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The endocrinological emergency of a fully blown myxedema crisis can present as a multicolored clinical picture. This can obscure the underlying pathology and easily lead to mistakes in clinical diagnosis, work-up, and treatment. We present a case of an unconscious 39-year-old patient with a medical history of weakness, lethargy, and findings of hyponatremia, intracerebral bleeding, and massive pericardial effusion. Finally, myxedema crisis was diagnosed as underlying cause. Replacement therapy of thyroid hormone and conservative management of the intracerebral bleeding resulted in patient’s survival without significant neurological impairment. However, diagnostic pericardiocentesis resulted in life-threatening pericardial tamponade. It is of tremendous importance to diagnose myxoedema crisis early to avoid adverse health outcomes. [ABSTRACT FROM AUTHOR]

Background Hyponatraemia is common and its differential diagnosis and consequent therapy management is challenging. The differential diagnosis is mainly based on the routine clinical assessment of volume status, which is often misleading. Mid-regional pro-atrial natriuretic peptide ( MR-pro ANP) is associated with extracellular and cardiac fluid volume. Methods A total of 227 consecutive patients admitted to the emergency department with profound hypo-osmolar hyponatraemia (Na < 125 mmol L−1) were included in this prospective multicentre observational study conducted in two tertiary centres in Switzerland. A standardized diagnostic evaluation of the underlying cause of hyponatraemia was performed, and an expert panel carefully evaluated volaemic status using clinical criteria. MR-pro ANP levels were compared between patients with hyponatraemia of different aetiologies and for assessment of volume status. Results MR-pro ANP levels were higher in patients with hypervolaemic hyponatraemia compared to patients with hypovolaemic or euvolaemic hyponatraemia ( P = 0.0002). The area under the curve ( AUC) to predict an excess of extracellular fluid volume, compared to euvolaemia, was 0.73 [95% confidence interval ( CI) 0.62-0.84]. Additionally, in multivariate analysis, MR-pro ANP remained an independent predictor of excess extracellular fluid volume after adjustment for congestive heart failure ( P = 0.012). MR-pro ANP predicted the syndrome of inappropriate antidiuresis ( SIAD) versus hypovolaemic and hypervolaemic hyponatraemia with an AUC of 0.77 (95% CI 0.69-0.84). Conclusion MR-pro ANP is associated with extracellular fluid volume in patients with hyponatraemia and remains an independent predictor of hypervolaemia after adjustment for congestive heart failure. MR-pro ANP may be a marker for discrimination between the SIAD and hypovolaemic or hypervolaemic hyponatraemia. [ABSTRACT FROM AUTHOR]

Background: Dealing with paediatric trauma is far more than treatment of just small people with the armamentarium of adult care. The aim of this study was the analysis of diagnostic quality in German trauma services using the example of paediatric ankle trauma, which is directed to clarify the need for further specialism in physicians involved in the care of young patients. Methods: Employing a retrospective analysis of documented school or kindergarten accidents over a 10-year period a total of 621 ankle injuries of children up to the age of 13 years were identified. Of these, 433 cases were analysed on the basis of the accident report form and follow-up reports. A correct diagnosis was found in 57.6%, while in 42.4% the diagnosis did not meet requested child-specific standards. Conclusion: The data show that a number of physicians involved in the treatment of paediatric injuries is not sufficiently trained in paediatric injury patterns and potential complications. Establishing requirements in combination with continuous education should help to overcome these shortcomings in paediatric trauma care. [ABSTRACT FROM AUTHOR]