Background: In developing countries, the substances most commonly used for self-poisoning are agricultural pesticides including rodenticides. Authors aimed to assess the clinical status and outcomes of patients with rodenticide poisoning in a tertiary care hospital.Methods: This retrospective record-based study was carried over three years. Apart from demographic details, information regarding the time of ingestion, nature and amount of the compound. Other details included clinical features, complications, treatment and outcome of the patient. Descriptive analysis was carried out by the mean and standard deviation for quantitative variables, frequency and proportion for categorical variables.Results: Of the 120 study subjects, 85 (93.40%) participants self-harmed, 2 (2.20%) were homicidal, and 4 (4.40%) had accidentally consumed the rodenticide. About 52 (32.70%) participants had vomiting, 34 (21.38%) had giddiness, 32 (20.13%) participants had abdominal pain. On the whole, 85 (73.28%) participants recovered, 23 (19.83%) participants had absconded, 6 (5.17%) participants had referred and 2 (1.72%) of them expired.Conclusions: Phosphorous compounds, particularly yellow phosphorous are the most lethal rodenticides followed by Coumadin. Symptomatic management of the patients at the earliest possible time is the mainstay, as there are no specific antidotes for any of the compounds.

How to cite this article: Vinoth Kumar Sethuraman, Kavitha Balasubramanian. Clinical spectrum of precipitating factors of hepatic encephalopathy in cirrhosis of liver and its relation to prognosis in a tertiary care hospital-a retrospective study. International Journal of Contemporary Medicine Surgery and Radiology. 2019;4(2):B65-B70.

An empty sella is reported to occur in 5.5%–23.5% of the population and is usually asymptomatic. It can be associated with endocrine disturbances. We report a 48-year-old woman who presented with refractory hypoglycemia, seizures, and shock that improved with levothyroxine, hydrocortisone, and octreotide. Investigations revealed central hypothyroidism, hypoprolactinemia, low gonadotropins, normal C-peptide and a primary empty sella. Case reports of Sheehan syndrome with or without empty sella causing hypoglycemia have been reported occasionally. Our patient had never become pregnant. She had experienced premature menopause and symptoms suggestive of hypothyroidism for many years (without treatment) before her emergency department admission for altered sensorium.

Scrub typhus is still underdiagnosed despite a resurgence in incidence as the clinical presentation is often atypical leading to low index of suspicion among clinicians. We report a case of a young girl presenting as lobar pneumonia and diagnosed as scrub typhus. Despite such a classical picture of community-acquired pneumonia on clinical presentation and radiological findings the patient was found to have scrub typhus serologically thereby posing a diagnostic dilemma. Upon serological confirmation, doxycycline therapy was initiated followed by a rapid and complete resolution of pneumonia, both clinically and radiographically. This case report highlights the importance of recognizing an uncommon clinical presentation of this common tropical disease and its prompt diagnosis and treatment.

Adult onset Still’s disease is uncommon in middle-aged and elderly individuals and can rarely present with shock; shock is usually associated with disseminated intravascular coagulation, multiorgan dysfunction syndrome or acute respiratory distress syndrome. We report a post-menopausal woman with arthritis, fever, pneumonitis and hypotension which was managed as septic shock. Steroids were inadvertently missed during the second day of hospitalization in the intensive care unit. Persistence of hypotension on inotropes, with normal renal, hepatic and neurological function and recurrence of fever when steroids were skipped, led to suspicion of an inflammatory disorder. A diagnosis of Still’s disease may be entertained in postmenopausal women with polyarthritis, rash, and fever with leukocytosis. Sepsis is mimicked, and multiple antibiotics use is common before the diagnosis of such an entity is made. Shock is rare in adult onset Still’s disease and is not necessarily associated with disseminated intravascular coagulation, acute respiratory distress syndrome, or multiorgan dysfunction.

Background: Myxedema coma is a medical emergency seen in patients with primary hypothyroidism. The prognosis is poor if not diagnosed and treated early. Here we report a case of secondary hypothyroidism due to empty sella syndrome presenting with initial manifestation of myxedema coma which is exceedingly rare. Case Report: A middle aged lady presented with easy fatigability for four months, giddiness for one month and vomiting for four days. Clinical diagnosis of myxedema coma was made; she was treated with levothyroxine and laboratory evaluation revealed hypo-pituitarism due to empty sella syndrome. Conclusion: Myxedema coma is an endocrine emergency seen rarely in patients with secondary hypothyroidism but early detection and management reduces the mortality.