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Wernicke's encephalopathy (WE) is a potentially reversible yet serious neurological manifestation caused by vitamin B1(thiamine) deficiency. It is commonly associated with heavy alcohol consumption. Other clinical associations are with hyperemesis gravidarum (HG), starvation, and prolonged intravenous feeding. Most patients present with the triad of ocular signs, ataxia, and confusion. It can be associated with life-threatening complication like central pontine myelinolysis (CPM). We report two cases of WE following HG, with two different outcomes.

Introduction Complicated malaria is a medical emergency with a high mortality if untreated. Aim To describe the clinical spectrum, treatment practices and outcome of severe malaria cases admitted to an intensive care unit. Method Thirteen severe malaria cases admitted to the ICU over a 6 years period (2012 – October 2018) were included. The data was retrospectively extracted from the hospital patient data management system. Results Nine patients had P. falciparum malaria, three had P.Vivax, and one had both. Only one had received malarial chemoprophylaxis. The median time of attending to medical health facility after symptoms started was 7 days (range: 2–21 days). All cases responded to antimalarial therapy and supportive management. Complications included shock 54%, kidney failure 38%, respiratory failure 69%, cerebral malaria 61%, hypoglycemia 23%, coagulation derangement 8%, and acidosis 23%. There were no fatal outcomes but one case had permanent brain damage and the rest recovered completely. Conclusion The median treatment delay of seven days explains why these patients ended in intensive care with multiple symptoms of severe malaria and often multiorgan failure. Pretravel advice and use of malaria chemoprophylaxis when visiting high risk areas would probably have prevented infection and timely attendance to healthcare once symptomatic would have reduced the morbidity associated with infection, reduced length of stay in hospital and hence resources.

Background Severe acute respiratory syndrome coronavirus 2 infection can be severe and fatal due to cytokine storm. Therapeutic plasma exchange (TPE) potentially mitigates the harmful effects of such cytokines. We investigated the use of TPE, as rescue therapy, in patients with severe Coronavirus disease 2019 (COVID‐19) infection. Study Design and Methods A retrospective analysis on COVID‐19 patients admitted to the intensive care unit and treated with TPE from April 17, 2020 to July 2, 2020. This group was compared with COVID‐19 patients who received standard therapy without TPE. The following outcomes were analyzed: changes in laboratory parameters, length of hospital stay (LOS), days on mechanical ventilation, mortality at days 14 and overall mortality. Results A total of 95 patients were included, among whom 47% (n = 45) received TPE. Patients who received TPE had reductions in C‐reactive protein ( P = .002), ferritin ( P < .001) and interleukin‐6 ( P = .013). After employing entropy‐balancing matching method, those on TPE were also more likely to discontinue inotropes (72% vs 21%; P < .001). However, they were more likely to be associated with longer LOS (23 vs 14 days; P = .002) and longer days on ventilatory support (14 vs 8 days; P < .001). Despite marginal mortality benefit at 14‐days (7.9% vs 24%; P = .071), there was no significant differences in overall mortality (21% vs 31%; P = .315) between the groups. Conclusions TPE was effective in reducing inflammatory markers in patients with severe COVID‐19 infection, however, further research is warranted.

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Enteral nutrition is the preferred mode of nutrition in critically ill patients whenever feasible as it has a number of advantages over parenteral feeding. Both gastric and small-bowel feeding can effectively deliver calories. In patients with gastroparesis, small-bowel feeding can help avoid parenteral feeding. We carried out a retrospective observational study to assess the ability to insert the Tiger 2 tube into the small bowel at the bedside in 25 patients who failed to tolerate gastric feeds. The time taken, rate of successful insertion, and ability to feed these patients using a standardized feeding protocol were noted. Success rate of insertion was 78% and feeding could be established. This method reduced the delays and risks associated with transportation and dependence on other specialties.

Hyponatremia is one of the more common electrolyte abnormalities in clinical medicine. Some sources estimate that the number of patients who experience sodium levels of <135meq/L can be as high as 30% of all hospitalized patients. SIADH is the usual cause of Hyponatremia in patients with Varicella Zoster infection. Severe hyponatremia can cause substantial morbidity and mortality. The most common manifestations are CNS-related and include lethargy, confusion, disorientation and agitation. Serious manifestations include seizures, hypoxia and coma. We present here a report of an adult patient who presented with Varicella Zoster infection with seizures, agitation and unresponsiveness due to hyponatremia. Patient was on homeopathic medications and salt free diet since 3 days and was advised to take only free water to prevent exacerbations of skin lesions.