Kalpit Devani

Acute liver failure with amiodarone infusion: A case report and systematic review

Amiodarone, a commonly used class III antiarrhythmic agent notable for a relatively long half‐life of up to 6 months and its pronounced adverse effect profile, is used for both acute and chronic management of cardiac arrhythmias. Chronic use of amiodarone has been associated with asymptomatic hepatotoxicity; however, acute toxicity is thought to be uncommon. There are only six reported cases of acute liver failure (ALF) secondary to amiodarone. In all these cases the outcome of death during the same hospitalization resulted. We aimed to report the only case of acute liver failure secondary to amiodarone infusion in the existing literature where the patient survived.

Endoscopic Management of Pancreatic Pseudo cyst Complicated with Obstructive Jaundice: Case Report and Literature Review

Obstructive jaundice due to pancreatic pseudocyst is not common. Local Complications of Pancreatic pseudocyst can be managed with Endoscopic drainage, achieved through transmural approach via stomach or duodenal wall into the cyst, or transpapillary/transductal stent placement. Endoscopic drainage of pancreatic pseudocyst is becoming more favorable nowadays because of shorter hospital stay, lower cost, and lower mortality rate. EUSguided drainage is preferred over conventional endoscopic drainage because of higher technical success rate and because of higher success rate, technical feasibility and quick resolution of pancreatic pseudocyst, fully covered fully covered self-expandable metal stents are recently gaining popularity.

Acute pancreatitis: Trends in outcomes and the role of acute kidney injury in mortality- A propensity-matched analysis

OBJECTIVES To assess national trends of AP (acute pancreatitis) admissions, outcomes, prevalence of AKI (acute kidney injury) in AP, and impact of AKI on inpatient mortality. METHODS We queried the Nationwide Inpatient Sample database from 2003 to 2012 to identify AP admissions using ICD-9-CM codes. After excluding patients with missing information on age, gender, and inpatient mortality, we used ICD-9-CM codes to identify complications of AP, specifically AKI. We examined trends with survey-weighted multivariable regressions and analyzed predictors of AKI and inpatient mortality by multivariate logistic regression. Additionally, both AKI and non-AKI groups were propensity-matched and regressed against mortality. RESULTS A total of 3,466,493 patients (1.13% of all discharges) were hospitalized with AP, of which 7.9% had AKI. AP admissions increased (1.02%→1.26%) with rise in concomitant AKI cases (4.1%→11.7%) from year 2003-2012. Mortality rate decreased (1.8%→1.1%) in the AP patients with a substantial decline noted in AKI subgroup (17.4%→6.4%) during study period. Length of stay (LOS) and cost of hospitalization decreased (6.1→5.2 days and

Acute kidney injury impact on inpatient mortality in Clostridium difficile infection: A national propensity‐matched study

13,654 to

Concurrent Diabetic Ketoacidosis in Hypertriglyceridemia-Induced Pancreatitis: How Does It Affect the Clinical Course and Severity Scores?

10,895, respectively) in AKI subgroup. Complications such as AKI (OR: 6.08, p < 0.001), septic shock (OR: 46.52, p < 0.001), and acute respiratory failure (OR: 22.72, p < 0.001) were associated with higher mortality. AKI, after propensity matching, was linked to 3-fold increased mortality (propensity-matched OR: 3.20, P < 0.001). CONCLUSION Mortality, LOS, and cost of hospitalization in AP has decreased during the study period, although hospitalization and AKI prevalence has increased. AKI is independently associated with higher mortality.

Pancreatic Tumor Presenting as Diarrhea.

Acute kidney injury (AKI) is used as a marker of severity in Clostridium difficile infection (CDI) patients. We estimated the true effect of AKI in inpatient mortality of CDI patients, as there are no large‐scale, population‐based, propensity‐matched studies evaluating AKIs effect in this patient cohort.

Ledipasvir/sofosbuvir induced nephrotic syndrome: A challenging case of Hepatitis C management

Objectives Concurrent diabetic ketoacidosis (DKA) is highly prevalent in patients with hypertriglyceridemia-induced pancreatitis (HP). Diabetic ketoacidosis could potentially complicate the diagnosis, management, and prognosis of HP. This study aimed to directly compare the clinical course of HP with and without DKA and assess the outcomes of frequently used severity-prediction scores in such population. Methods We retrospectively analyzed 140 patients with HP; 37 patients (26.4%) had concurrent DKA. We compared epidemiologic characteristics, initial laboratory values, and clinical courses between the DKA and non-DKA groups. Bedside Index for Severity in Acute Pancreatitis score, Sequential Organ Failure Assessment score, Ranson criteria, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and Marshall score were calculated and compared between groups. Results We observed more acute kidney injury in the DKA group. Patients with DKA more likely required intensive care unit admission, received intravenous insulin, and were discharged on subcutaneous insulin. Ranson criteria and APACHE II score were significantly higher with DKA. Conclusions Concurrent DKA does not affect length of stay, in-hospital mortality, and readmission rate in patients with HP. Higher Ranson criteria and APACHE II score likely reflected derangement of clinical parameters secondary to DKA rather than true severity of pancreatitis in such population.

CRT-100.21 Impact of Chronic Kidney Disease on Guideline Directed Interventions Among Patients Admitted With Acute ST-Elevation Myocardial Infarction: A Nationwide Inpatient Sample 2012-2014

VIPoma, Verner-Morrison syndrome, is a rare functioning neuroendocrine tumor that secretes vasoactive intestinal polypeptide (VIP). It is also known as pancreatic cholera or WDHA syndrome (watery diarrhea, hypokalemia and hypo or achlorhydria). Verner and Morrison first described the symptoms of VIPoma in 1958 as watery diarrhea, hypokalemia and achlorhydria [1]. Approximately 90 % of cases arise from the pancreas but they may also occur in periganglionic tissue or other locations such as the adrenals, colon, bronchus, liver and sympathetic ganglia. VIPomas are found to be malignant in about 60–80 % cases and are metastatic at the time of diagnosis, with the liver being the most common site of metastasis [2]. Herein, we present a patient with chronic diarrhea who was found to have VIPoma and did well after surgical resection.