Enteral nutrition is the preferred mode of nutrition in critically ill patients whenever feasible as it has a number of advantages over parenteral feeding. Both gastric and small-bowel feeding can effectively deliver calories. In patients with gastroparesis, small-bowel feeding can help avoid parenteral feeding. We carried out a retrospective observational study to assess the ability to insert the Tiger 2 tube into the small bowel at the bedside in 25 patients who failed to tolerate gastric feeds. The time taken, rate of successful insertion, and ability to feed these patients using a standardized feeding protocol were noted. Success rate of insertion was 78% and feeding could be established. This method reduced the delays and risks associated with transportation and dependence on other specialties.

Introduction:Posterior reversible encephalopathy syndrome (PRES) is characterized by a range of clinico neuro radiological manifestation along with hypertension due to varied etiology. Contrary to its name, a small number of patients have residual neurological deficits. Patients with severe manifestation of PRES may get admitted to the Intensive Care Unit (ICU) due to coma or status epilepticus. Small case series and large multicenter studies have been reported.Materials and Methods:We report a single center series of ten cases admitted to ICU over a 5 year period in a tertiary care centre. We retrospectively analyzed patients, admitted to adult ICU with different etiologies, and diagnosed to have PRES. Outcome at discharge and at 90 days after ICU admission was noted.Result:The most common etiologies were medications. ICU admissions were mainly for uncontrolled hypertension, seizures, and low level of consciousness. All except one patient were ventilated. Four patients had residual neurological damage.Conclusion:Irrespective of the etiology, early control of blood pressure, and removal of precipitating factors is of paramount importance to prevent morbidity and mortality. Awareness about PRES among the intensivist is necessary to ensure early recognition and treatment.

Hyponatremia is one of the more common electrolyte abnormalities in clinical medicine. Some sources estimate that the number of patients who experience sodium levels of <135meq/L can be as high as 30% of all hospitalized patients. SIADH is the usual cause of Hyponatremia in patients with Varicella Zoster infection. Severe hyponatremia can cause substantial morbidity and mortality. The most common manifestations are CNS-related and include lethargy, confusion, disorientation and agitation. Serious manifestations include seizures, hypoxia and coma. We present here a report of an adult patient who presented with Varicella Zoster infection with seizures, agitation and unresponsiveness due to hyponatremia. Patient was on homeopathic medications and salt free diet since 3 days and was advised to take only free water to prevent exacerbations of skin lesions.

A bstract Coagulase-negative Staphylococcus (CoNS) represents one of the major nosocomial pathogen in multimorbid, immunosuppressed patients, especially with device-associated infections, often presenting with a diagnostic dilemma and aggressive antibiotic resistance. We report a case of a healthy young man with no comorbidities who succumbed to an extensive abdominal infection with Staphylococcus epidermidis and Staphylococcus schleiferi after an uneventful diagnostic procedure, despite aggressive antibiotic therapy and surgical source control. Early identification, diagnosis, and aggressive management of CoNS species is warranted depending on clinical scenario and should not be viewed as mere skin contaminants or physiological colonization. How to cite this article Abraham B, Gokhale AU, Mohsin J, Prakash S. Staphylococcous epidermidis , Staphylococcous schleiferi Infections: Are CoNS Cons? Indian J Crit Care Med 2020;24(8):716–718.

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