A bstract Pulmonary involvement in leptospirosis is common. Severe pulmonary forms of leptospirosis (SPFL) carry high mortality. We report two cases of an otherwise healthy adult male from the western suburbs of India, admitted with severe pulmonary hemorrhage with extremely poor oxygenation. Veno-venous extracorporeal membrane oxygenation (VV-ECMO) was used as the last-rescue life-saving measure. Both the patients showed good pulmonary recovery within 2 weeks. Despite having thrombocytopenia, we experienced lesser bleeding complications requiring transfusions during the extracorporeal membrane oxygenation (ECMO) period. How to cite this article Sen S, Goyal A, Lokhande V. Extracorporeal Membrane Oxygenation in Severe Pulmonary Forms of Leptospirosis: A Report of Two Cases. Indian J Crit Care Med 2022;26(8):966–969.
CASE SERIESwith stomach cramps. After hospitalization, he had hematemesis and bloody diarrhea. Crystalloid infusion and IV PPI were administered. The patient improved with conservative treatment, and hematemesis and hematochezia ended after 24 hours. However, GI discomfort and nausea persisted for 2 days. Case IIIA 64-year-old man with hypothyroidism and a history of bitter bottle gourd juice drinking was admitted with hematemesis and bloody stool. Crystalloid and pantoprazole were given with IV. Over the next 24 hours, hematochezia and hematemesis stopped, although he continued to have sinus tachycardia and slight dyspnea. A 12-lead echocardiogram (ECG) found ST-segment depression in all leads. Troponin I was found to be elevated. Two-dimensional (2D) ECG was revealed to have global hypokinesia with a left ventricular ejection fraction (LVEF) of 35%. (His previous 2D ECG done 6 months back had a normal systolic function.) He also required noninvasive ventilator support. In addition, he needed insulin for recurrent hyperglycemia. IntroductIonIn India, the bottle gourd is a popular cooked vegetable. Uncooked bottle gourd is also often consumed as juice in India due to its perceived health benefits in cases like diabetes mellitus, cardiovascular diseases, dyslipidemia, constipation, liver disease, urinary problems, and depression. 1 These vegetables usually contain a trace amount of toxic tetracyclic triterpenoid compounds called cucurbitacins. The vegetable becomes bitter if this chemical remains in a large amount. When consumed uncooked, this may pose significant health risks. 2,3 Here, we have described seven cases of toxic enteritis after uncooked bitter bottle gourd juice ingestion and their subsequent management. case descrIptIon Case IA 49-year-old man with no known comorbidities was admitted to the intensive care unit (ICU) with loose stools and vomiting after drinking bitter bottle gourd juice. He had hematemesis and bloody diarrhoea after admission. Due to hemodynamic instability, resuscitation was started with crystalloid solutions. He also required two units of packed red cells and noradrenaline support during the initial period.Upper GI endoscopy revealed to have significant erythema and erosion in the stomach and duodenum. The entire colon, from the terminal ileum to the lower GI, was inflamed and degraded. Hemodynamic stability was re-established using resuscitative procedures, and noradrenaline was weaned off the same day. He received an intravenous (IV) proton pump inhibitor (PPI). The bleeding ceased after 24 hours, but loose stools and abdominal pain lasted 2 days. After 3 days, he was transferred out of the ICU (Fig. 1).
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