Journal of Acute Disease

53-59

Authors: Jakub Mizera, Adrian Bystron, Karolina Matuszewska, Justyna Pilch, Ugo Giordano

Sepsis and septic shock are life-threatening conditions that are globally responsible for almost 20% of mortality, especially in low and middle-income countries. This review was conducted on PubMed and Google Scholar databases with keywords sepsis, septic shock, sepsis management, and sepsis complications. Articles published up to July 2023 in English were included. Diagnosis and management should be carried out without unnecessary delay. Cooperation between various medical specialties including intensive care doctors, neurologists, hepatologists, cardiologists, and pediatric doctors is needed if a child is affected. New strategies have to be implemented in low and middle-income countries to decrease the sepsis incidence and reduce mortality in the population.

67-73

Authors: Hoda Amiri, Khadijeh Yazdanparast, Mohsen Pourkhosravani, Maryam Rastegar

Objective: To investigate the distribution pattern of animal bites in Mirjaveh, Iran from 2015 to 2020. Methods: The data on animal bites were collected from the Department of Infectious Diseases, the provincial health center. Monthly climatic data on precipitation and temperature during the study period were also collected. The correlation between incidence and temperature, precipitation rate, land type, and altitude was also analyzed. Results: The results showed that men were more affected by animal bites than women (76.4%, P<0.001), and the highest incidence rate occurred in the age group of 5-19 years. The incidence rate of animal bites was found to be correlated with temperature and altitude. An increase in temperature was associated with a rise in the incidence rate of animal bites. The number of animal bites increased until 2019, possibly due to an increase in the number of dogs in the area. Conclusions: Targeted interventions should be implemented to reduce the incidence of animal bites, particularly among children, housewives, and students. Improving access to appropriate treatments, increasing public awareness of the hazards of animal bites, and increasing the number of vaccinated dogs in the area are essential strategies to be considered.

81-84

Authors: Shao Hui Koh, Jacqueline C. L. Tan

Rationale: Acute caustic ingestion from suicidal intent is not usual in emergency departments in developed countries. One of the substances commonly ingested by suicidal patients, phosphoric acid, tends to cause multi-system derangements. Patient’s Concern: A 41-year-old male patient presented with complaints of throat discomfort, severe generalized abdominal pain, and multiple episodes of hematemesis after ingesting a restroom cleaning solution. Diagnosis: Poisoning by acute caustic ingestion (containing <30% phosphoric acid and <4% ethylene glycol). Interventions: The patient was administered 50 mL of 8.4% sodium bicarbonate solution followed by an isotonic sodium bicarbonate solution running at 500 mL/h, a hyperkalemia kit, ceftriaxone, metronidazole, omeprazole, and atropine. The patient then underwent urgent hemodialysis. Outcomes: The patient suffered gastrointestinal bleeding as a result of local caustic injury. In addition, his course of illness was complicated by severe acidemia from high anion gap metabolic acidosis and deranged electrolytes (hyperphosphatemia, hyperkalemia, and hypocalcemia). He developed multi-organ failure and eventually demised. Lessons: The clinician needs to be mindful of the multi-system complications arising from such a caustic ingestion. These patients need to be monitored closely for deterioration, and have prompt management of the various arising complications, to reduce the high morbidity and mortality associated with this condition.