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- Critical Care Department, Hamad Medical Corporation (HMC), Doha, Qatar E-mail: [email protected] [1]
- Department of Critical Care Medicine, Hazm Mebaireek General Hospital (HMGH), Hamad Medical Corporation (HMC), Doha, Qatar. E-mail: [email protected] [1]
- Faculty of Nursing, University of Calgary in Qatar (UCQ), Doha, Qatar. [1]
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Epidemiology, clinical features, and management of hypertriglyceridemia-induced pancreatitis: A case series
Background: Hypertriglyceridemia-induced pancreatitis accounts for up to 15 % of all acute pancreatitis admitted to hospitals. It is important to diagnose the etiology to provide adequate and timely management of the case and reduce complications. Epidemiological and clinical data on hypertriglyceridemia-induced pancreatitis in the Intensive Care Unit (ICU) are scarce especially in Middle Eastern countries. We are reporting a case series of 18 patients admitted managed in the ICU over a period of 10 months. Methods: All patients above 18 years of age were diagnosed with hypertriglyceridemia-induced pancreatitis admitted to the ICU and High Dependency Unit (HDU) were included. Our objectives were to characterize the clinical and epidemiological features of hypertriglyceridemia-induced pancreatitis (HTG-AP) and calculate the number of insulin infusion days required to manage HIP. Results: Patients were mostly middle-aged males from different ethnicity. Most of the patients presented with abdominal pain elevated pancreatic enzymes and triglyceride. The mean triglyceride level on admission was 15.68 mmol/L. Most clinical findings were resolved when the triglyceride level dropped to below 5.6 mmol/L within 3.5 days. All patients presented with mild forms of pancreatitis without major complications. Fifty percent of our patients showed radiological features of acute pancreatitis but no one developed local complications. Conclusion: Our case series showed that hypertriglyceridemia is a common cause of acute pancreatitis in Qatar. Upon admission the mean triglyceride level was 15.68 mmol/L and the cause of the hypertriglyceridemia was unclear but could be related to ethnicity. Patients were primarily managed with insulin therapy and supportive care. None of the patients developed any local complications such as necrotizing pancreatitis or abscess formation. Around 16% of the patients had systemic complications which were managed successfully.
Methemoglobinemia induced by Dapsone: A case report
Many drugs can cause methemoglobinemia and dapsone is one of the most familiar. Dapsone is used to treat skin disorders like leprosy and infections like Pneumocystis jiroveci pneumonia. It is also used off-label in conditions like dermatitis herpetiformis and relapsing polychondritis. In this case report a 26-year-old male presented to the emergency department with fever and generalized weakness complaints. He was on treatment for lepromatous leprosy with dapsone clofazimine and rifampicin. His room air oxygen saturation was 80 % so he was started on high-flow oxygen therapy and vitamin C. His blood gas and methemoglobin levels were frequently monitored till the methemoglobin level was normal. By the third day he maintained his saturation above 95% on room air. The results in this work emphasize the importance of evaluating hypoxia for uncommon causes like methemoglobinemia as misdiagnosis can lead to fatal complications.