tailieunhanh - Báo cáo y học: "Delayed ethylene glycol poisoning presenting with abdominal pain and multiple cranial and peripheral neuropathies: a case report"

Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Delayed ethylene glycol poisoning presenting with abdominal pain and multiple cranial and peripheral neuropathies: a case report. | Baldwin and Sran Journal of Medical Case Reports 2010 4 220 http content 4 1 220 Ws CASE REPORTS CASE REPORT Open Access Delayed ethylene glycol poisoning presenting with abdominal pain and multiple cranial and peripheral neuropathies a case report Fiona Baldwin and Hersharan Sran Abstract Introduction Ethylene glycol poisoning may pose diagnostic difficulties if the history of ingestion is not volunteered or if the presentation is delayed. This is because the biochemical features of high anion-gap metabolic acidosis and an osmolar gap resolve within 24 to 72 hours as the ethylene glycol is metabolized to toxic metabolites. This case illustrates the less well-known clinical features of delayed ethylene glycol poisoning including multiple cranial and peripheral neuropathies and the clinical findings which may point towards this diagnosis in the absence of a history of ingestion. Case presentation A 53-year-old Afro-Caribbean man presented with vomiting abdominal pain and oliguria and was found to have acute renal failure requiring emergency hemofiltration and raised inflammatory markers. Computed tomography imaging of the abdomen revealed the appearance of bilateral pyelonephritis however he failed to improve with broad-spectrum antibiotics and subsequently developed multiple cranial neuropathies and increasing obtundation necessitating intubation and ventilation. Computed tomography of the brain showed no focal lesions and a lumbar puncture revealed a raised cerebrospinal fluid opening pressure and cyto-albuminological dissociation. Nerve conduction studies revealed a sensorimotor radiculoneuropathy mimicking a Guillain-Barre type lesion with an atypical distribution. It was only about two weeks after presentation that the history of ethylene glycol ingestion one week before presentation was confirmed. He had a slow recovery on the intensive care unit requiring renal replacement therapy for eight weeks and complicated .