Clostridium novyi has recently been identified as the causative organism responsible for the deaths of 35 heroin addicts who had injected themselves intramuscularly. We present two heroin addicts who developed C. botulinum infection following intramuscular or subcutaneous injection of heroin. Like C. novyi, this grows under anaerobic conditions and clinical presentation may be similar; however, descending motor or autonomic signs are invariably present in botulism. The prognosis is good if the diagnosis is made early and appropriate treatment commenced.

Parenteral nutrition (PN) is widely used when enteral feeding is contraindicated or not possible in patients who are malnourished or at risk of malnutrition, but it is not without complications. We describe the rare complication of PN-related chylothorax that can lead to extensive investigations if not picked up early with clinical suspicion and simple biochemical tests.

No abstract

Ensuring adequate oxygenation and ventilation in patients with severe asthma can be challenging. Although no randomized trials have been performed, neuromuscular blockade is a useful adjunct in the care of severe life-threatening asthma with respiratory failure. Neuromuscular blockers can prevent respiratory dysynchrony, help lower peak pressures and allow longer expiratory times to reduce dynamic hyperinflation and its attendant risk of barotraumas and pneumothorax. Patients with severe life-threatening asthma and respiratory failure are often young, male and can be difficult to sedate.

No abstract