Chhattisgarh Institute of Medical Sciences

Alcoholic ketoacidosis (AKA) is a form of high anion gap metabolic acidosis characterized by ketosis, typically occurring in malnourished individuals after binge alcohol consumption. If not identified early, it can lead to life-threatening electrolyte disturbances and cardiac arrhythmias. A man in his fifties presented with altered mental status and shortness of breath. Arterial blood gas analysis revealed severe metabolic acidosis with a pH of 7.22, a bicarbonate level of 4.2 mmol/L, and normal lactate levels. Urine ketones were strongly positive (4+). Electrocardiography demonstrated tall T waves, and serum potassium was elevated at 5.8 mEq/L. The combination of recent binge alcohol use, normoglycemia, ketosis, and high anion gap metabolic acidosis suggested AKA. Prompt fluid resuscitation and electrolyte correction resulted in progressive clinical improvement, and the patient was discharged without complications. This case highlights the importance of considering AKA in normoglycemic patients presenting with high anion gap metabolic acidosis and ketosis, particularly those with a history of excessive alcohol consumption. Accurate differentiation from diabetic ketoacidosis is essential because management strategies differ significantly. It is further distinguished by significant hyperkalemia with electrocardiographic changes, an atypical presentation of AKA in which serum potassium levels are usually normal or low.

Bipolar affective disorder (BPAD) is strongly associated with increased cardiovascular morbidity due to autonomic dysregulation, inflammatory activation, metabolic effects, and psychotropic-induced cardiac changes. Congenital cardiac anomalies such as dextrocardia add an additional layer of complexity to psychiatric management. We describe an 18-year-old female who presented with a manic episode and was simultaneously diagnosed with dextrocardia. The case highlights diagnostic challenges, cardiovascular considerations during psychotropic treatment, and the importance of multidisciplinary care. Literature shows that individuals with bipolar disorder (BD) have significantly higher cardiovascular disease (CVD) risk and require systematic screening and integrated care approaches. Early recognition and tailored management can improve psychiatric and cardiac outcomes.

Older patients with Alzheimer’s disease (AD) are more susceptible to pneumonia because of their limited mobility, malnourishment, and difficulty swallowing. This study highlights demographic and geographic while examining AD and pneumonia-related mortality rates among older adults in the United States (U.S.) between 1999 and 2023. Retrospective cohort research utilized mortality data from the Centre for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research (CDC-WONDER). Demographic factors (age, gender, race/ethnicity) and geographic classifications (urbanization, regions, states) were examined during the analysis. We used joinpoint regression and standardization techniques to determine age-adjusted mortality rates (AAMR) and annual percentage changes (APC). A total of 202,678 AD and pneumonia-related deaths were reported. Overall AAMR declined significantly from 1999 to 2023 (APC − 6.65; P < 0.05). From demographics males (22), non-Hispanic (NH) Whites (20.8), individuals aged 85 + years (98.3) had the highest mortality rates. Geographically, residents of non-metropolitan (25.6) and west regions (26.9) represented peak rates. We observed notable demographic and geographic disparities in AD and pneumonia associated mortality, the burden of which is higher among males, NH Whites and those residing in non-metropolitan regions and therefore we emphasize the need of targeted interventions and equitable resource allocation to reduce this burden especially among high-risk populations.

INTRODUCTION:Intracerebral hemorrhage (ICH) is a serious complication of oral warfarin in patients with mechanical heart valves, leading to high mortality and disability. This study aimed to evaluate the clinical and radiological features and the variables associated with patient outcomes in such cases, particularly in resource-limited settings. METHODS:This retrospective observational study included 125 patients on warfarin with mechanical heart valves who developed spontaneous ICH and presented within 24 hours of symptom onset. Hematoma volume was calculated using the ABC/2 method. Outcomes were assessed at 90 days across the entire cohort using mortality data and the modified Rankin Scale (mRS), with mRS ≥3 indicating poor functional recovery. RESULTS:Among the 125 patients, 42 (33.6%) died within 90 days, and 38 (30.4%) experienced poor functional recovery (mRS ≥3). Unadjusted analyses identified several shared clinical and radiological variables significantly associated with both mortality and poor functional recovery, respectively: advanced age >60 years (p=0.024; p=0.005), hypertension (p=0.007; p=0.045), smoking (p=0.002; p=0.040), atrial fibrillation (p=0.012; p=0.011), anemia (p=0.024; p<0.001), hematoma volume >30 cc (p=0.033; p=0.004), midline shift (p<0.001; p=0.010), and higher composite ICH scores (p=0.035; p=0.014). Furthermore, intraventricular extension (p=0.005) and severe admission blood pressure >230/140 mmHg (p=0.019) were specifically linked to increased mortality. A low admission Glasgow Coma Scale (GCS) score <8 (p<0.001) was associated with poor functional recovery among survivors. While an association was observed between neurosurgical intervention and improved functional outcomes in unadjusted analyses, this finding should be interpreted with caution, given the potential selection bias inherent in the retrospective design. CONCLUSION:Warfarin-associated ICH in patients with mechanical heart valves remains a devastating complication characterized by high rates of mortality and long-term functional disability. This study identified several clinical and radiological variables associated with adverse outcomes, including advanced age, large hematoma volume, midline shift, intraventricular extension, low admission GCS, and concurrent comorbidities such as anemia and severe hypertension. Optimizing outcomes in this vulnerable population requires early risk stratification using comprehensive clinical grading systems such as the ICH score, rapid neuroimaging, rigorous blood pressure control, international normalized ratio (INR) reversal, and individualized, selective neurosurgical interventions.