BMJ case reports
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We discuss a case of a 25-year-old man who presented to the acute medical take with a mixed overdose of mephedrone and paracetamol. Sixteen hours after ingestion, he reported that he was unable to micturate. A bladder scan confirmed that he was in urinary retention and he was catheterised. We discuss the increasingly popular recreational drug mephedrone including its more common side effects.
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We describe a case of a healthy male full-term neonate, 21 days old, admitted to the emergency room, presenting a severe cardiovascular collapse with an initial sinus rhythm. The first diagnostic hypothesis was of septic shock, having antibiotics, fluid resuscitation, inotropic drugs and ventilatory support started immediately. ⋯ Cardiogenic shock should be considered despite being a much rarer cause of shock in neonates. SVT is promptly diagnosed when a cardiorespiratory monitor is available; however, the intermittent occurrence of the tachycardia episodes makes this diagnosis more difficult to recognise and manage.
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Case Reports
Early treatment causes clinicoradiological reversal of myelopathy due to vitamin B12 deficiency.
Vitamin B12 deficiency has a wide spectrum of clinical presentation with a variety of neurological symptoms and signs. As a result, many patients lack classic features of advanced severe deficiency. ⋯ His serum vitamin B12 levels were low and neuroimaging revealed myelopathy. The patient was treated promptly with cyanocobalamin injections, which lead to a rapid resolution of symptoms and radiological abnormalities.
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A 33-year-old lady in the second trimester of pregnancy presented to the emergency department having suffered a cardiac arrest at home. An emergency caesarean section was performed in the resuscitation area. ⋯ She was transferred to our tertiary centre for an emergency coronary angiography and was successfully treated, making a full recovery. This case report examines the relatively rare entity of myocardial infarction in pregnancy and looks at the mechanisms underlying this.
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Case Reports
Methylene blue reverses recalcitrant shock in β-blocker and calcium channel blocker overdose.
β-blocker and calcium channel blocker toxicity generally present with bradycardia and hypotension. A 69-year-old woman presented after a suicide attempt with a β-blocker and calcium channel blocker overdose. Her blood pressure was 69/35 mm Hg and her HR was in the 40s. ⋯ She suffered two cardiac arrests and required a transvenous pacemaker. When all interventions failed, she was started on a methylene blue infusion for refractory vasodilatory shock which resulted in a dramatic improvement in her blood pressure. The patient was successfully weaned off all vasopressors and from mechanical ventilation without any end-organ damage.