A 65-year-old female patient was brought to our emergency department (ED) with alleged history of road traffic collision (RTC). The patient had respiratory distress on arrival and hence she was immediately intubated a...A 65-year-old female patient was brought to our emergency department (ED) with alleged history of road traffic collision (RTC). The patient had respiratory distress on arrival and hence she was immediately intubated and ventilated. Blood pressure and peripheral pulses were not measurable;however the central pulses were present. Aggressive fluid resuscitation was started. Primary assessment revealed distended neck veins, bony crepitus over right chest. Bedside plain chest radiograph and focused assessment with sonograph in trauma (FAST) were done which did not establish an immediate diagnosis. Computed tomography (CT) of the thorax revealed a tension pneumopericardium and moderate right hemopneumothorax, with multiple ribs fracture. An intercostal drainage tube (ICD) was inserted on right chest. The patient suffered a cardiac arrest and resuscitation measures were unsuccessful. The diagnostic pitfalls, the CT findings, possible clues to the diagnosis and the discussion of this rare case are presented in this case report.展开更多
We described the case report of a patient presented with no known predisposing factor, generalized malaise with vomiting, locked jaw, perioral paraesthesia, carpopedal spasm and a positive Chvostek’s sign which resul...We described the case report of a patient presented with no known predisposing factor, generalized malaise with vomiting, locked jaw, perioral paraesthesia, carpopedal spasm and a positive Chvostek’s sign which resulted from severe electrolyte disturbance at 5 hours after use of oral sodium phosphate solution (NaPO4) as bowel preparation for colonoscopy. On presentation, she developed hyperphosphatemia and symptomatic hypocalcaemia with serum phosphate of 1.84 mmol/L and adjusted calcium level 1.67 mmol/L respectively. Her symptoms subsided after immediate intravenous calcium gluconate followed by oral calcium supplement. The electrolyte disturbances were normalized with an uneventful clinical course. The potentially fatal complications of sodium phosphate solution which commonly prescribed as bowel preparation for conventional colonoscopy could develop though previously reported as uncommon in patients without predisposing factors, and should not be overlooked. Urgent assessment and immediate correction of electrolyte disturbances are needed. Recommendations on patient selection of use of sodium phosphate to minimize risk of developing adverse events are needed to incorporate in clinical protocols.展开更多
文摘A 65-year-old female patient was brought to our emergency department (ED) with alleged history of road traffic collision (RTC). The patient had respiratory distress on arrival and hence she was immediately intubated and ventilated. Blood pressure and peripheral pulses were not measurable;however the central pulses were present. Aggressive fluid resuscitation was started. Primary assessment revealed distended neck veins, bony crepitus over right chest. Bedside plain chest radiograph and focused assessment with sonograph in trauma (FAST) were done which did not establish an immediate diagnosis. Computed tomography (CT) of the thorax revealed a tension pneumopericardium and moderate right hemopneumothorax, with multiple ribs fracture. An intercostal drainage tube (ICD) was inserted on right chest. The patient suffered a cardiac arrest and resuscitation measures were unsuccessful. The diagnostic pitfalls, the CT findings, possible clues to the diagnosis and the discussion of this rare case are presented in this case report.
文摘We described the case report of a patient presented with no known predisposing factor, generalized malaise with vomiting, locked jaw, perioral paraesthesia, carpopedal spasm and a positive Chvostek’s sign which resulted from severe electrolyte disturbance at 5 hours after use of oral sodium phosphate solution (NaPO4) as bowel preparation for colonoscopy. On presentation, she developed hyperphosphatemia and symptomatic hypocalcaemia with serum phosphate of 1.84 mmol/L and adjusted calcium level 1.67 mmol/L respectively. Her symptoms subsided after immediate intravenous calcium gluconate followed by oral calcium supplement. The electrolyte disturbances were normalized with an uneventful clinical course. The potentially fatal complications of sodium phosphate solution which commonly prescribed as bowel preparation for conventional colonoscopy could develop though previously reported as uncommon in patients without predisposing factors, and should not be overlooked. Urgent assessment and immediate correction of electrolyte disturbances are needed. Recommendations on patient selection of use of sodium phosphate to minimize risk of developing adverse events are needed to incorporate in clinical protocols.
