Thyrotoxic periodic paralysis (TPP), a disorder most commonly seen in Asian men, is characterized by abrupt onset of hypokalemia and paralysis. The condition primarily affects the lower extremities and is secondary to thyrotoxicosis. The underlying hyperthyroidism is often subtle causing difficulty in early diagnosis. Factors like high-carbohydrate meal exercise, steroid, and stress can precipitate an attack of TPP. Evidence is building up showing role of genetic mutations in Kir2.6 channel in the pathogenesis of TPP. Loss of function of Kir2.6 together with increased activity of Na+/K+ ATPase may trigger a positive feed-forward cycle of hypokalemia. Biochemical hyperthyroidism with normal urinary potassium excretion and ECG changes are characteristic of TPP. Treatment with low-dose potassium supplements and nonselective beta-blockers should be initiated upon diagnosis, and the serum potassium level should be frequently monitored to prevent rebound hyperkalemia.
Necrotizing fasciitis or necrotizing soft-tissue infections (NSTIs) are infrequent but highly lethal infections. They can be defined as infections of any of the layers within the soft tissue compartment (dermis, subcutaneous tissue, superficial fascia, deep fascia, or muscle) that are associated with necrotizing changes. At onset, necrotizing fasciitis can be difficult to differentiate from cellulitis and other superficial infections of the skin. In fact, only 15% to 34% of patients with necrotizing fasciitis have an accurate admitting diagnosis. Early diagnosis and management with surgical debridement, antimicrobials, and supportive measures reduce mortality. Even with modern ICU care mortality ranges between 16 and 36%; this is related to delays in diagnosis and comorbidities. Various scoring systems have been developed which help in diagnosis and stratifying patients into risk groups. The present review deals with varied presentation, early diagnosis, and management of necrotizing fasciitis.
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