Acetaminophen is one of the most common analgesic medications available over the counter. Acetaminophen overdose can cause both hepatic and renal injuries. The literature suggests the incidence of acute kidney injury is around 2% - 10% in those with acetaminophen overdose. We report a case of acute kidney injury from acetaminophen overdose requiring hemodialysis.

Metformin is a first-line biguanide agent for the treatment of diabetes mellitus. It has been known to be associated with lactic acidosis. This side effect especially worsens when being used with other medications affecting the kidney such as angiotensin-converting enzyme inhibitors (ACEi) and loop diuretics. This is a case of a 63-year-old male who suffered from metformin-induced lactic acidosis and underwent hemodialysis for treatment.

Twiddler's syndrome, reel syndrome, and ratchet phenomenon are rare causes of pacemaker lead displacement. The presentation of Twiddler's syndrome with underlying ratchet mechanism is quite rarely reported in literature. In this case report we present a 63-year-old male with a history of non-ischemic cardiomyopathy who had his biventricular implantable cardioverter defibrillator leads dislodged and presented as sub-acute exacerbation of heart failure. This case highlights the underlying mechanism of twiddler's syndrome, its clinical presentation, management, and prevention.

Primary hyperparathyroidism (PHPT) is the third most common endocrine disorder after diabetes and thyroid disease. Most cases of hyperparathyroidism remain clinically silent. The clinical manifestations of hypercalcemia captured in the classic medical student mnemonic of “stones, bones, groans, and psychic moans” are often not found. Sometimes patients can present with unique complications. This case describes perforated peptic ulcer as the first presentation of primary hyperparathyroidism.