Pattern of Electrolyte Imbalance in Hospitalized DiabeticPatients 22% were on oral anti-diabetic agents and 6% were on medical nutrition therapy. Among the co-morbidities, hypertention was the most prevalent (61%), followed by ischaemic heart disease (24%), chronic kidney disease (21%), dyslipidaemia (8%) and fatty liver (4%). Diabetic peripheral neuropathy was present in 41% cases, nephropathy in 13% cases and retinopathy in 12% cases. Over all 78% (100 patients had electrolyte imbalance out of 128 patients) of patients had some sort of electrolyte imbalance, irrespective of cause of admission. Hyponatraemia was the most common electrolyte imbalance in this study (80%), followed by hypomagnaesemia (38%), hypokalaemia (36%) and hyperkalaemia (14%). In 11% cases there were hyponatraemia, hypokalaemia and hypomagnaesemia. Regarding the precipitating factors, vomiting was most common (51%). In 28% cases electrolyte imbalance was precipitated by various drugs. Diarrhea and renal failure were responsible in a minority of cases. In 4% cases no cause could be identified. No death occurred.Conclusion: From this cross-sectional study it can be concluded that, electrolyte imbalance is common in hospitalized diabetic patients. Serum electrolytes should be checked routinely in hospitalized diabetic patients irrespective of their purpose of admission.

Background: Diabetic ketoacidosis (DKA) is an acute metabolic complication of diabetes mellitus (DM). It may be the presenting feature in type 1 DM, but more commonly it complicates previously diagnosed diabetic patients, both type 1 and type 2. If not recognized early and treated in a judicious way the outcome is often fatal. Objectives: The objectives of this study was to see the common presenting features of DKA, their precipitating causes, patterns of electrolyte imbalance, treatment requirement in early hours and to see the outcome. Materials and methods: This cross sectional study was done in BIRDEM General Hospital on fifty adult patients who presented with DKA over a period of nine months (January 2007 to September 2007). Results: Total number of patients were 50, male were 24 and female were 26 (M:F =12:13). Mean age was 27.6 ± 3.7 years. The incidence of DKA was more in known diabetic patients (32, 64%), in comparison with new cases (18, 36%). Frequency was more in poor village people (31, 62%). Vomiting (24, 48%) was the most frequent complaint, followed by fever (19, 38%), nausea (16, 32%), abdominal pain (14, 28%), weakness (13, 26%), polyuria (12, 24%) and polydypsia ( 8, 16%). Infection (18, 36%) was the most common precipitating cause, closely followed by inadherence to insulin therapy (17, 34%). In 12 (24%) cases no cause could be identified. Glycaemic control was poor, HbA1c was >7% in 98% cases. Severe acidosis (pH < 7) was less common (4, 8%) and gross electrolyte imbalance was uncommon but all patients required potassium supplementation in course of treatment. Neutrophilic leukocytosis was present in 44 (88%) cases, irrespective of presence of infection. Mortality was low (3, 6%). Conclusion: Diagnosis and treatment of DKA is not difficult if recognized early. So, high index of suspicion is necessary, particularly in previously undiagnosed cases. DOI: http://dx.doi.org/10.3329/birdem.v1i1.12380 Birdem Med J 2011; 1(1): 15-20

Histoplasmosis is a mild self-limiting respiratory illness in immune-competent individuals. It disseminates in immune-suppressed states like patients with human immunodeficiency virus (HIV) infection, haematological malignancies, post transplant states and patients receiving immunesuppressive therapy. Here we report a case of disseminated histoplasmosis in a 45 year old diabetic, returning worker who presented with fever, cough, rash, oro-genital ulcer and weight loss. He was anaemic, there was crepitation on lung auscultation and hepatomegaly. Diagnostic workup revealed HIV infection with disseminated histoplasmosis. Intravenous amphotericin B was started along with other supportive therapy and for anti-retroviral therapy he was sent to a referral center. Being an uncommon condition in our perspective, we are reporting the case. DOI: http://dx.doi.org/10.3329/bjmed.v24i2.20221 Bangladesh J Medicine 2013; 24 : 78-81

Relapsing polychondritis (RP)

Introduction: In 2020, during the epidemic of corona, this study was done to see the patterns of the cases of Poisoning, in a tertiary hospital in Dhaka city. Poisoning exposure in adults and teenagers are more often intentional (recreational or suicidal), may involve multiple agents, which are commonly pharmaceuticals, and may be delayed in diagnosis and treatment. Objective: To assess the pattern of cases of poisoning found in 2020 January to February 2021, management and outcome. Methods: This Observational study was performed at Square Hospital, Dhaka, exclusively over 40 poisoned patients. It included the cases of poisoning, admitted in 2020 January to 2021 February. The collected cases are of commuter poisoning, suicidal poisoning, methyl alcohol poisoning and poisoning with sedative agents by housemaids. All these cases were admitted initially in the ICU after the initial management given in the Department of emergency.Results: In total we managed 40 cases. Among the 22 cases of suicidal poisoning, sedative poisoning was 10, antidepressant were 4, anti-schizophrenic was 1, anticonvulsant were 2, paracetamol poisoning was 1, propranolol poisoning 1. We found 1 case of paracetamol poisoning, 1 case of mixed oral anti diabetic agents (dapagliflozin, sitagliptin, glimeperide, added with metformin) 1 case of unknown poisoning (as blood level of drugs revealed nothing may be because of late presentation). We also found 12 cases of methanol poisoning and 6 patients of unknown poisoning. Among them 3 patients was poisoned by housemaid, 3 patients were cases of street poisoning. Benzodiazepine was found in all these 6 cases. In other studies it is found that, street poisoning by sedative hypnotic drugs were the highest percentage (37%) and all were male. E. Most of the victims of street poisoning were business man (67.56%) rest were normal/domestic travelers (16.2%) and few were service holders (10.81%). E. There were financial loss (loss of money or expensive things) of the patients. In analysis of the causes behind suicidal poisoning in other studies it is also found that, 57% were due to familial disharmony, 23% were poverty related, 15% were due to failure in affairs, 11% were due to failure in the examination, 4% were due to sexual abuse and 5% due to chronic illness and unknown cause. E. Conclusion: In the year of 2020, January to December, it was observed that the cases of alcohol poisoning was reduced. But in 2021 January to February there was a rapid rise of cases (8 cases in 2 months, the number we found in whole year of 2020 was only 4).