEA) cardiac arrest. Pesakit telah diresusitasi dan berjaya dipulihkan dengan mencapai peredaran darah spontan (return of spontaneous circulation) tidak berapa lama selepas itu. Keadaan pesakit dirumitkan lagi dengan keadaan Hyperosmolar Hyperglycemic State (HHS), oliguric acute kidney injury, dan non- ST elevation myocardial infarction (NSTEMI). Pesakit kemudian dimasukkan ke unit rawatan rapi dan dirawat dengan IV Ceftriaxone 2 g sekali sehari selama empat hari, dan kemudian ditukar kepada IV Ceftazidime 2 g dua kali sehari untuk seminggu disebabkan ventilator acquired pneumonia (VAP). Keadaan pesakit bertambah baik dan akhirnya di benarkan pulang ke rumah pada hari yang ke 18.
Matched MeSH terms: Hyperglycemic Hyperosmolar Nonketotic Coma
Percutaneous Endoscopic Gastrostomy (PEG) tubes were often offered to patients requiring long term enteral feeding. Even though the procedure is relatively safe, it is associated with various complications such as peritonitis or even death.1 We presented a case of a 54-year-old gentleman with underlying ischemic stroke and pus discharges from a recently inserted PEG tube. Computed Topography (CT) scan confirmed abdominal wall necrotising fasciitis complicated with hyperosmolar hyperglycaemia state (HHS) and later succumbed after 48 hours of admission. Our case illustrated the rare complication related to the insertion of PEG tube; abdominal wall necrotising fasciitis that was associated with mortality.
Matched MeSH terms: Hyperglycemic Hyperosmolar Nonketotic Coma