Hodgkin’s Lymphoma Presenting as Multiple Cavitary Lung Lesions

Hodgkin Lymphoma (HL) typically presents similarly to an infectious etiology, thus awareness of its atypical presentations is essential. We present a case of an adult woman who was found to have HL after presenting with a dry, non-productive cough and showing cavitary lesions on chest computed tomography (CT). We also describe the clinical, laboratory, and radiological workup done leading to the diagnosis and management of HL in a critical care setting.

Psychopharmacology in the Critical Care Setting

Psychotropic medications can be a powerful tool for enabling treatment of critically ill patients. However, a careful approach to psychopharmacology is necessary in the critical care setting. Special considerations include interactions with other medications and treatments, high levels of physiologic stress that alter metabolism, and the challenges of obtaining diagnostic clarity due to limitations in assessment and confounding factors during critical illness. This chapter outlines common consult questions posed by intensive care teams to psychiatry consultation teams, including management of agitation and sedation, poor participation in care, anxiety, continuation of outpatient medication regimens, and alternatives to oral medication.

Incidence, etiology, and course of hypercalcemia-induced AKI in a tertiary care center from northern India

Background Hypercalcemia is known to cause acute kidney injury (AKI). Literature related to hypercalcemic AKI is predominantly in the form of case reports and case series. The purpose of this study is to find the incidence, etiology, and course of hypercalcemia-induced AKI in a non-critical care setting. To our knowledge, this is the first study done to look for the incidence, etiology, and course of hypercalcemia-induced AKI in a non-critical care setting. This is a prospective observational study conducted in the Department of Medicine in a tertiary care center from Jammu and Kashmir, India, from June 2010 to June 2012. Patients admitted with hypercalcemia were assessed for AKI and evaluated and treated for hypercalcemia. Renal function was monitored during hospitalization and at 1 month of discharge. AKI and hypercalcemia were arbitrarily defined as serum creatinine > 1.5 mg/dl and corrected serum calcium of ≥ 11.5 mg/dl (as per reference hospital lab), respectively. Results Thirty patients are included. Hyperparathyroidism and multiple myeloma accounted for 13(43.3%) and 10 (33.3%) cases, respectively. Mean ±SD corrected serum calcium at diagnosis and after treatment at 1 month was 13.56 ± 1.86 mg/dl and 9.49±1.35 mg/dl, respectively; p < 0.001. Mean ±SD serum creatinine at baseline and after treatment of hypercalcemia was 2.87 ±1.68 mg/dl and 1.49±1.34 mg/dl, respectively; p < 0.001. Twenty-three (76.7%) patients had AKI. AKI recovered after treating hypercalcemia in 25 (83.3 %) patients. Mean ± SD days taken for the decrease in serum creatinine to ≤ 1.5 mg/dl was 8.28 ± 4.17 days. Mean ± SD serum creatinine after treatment of hypercalcemia in hyperparathyroidism group versus non-parathyroid group was 0.97 ± 0.35 mg/dl and 1.88 ±1.67 mg/dl, respectively; p value 0.009. Conclusions Hypercalcemia is commonly associated with AKI. Primary hyperparathyroidism and multiple myeloma account for the majority of the cases. Hypercalcemic AKI with primary hyperparathyroidism is less common and the outcome is better, as compared to non-hyperparathyroidism-related causes. AKI is reversible in most cases.

The effect of opioids on gastrointestinal function in the ICU

Gastrointestinal (GI) dysfunction is common in the critical care setting and is highly associated with clinical outcomes. Opioids increase the risk for GI dysfunction and are frequently prescribed to reduce pain in critically ill patients. However, the role of opioids in GI function remains uncertain in the ICU. This review aims to describe the effect of opioids on GI motility, their potential risk of increasing infection and the treatment of GI dysmotility with opioid antagonists in the ICU setting.