Nowadays, schizophrenia is treated with atypical antipsychotics that can determine neuroleptic malignant syndrome or rhabdomyolysis appearance. In addition to trauma and muscular hypoxia, there are some drugs and toxins associated with rhabdomyolysis development, among which olanzapine. A case of severe rhabdomyolysis syndrome, with extremely high levels of serum creatine kinase (CK), followed by acute kidney failure, secondary to olanzapine overdose and prolonged immobilization is outlined. Continuous renal replacement therapy was performed, with a slow clearance of serum CK levels. Under supportive therapy, systemic alkalinisation with volume resuscitation and corticotherapy, patient’s general condition was improved, as well as his lower limb paresis. He followed frequent psychiatric evaluations and psychotherapies, before and after being transferred to a medical service. Rhabdomyolysis diagnosis is difficult in mild cases due to non-specific signs and symptoms, but it also has some typical manifestation, generically called “the rhabdomyolysis syndrome triad”. The treatment is usually supportive; renal replacement therapy is required in the presence of acute kidney injury unresponsive to aggressive volume resuscitation. The systemic myoglobin release is responsible for renal injury. Olanzapine muscle toxicity can lead to severe rhabdomyolysis syndrome complicated with acute kidney injury and multiple organ dysfunction syndrome. Rapid identification and aggressive therapeutic management are essential for improving patients’ outcome and prevent the occurrence of irreversible injuries.

Approximately 72% of patients with anaphylaxis present cardio-vascular manifestations, with only few reported cases of cardiogenic shock and cardiac arrest. Cephalosporins are the most used antibiotics for prophylaxis in the perioperative period with a prevalence of allergic reactions between 1-3%. Cefuroxime, a second-generation semisynthetic cephalosporin, presents relatively rare anaphylactic reactions (0.015%). Kounis syndrome is characterized by appearance of acute coronary syndrome in the presence of platelets, basophils or mast cells activation, due to an allergic reaction, hypersensitivity, anaphylactic reaction or shock. We report a rare case of a 53-year-old female patient with intraoperative anaphylactic shock following Cefuroxime-axetil routine test, complicated with Kounis syndrome and finally with cardiac arrest.

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Introduction:The prevalence of hypokalemia in psychiatric population is very high with eating disorders and laxative abuse being the main incriminated factors. Case presentation: We report a case of a 34-year-old woman with history of sleeve gastrectomy and breast implant, who presented for fatigue, severe myalgia, generalized hypotonia and palpitations. Laboratory exams revealed severe hypokalemia and rhabdomyolysis. The electrocardiography showed prolonged QT interval and ST segment depression with second-degree atrioventricular block. She received intravenous potassium supplementation with consecutive hydration. When potassium level was within safety limits, the patients received loop diuretics in order to decrease rhabdomyolysis and avoid kidney injury. The underlying cause was a pathological behavior, with frequent self-provoked episodes of nausea and vomiting after eating and chronic consumption of laxatives. She started psychotherapy. Conclusion: Psychiatric behaviour can lead to life-threatening conditions, therefore it should be discovered and managed promptly. RezumatIntroducere: Prevalenţa hipopotasemiei în rândul pacienţilor psihiatrici este foarte mare, tulburările alimentare și abuzul de laxative fi ind principalii factori incriminaţi. Prezentare de caz: Vă prezentăm cazul unei paciente de 34 ani, cu iantecedente de sleeve gastric și augmentare mamară cu proteze de silicon, care este admisă în unitatea de primiri urgenţe pentru oboseală, mialgie severă, hipotonie generalizată și palpitaţii. Investigaţiile de laborator evidenţiază hipopotasemie severă și rabdomioliză. Electrocardiografi a arată prelungirea segmentului QT, subdenivelare de segmente ST, cu bloc atrioventricular de gradul II. Paxcientei i se administrează clorură de potasiu intravenos, concomitent cu reechilibrarea volemică. În momentul în care nivelul potasiului este în limite de siguranţă, se instituie terapie diuretică cu scopul de a reduce rabdomioliza și a evita injuria renală acută. La baza acestor simptome și manifestări clinice și paraclinice se află un comportament patologic, cu episoade de vărsături auto-provocate după ingestia de alimente, precum și consumul cronic de laxative. Pacienta a început sedinţele de psihoterapie. Concluzie: Comportamentele psihiatrice pot fi ameninţătoare de viaţă, așadar, ar trebui identifi cate și tratate cu promptitudine. Cuvinte cheie: hipopotasemie, comportament psihiatric, interval QT prelungit, palpitaţii, rabdomioliză. CASE REPORTMirela TIGLIS et al.

Introduction: Acute hypoxemic respiratory failure may have different causes. Case presentation: We present the case of a 42-year-old woman, with history of recent thyroidectomy and a late history of sleeve gastrectomy, who presented for acute dyspnoea. The chest X-ray revealed hydropneumothorax, and, therefore, an intercostals chest tube drainage was inserted. The evolution was unfavourable, with further respiratory status deterioration. A computed tomography of the thorax and abdomen was performed, that revealed a dilated thoracic oesophagus and stenosis of the esophagogastric junction, with lack of substance in the oesophageal wall and extravasation of oesophageal content in the posterior mediastinum, due to an oesophageal pleural fi stula. An oesophageal stent was inserted under endoscopic guidance and the patient underwent minim-invasive surgical interventions for evacuation of the mediastinal and pleural collections, with a favourable evolution. Conclusions: Acute respiratory failure can be the face of multiple conditions, some of these can be life threatening and in need for rapid detection and treatment.