Syndrome of inappropriate antidiuretic hormone secretion in hospital inpatients: a descriptive study in a tertiary care centre in South India

Background: Hyponatremia is the most common electrolyte abnormality among the patients in medical wards as well as in the intensive care unit contributing to substantial morbidity and mortality. The most common cause of hyponatraemia in hospital inpatients is Syndrome of Inappropriate Anti Diuretic Hormone secretion (SIADH). This prospective observational study was designed to assess the clinical profile of SIADH. Aim: To assess the clinical profile of SIADH in medically ill patients. Methods: This was an observational study for 24 months conducted in a tertiary care hospital. Patients were assessed clinically to study the volume status, effects of hyponatremia on nervous system and find out various etiologies for SIADH. All patients underwent routine hemogram, blood biochemistry, serum electrolytes, thyroid function tests, morning serum cortisol estimation, plasma and urinary osmolality determination as well as urinary sodium estimation. Patients were diagnosed to have Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH) if they satisfied the Bartter and Schwartz criteria.  Results: Among the eighty patients with euvolemic, hypoosmolal hyponatremia who were screened for SIADH, seven patients were excluded due to various reasons (hypothyroidism, Sheehan’s syndrome, Addison’s disease). The mean age of the patients was 64 ± 13 years. Among 73 patients included there were 33 (45.2%) male patients and 40 (54.8%) female patients. Severe hyponatremia (Na <110 meq/l) was detected in 33 patients (45%). Pulmonary causes were the most common cause of SIADH in this study seen in 25 (34.2%). The other causes were idiopathic in 20 (27.4%), neurological in 17 (23.3%), drug induced in 2 (2.7%), positive pressure ventilation in 5 (6.8%) and other infections in 4 (5.5%).The average rate of correction was 5 meq ± 1.5 in the first 24 hours. The overall mortality was found to be 7%.Conclusion: Hyponatremia due to SIADH is common among elderly patients with preponderance for female population. Majority of the patients in the present study were noticed to have an underlying respiratory cause as the etiology. Mortality in SIADH patients was related to the underlying cause rather than the severity of hyponatremia.

Urinary tract infection in type 2 diabetic patients: risk factors and antimicrobial pattern

Background: Diabetes increases the risk of infection and the commonest amongst them are the ones involving the genitourinary tract. Diabetic patients are found to have an increase in the risk of developing urinary tract infection (UTI) by 60%. The study aimed to determine the causative pathogens and their antimicrobial pattern, identify risk factors associated in type 2 diabetic subjects having UTI. Methods: This was an observational study conducted in the medicine unit of a tertiary care hospital over a period of 8 months. A total of 619 (M:F 289:330) type 2 diabetic subjects were studied. History, clinical examinations, and the duration of diabetes were recorded in all patients at admission. Diabetes was diagnosed based on the WHO criteria. An immunoturbidimetric method was used to estimate glycosylated hemoglobin (HbA1C%). Diagnosis of UTI was made from midstream urine samples of patients if the urine cultures has >103 to >105 colony forming units (CFUs)/mL of a pathogen.Results: Among the 619 diabetic patients 220 patients had pus cells in urine but 72 patients had insignificant colony count. 90 (60.8%) patients were more than 60 years old, 48 (32.4%) were in the age group of 40-60 years and 10 (6.7%) were less than 40 years old. Among the 148 patients studied 52 (35.1%) were males and 96 (64.9%) were females. 116 (78.4%) had diabetes for more than 15 years and the rest had a duration lesser than 15 years. The HbA1C of patients with and without UTI were 10.2 ± 1.6 and 8.4 ± 1.3 respectively. Gram negative bacilli were isolated from 129 (87.2%) patients which included E. coli in 75 (50.7%), Klebsiella in 30 (20.3%), Pseudomonas species in 12 (8.1%) and Citrobacter in 12 (8.1%). Gram positive cocci were responsible for UTI in 15(10.1%) of subjects including Enterococcus in 13 (8.9%) and Staphylococcus in 2 (1.3%). Gram negative bacilli including E. coli, the Klebsiella species, pseudomonas and Citrobacter had good response to piperacillin-tazobactum, cefoperazone sulbactum, imipenam and amikacin. Gram positive cocci (Enterococcus and Staphylococcus) responsible for UTI showed good susceptibility to vancomycin (81 and 94% respectively) but a high resistance to ciprofloxacin and tetracyclines (68 and 57% respectively).Conclusions: Female gender, age and duration of diabetes were found to have increased risk factors for developing UTI in diabetes. Escherichia coli was the commonest organism causing UTI in diabetes which showed good response to piperacillin/tazobactum, cefoperazone-sulbactum, imipenam and amikacin.

Varicella-zoster virus transverse myelitis in an immunocompetent patient

Transverse myelitis is one of the rare neurological complications of Varicella-Zoster Virus (VZV) infection in immuno-competent. We report a 26-year-old immuno-competent gentleman who developed virologically confirmed myelopathy caused by VZV which improved with steroids and acyclovir leaving no residual neurological deficits

Melioidosis with endocarditis and massive cerebral infarct

Endocarditis due to melioidosis is rare. A 60-year-old male was admitted with upper abdominal pain and vomiting for one month. Contrast enhancing computed tomography (CT) of the abdomen showed multiple hepatic, splenic and pancreatic nonenhancing cystic lesions. Culture of CT guided aspirate from the liver lesion showed growth of Burkholderia pseudomallei. He was started on ceftazidime and cotrimoxazole. Four days after admission patient developed decreased speech and response. Magnetic resonance imaging (MRI) and MR angioram brain showed massive infarct in the middle cerebral artery territory and occlusion of the middle cerebral artery. Echocardiogram showed vegetation in the aortic valve. He was diagnosed to have disseminated melioidosis with endocarditis resulting in massive infarct in the middle cerebral artery territory

A rare presentation of spontaneous ventricular tachycardia in young adult

Arrhythmogenic right ventricular dysplasia (ARVD) is a common cause of sudden cardiac death in young adults. It is a disease that has a wide spectrum of presentation. Early identification of the disorder is of paramount importance considering the fatal complications. Here, with this case, a rare sporadic presentation of ARVD, we try to discuss the various presentations, methods of diagnosis and options for treatment for this frequently masquerading and occasionally fatal disorder of cardiac myocytes

Esophageal stricture in lichen planus

Lichen planus (LP) is a rare cause of esophageal stricture. It is usually associated with oral mucosal involvement, and the diagnosis has to be considered in these patients who present with dysphagia. We present a case of esophageal stricture secondary to LP

Dengue fever presenting as epididymo-orchitis

Dengue is an arthropod-borne viral infection of humans with potential fatal complications. Dengue virus infection can clinically manifest as dengue fever, dengue shock syndrome, and dengue hemorrhagic fever. Usual symptoms during the early febrile stage include fever, malaise, headache, body pains and rash. Atypical manifestations of dengue can be diverse and multisystemic. We describe a case of dengue presenting with epididymo-orchitis which to our knowledge is the first such report