The objective of this study was to report a case of a person with psychiatric illness treated with clozapine presented with diabetic ketoacidosis (DKA). A clinical monitoring was done on a 38-year-old Indian man affected by schizoaffective disorder, bipolar type presented with DKA after 3 months of clozapine therapy (250 mg/day). After treatment of DKA and discontinuation of clozapine, the patient improved symptomatically, his blood sugar levels normalized and insulin requirements also decreased. This report thus highlights that clinicians should be vigilant about the potential risk of new-onset diabetes and DKA in patients taking clozapine and utilize appropriate clinical and laboratory monitoring early in the course of treatment to prevent serious adverse effects.
The study aims to characterize community-acquired sepsis patients admitted to our 1300-bedded tertiary care hospital in South India from the Surviving Sepsis Campaign (SSC) guideline-compliant e-sepsis registry stratified by focus of infection. The prospective observational study recruited 1009 adult sepsis patients presenting to the emergency department at the center based on Sepsis-2 criteria for a period of three years. Of the patients, 41% were between 61 and 80 years with a mean age of 57.37 ± 13.5%. A total of 13.5% (136) was under septic shock and in-hospital mortality for the study cohort was 25%. The 3 h and 6 h bundle compliance rates observed were 37% and 49%, respectively, without significant survival benefits. Predictors of mortality among patients with bloodstream infections were septic shock (p = 0.01, OR 2.4, 95% CI 1.23–4.79) and neutrophil-to-lymphocyte ratio (p = 0.008, OR 1.01, 95% CI 1.009–1.066). The presence of Acinetobacter (p = 0.005, OR 4.07, 95% CI 1.37–12.09), Candida non-albicans (p = 0.001, OR16.02, 95% CI 3.0–84.2) and septic shock (p = 0.071, OR 2.5, 95% CI 0.97–6.6) were significant predictors of mortality in patients with community-acquired pneumonia. The registry has proven to be a key data source detailing regional microbial etiology and clinical outcomes of adult sepsis patients, enabling comprehensive evaluation of regional community-acquired sepsis to tailor institutional sepsis treatment protocols.
Background: Adult sepsis in India poses a major challenge for clinicians and hospitals given the complete lack of local and national data of its public health magnitude. Severe sepsis is often associated with high mortality and morbidity leading to increased cost of care for patients and institutions. To better respond to the clinical and financial cost of sepsis care in our tertiary care hospital we developed a sepsis registry based on the Surviving Sepsis Campaign. Methods & Materials: A computer based real time sepsis registry was developed to collect data of all sepsis patients presenting to the ED. This registry included demographic information, prehospital care, clinical information and patient care details as per the Surviving Sepsis Campaign guidelines. This database was aligned with our hospital laboratory information system. Frequent reviews of the data collection process, quality and completeness were done to optimize the registry. Results: Out of a total 301 patients, 66% (199/301) were males. 44% (131/301) were between 61-80 yrs while 34% (102/301) were between 41-60yrs of age. 40% (120/301) of the cases were transfers from nearby hospitals to our tertiary care. Further categorization revealed 46% cases were 'sepsis', 14% 'septic shock' and 40% were 'severe sepsis'. The SOFA score on admission of the 65% of the cases were < 9 while 19% had a SOFA score of 9-10 and 16% had a score more than 11. 51% (153/301) had an average length of stay < 7 days. The primary focus of infection were pneumonia (39%), UTI (38%) and skin and soft tissue infections (16%). 22% of the cases had concomitant bacteremia. Compliance with the 3hr bundle was present in 83% of the cases. Overall mortality was 28% (86/301) with male gender and a SOFA score of > 9 significantly associated with fatality (p<0.05). Lack of compliance with 3 hr bundle and lactate levels > 2.5 mmol/L were also associated with mortality (p<0.05). 71% of the registry cases were culture positive, of which 33% had a polymicrobial infection. Conclusion: This sepsis registry is proving to be a key data source for defining the burden of the disease in our community.
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