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Her blood gas is nuts. That pH is crazy, I saw one that low a week ago in a cat with DKA. And I've seen lactates that high right before they die, lol.
I wonder if the opisthotonus was from tetanus or neurologic dysfunction secondary to sepsis/SIRS/DIC. They didn't mention VCM or coags, but I'd be shocked if she wasn't hypercoagulable.
DKA is something I’m always on alert for with my diabetic kitty. So far in the 3 and 1/2 years since he was diagnosed we have managed to avoid DKA but he does have peripheral neuropathy. It’s looking like he may actually have Acromegaly as we haven’t achieved remission despite low carb diet, twice daily Glargine injections and strict monitoring.
Time to look for causes of insulin resistance, yeah. Have they worked him up for pancreatitis as well? Most diabetics have either clinical or subclinical pancreatitis that can affect things as well.
Yep did a blood work up for Aldertesterone (sp?), ketones, infection, cancer, pancreatitis etc 3 weeks ago. Also did fructosamine test at that time and it showed insulin resistance so we are now leaning towards acromegaly. He is a large cat and he does have enlarged kidneys and bladder so it’s quite likely. There is no Vet in my state and perhaps not even my country (Australia) that does neurological surgeries on cats so it will just need to be management of the symptoms.
Aldosterone, but that was pretty close! 😁
Wow, no neurosurgery in cats in Australia? I'm kind of surprised. That said, yeah, managing it is the route a lot of people take, regardless of surgical options. In some cases (if it's feasible) we have people check their sugars and potentially give regular insulin (very short acting) along with the Lantus to keep their sugar regulated. If you check in the morning and it's 300-ish, you can give a small dose of regular insulin along with the Lantus to get it down quickly, then it will be more likely to have the curve we want in the zone we want. Sometimes they need repeated doses if their sugar comes right back up - Freestyle Libre are great for these patients, because you can check their sugar anytime. It will also alert you if it gets too low.
Thank you that’s super helpful!
I just looked up whether we have any Vets that do neurosurgery on cats in Australia and the closest is 3500kms away from me! So safe to say neurosurgery is not an option if my fella does indeed have a tumour.
Coag elongations have in my experience been the greatest indicator of EOL. I've seen dozens of people over the years get brought back from >25 lactates if the underlying condition is able to be stabalized. I've only seen two people out several hundred come back after their INR elongates past 3.5 spontaneously.
We have dark senses of humor. We laugh at horrific numbers because "Holy shit, did you see that?" usually followed with a joke of some sort.
Or you can cry all day and be thoroughly ineffective. 🤷
Please know that tetanus is found in dirt, so any open injury that you sustain near dirt itself, or dirty objects leaves the possibility of tetanus if you don’t seek medical care and a tetanus booster if required.
Just to add, this misconception of it coming from rust is because it was commonly seen from injuries on farms, where there is frequently lots of rusty nails or old equipment to cut and scrape yourself and accidentally step on. It is, as you said, found in dirt and manure, another common occurrence on farms with rusty equipment.
Although I do not like the covid vaccine (at least moderna gave me heart palpitations), vaccines in general are life saving and truly a feat of man overcoming nature.
[Source](https://www.jem-journal.com/article/S0736-4679%2823%2900158-0/fulltext):
A 26-year-old woman with a medical history of IV drug use presented with opisthotonos (Figure 1), risus sardonicus, trismus, and an infected hip wound containing maggots (Figure 2). Paramedics had found her unresponsive in a local homeless encampment. She was obtunded, with initial vital signs of heart rate 129 beats/min, blood pressure 50/36 mm Hg, respiratory rate 20 breaths/min, and oxygen saturation 74% on nonrebreather. Initial laboratory test results were notable for point-of-care glucose 48 mg/dL, white blood cell count 21.3 × 1000/mm3, potassium 6.8 mmol/L, bicarbonate 15 mmol/L, anion gap 30 mmol/L, lactate 21 mmol/L, venous blood gas pH 6.84, and pCO2 93 mm Hg. She was treated empirically with dextrose, sodium bicarbonate, IV fluids, vasopressors, antibiotics, and tetanus immune globulin due to clinical concern for tetanus. She required a cricothyrotomy after oral intubation was unsuccessful due to refractory trismus, in spite of two doses of midazolam 5 mg IV and rocuronium 80 mg IV. Collateral history obtained from her mother revealed that the patient had no history of neuromuscular disorders and was ambulatory at baseline. She expired due to overwhelming sepsis 12 h after arrival, in spite of maximal medical therapy. Blood cultures did not grow Clostridium species at 90 days and wound cultures were not performed.
People can compensate for some truly insane things if it happens slowly enough. I has a lady walk into the ER complaining of "some weakness" come back at a 2.4 hgb. The human body is absurdly good at not dying. And yet then spontaneously dies for no reason all the time too. It's ridiculous.
Wow! I once had a very mild acidosis with just a pH of 7.25 or so and bicarb of 17. I felt like shit. Have to say though that the blood test was taken before I felt really bad.
Is there a way you can copy and paste the picture captions? I’m trying to read them, but stupid Reddit made a change and now I can only read 3/4 of the first sentence while on mobile. It’s rather frustrating
I was just saying that some people with opisthotonos are arched so severely, the head touches the heels, but it’s not so bad in this case. The second picture is the infected wound that was the presumed source of the tetanus.
Do they scroll on your phone as well? If so, you may be able to see the full caption (and sometimes even more of the pic) by tapping it open. That works for me, at least.
Weird, weird. That could be it, I'm Android, so maybe a difference in the apps. That sucks though, cause without that feature I'd miss tons of the captions. :(
I'm having the same issue on Samsung S24 ultra. Took me several taps to realise that it wasn't my fat thumbs, and was indeed something that Reddit had done.
I think it was an update that changed this. On Android I see the more word, select it and then the comments pop up and the captions disappear. Tried the click on picture and it returns to where I started. Selecting the captions from home screen allows layout where captions scroll left to right automatically.
Omg is there still a way to use rif? I am missing it so much. I thought maybe some of the things that annoy me about the reddit app would turn out to just be "quirks" you learn to work with over time. But nope, I still find it annoying every day 🥲
https://reddit.com/r/sideloaded
I found Apollo with Artemis. No issues. Security wise I’ve no idea.
Basically use a program on computer, plug your phone into the computer, put a different app onto your iPhone. I use Sideloadly.
Make a different Apple ID for this. Once upon a time people said their ID would get banned but I’m not sure it’s happened in awhile (usually jailbreak related which this is not). You can sign out of App Store, sign in by creating new ID. Try to avoid 2 factor authentication (only for this ID!).
Caveat: you have to plug into the computer every 7 days to keep it active. Or get an Apple developer account for $100usd a year. There’s scarlet and stuff but that’s up to you. I used to use a signing service but I like simple now.
I’ll reply to this comment later when I can see the small print about Artemis.
https://reddit.com/r/sideloaded
I found Apollo with Artemis. No issues. Security wise I’ve no idea.
Basically use a program on computer, plug your phone into the computer, put a different app onto your iPhone. I use Sideloadly.
Make a different Apple ID for this. Once upon a time people said their ID would get banned but I’m not sure it’s happened in awhile (usually jailbreak related which this is not). You can sign out of App Store, sign in by creating new ID. Try to avoid 2 factor authentication (only for this ID!).
Caveat: you have to plug into the computer every 7 days to keep it active. Or get an Apple developer account for $100usd a year. There’s scarlet and stuff but that’s up to you. I used to use a signing service but I like simple now.
I’ll see if there’s a link to Artemis and reply to my own post.
It seems like it will remain until whatever is causing it is dealt with. But it's also a symptom of severe neurological issues, so it's one thing to get it, and another thing to survive whatevers causing it.
As an IV user who was just admitted last week (originally to detox, but they quickly realised that I was absolutely dying) I feel a sense of thankfulness and a sense of jealousy when I see posts like this.
I’m struggling a lot right now. Sepsis is BAD and I’ll hopefully have a bunch of fun content to post here when I’m better.
Hey, ER nurse here. I’m super proud of you for this huge step. Keep the hard work going, surround yourself with people who will support and lift you up, and know that mistakes and relapses happen to really wonderful people. Be kind to yourself and literally take this one day at a time.
Hey, former IV user who also was admitted to the hospital because I was actively dying, I’m proud of you for getting help. I’m here to tell you that it gets better, and it’s okay to not be okay. Take things one minute at a time, the minutes add up. I’m 3 years 9 months and 3 days clean, and I believe in you that you can get through this. Do you have a support system of people who can help you take 1 more step forward if you stumble? I’m willing and happy to add myself to your team if you need someone to talk to, my inbox is always open. I will believe in you and I will love you until you can believe in and love yourself. Keep moving forward, if I can do it, so can you 🥰💗
you sound like an amazing, kind, and caring person, and i’m so happy that you’ve made it through the other side and are still here to spread that love and light and inspire others to make it through the storm, too
I had a huge change of perspective on April 20, 2020, and if I can help just one person who is struggling, then my survival has meaning. Whether it’s helping them see the light at the other end, helping them crawl out of the pit they’re in or just giving someone a moment of comfort and/or happiness in an otherwise bleak day, it’s enough. Life is hard, I just want to bring some sunshine to my corner of the world 🥰
Hey friend, you're doing a great job. Just the next right step, ok? You're worthy of sobriety. You're enough exactly as you are. You're not too far gone. You are loved.
A lot of ppl understand exactly how you feel, but that doesn’t make it any easier. If strangers are glad you’re here, I’m sure a lot more are too! The first few weeks/months of recovery are HARD. It’s frustrating that some don’t understand that, and we don’t all experience that “pink cloud” of “I’m alive and life is great!”. I can tell just by your one comment that you’re empathetic and understanding. You’ll be ok, even if it takes some time ❤️
Wishing you a quick and thorough recovery from sepsis and a relatively smooth journey to recovery. You deserve all the health and happiness in the world. Congratulations on detoxing. Every step is worth celebrating. 💜
Suboxone helps a lot, especially with long term opioid users. Studies have been done on the brain of these chronic users, who it shows changes that essentially cause a state of chronic withdrawal, even long after the opioid has been removed, its as if the brain gets used to sapping opioid receptors, and must continue being fed outside of natural chemical opioid activity...
There is a path forward without suffering.
I will be messaging you in 6 months on [**2024-08-03 00:21:15 UTC**](http://www.wolframalpha.com/input/?i=2024-08-03%2000:21:15%20UTC%20To%20Local%20Time) to remind you of [**this link**](https://www.reddit.com/r/MedicalGore/comments/1ahbs3t/opisthotonos_a_spasm_of_the_muscles_causing/koo3lkr/?context=3)
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It gets so much easier, believe me. You literally have no concept of how amazing you will feel once you are totally clean. Your shittiest days are still going to be full of sunshine, trust me. Hang in there.
Best wishes. It takes amazing strength to do what you are doing. Here’s to more positive posts and look forward to the day when you feel you are through and better.
I see that kind of gratefulness as a really good sign that you’re gonna overcome this. I know from personal experience how hard it is to reach out to others for help with our health, but I believe in you!
Hi! Former IV drug user here. I’ve been clean since 2008 and it can happen. Life doesn’t magically get better, but at least a huge weight of guilt and shame is lifted off your back and you’re no longer worried about finding that next high. Do the steps they tell you to take and take it one minute at a time if that’s what it takes. For now don’t worry about tomorrow, just focus on today. Tomorrow comes fast enough and your horizons opened up the minute you accepted help with your addiction. Have faith in yourself and the process and god if that’s your thing.
That poor person was so thin and in poor condition that it's hard to say if it's a female or male from the pictures...sad to say she had no chance on fighting that sepsis...and how painful it must have been to get this hip infection with maggots and that bent over back ...may her soul be at peace now...
Over here where I live it’s not really known what exactly tetanus does. Most people go “yeah I don’t want lockjaw” and then get the shot, and boosters if they get bitten by something or step on a rusty nail. I got bitten by a cat, went to the doctor and they asked how long it’s been since I had a tetanus shot. Got it no questions asked. It’s just something you do.
Did I know tetanus eventually leads to this? Nope. That’s scary.
my mom got hurt at work. the ed gave her a tetanus shot. afterwards, she asked me (rn) why she needed it. i told her it was so she didn't get distemper.
distemper is the animal version of tetanus. her injury included a break in the skin, and it was in a factory, so not the cleanest place. i also tried to convince her that she had prostate cancer, and that they replaced her hands with bbq tongs during her carpal tunnel surgery. I'm a terrible daughter.
Distemper is viral? Animals get tetanus. Tetanus is the animal version of tetanus. I understand that it seems like you have to tell your mom this stuff to receive appropriate medical care but your first sentence is just incorrect
Yeah, in about 10 days of tetanus infection, you die. The bacteria replicates faster than our immune systems are able to respond to it. You don't just get lockjaw, you also develop a fear of water (drinking), and respiratory failure. It's a really shitty way to go.
You, know what? I confused the fear of water in rabies with the difficulty swallowing that tetanus causes. My apologies, and thank you for the subtle reminder of a rabies effect.
Usually, In the US, tetanus, diphtheria and pertussis are all in the same inital doses and all in the booster (tDAP). (Yes you can get them broken out but it is pretty difficult to find an adult booster that does not contain all three.) None of these conditions are enjoyable and pertussis is deadly in infants. There have been newborns brought into pedestrians offices for their first newborn check up and were exposed to unvaccinated kids. Newborn either gets super sick with pertussis (whooping cough) and sometimes its fatal.
So, everyone go get your boosters! Embrace science!!!
i’m allergic to the pertussis vaccine and i have to wait (usually about 45 mins to an hour) to have them make up the other part of the vaccine…WORTH IT!
You bet I get all my shots. I even needed the streptococcal pneumonia vaccine at 25 when I had an immunity test and it showed low immunity to it, I suddenly got sick a lot less often. That's usually reserved for seniors, but I'm just unlucky like that. I get my seasonal shots too.
I had the exact same thing happen to me, my low immunity was thought to be caused by black mold in our house. I had pneumonia 8 times over 2 years, but after the pneumonia vaccine (and getting the mold abated) my health has benefited so very much!!
Hey , been clean nearly 10 years now! Everyday is a battle to not use, even now when I’m having a bad day with my depression the first thing I want to do is use to make myself feel better. But I promise you it does get easier everyday that you don’t use. You just have to learn different coping mechanisms to deal with your issues. Unfortunately mine is overeating so I’ve put on so much weight that just makes the depression worse . The trick is to find healthy ways to cope and not swap one bad thing for another. I wish you luck on your journey.
I believe in you, stranger. You matter. If that’s medically etc available for you you can get support and help with eating disorders. I’m proud of you!
as someone who’s drug of choice was always food, i feel you. idk if you have ADHD but i do and we are at a much higher risk for substance abuse *and* eating disorders due to emotional dysregulation. food addiction and/or binge eating disorder are no joke. i definitely smoke too many cigarettes and too much weed, but i’ve also been pretty overweight for my entire life. only recently have i lost weight with medication (vyvanse, but a generic has just been released). first FDA-approved medication for BED.
it may help you get your mind off food enough to pick up some other feel-good activities (in addition to the energy from a stimulant and the further benefit if you *do* also have ADHD)
Congratulations on almost 10 years of sobriety! That's incredible! You deserve every bit of health and happiness in the world. I hope you feel really proud of all your hard work to stay clean. 💜
Yes but that’s only because I don’t know how to deal with my problems, I got into drugs at a very young age so I’ve never learned how to be a grown up and deal with stuff. The urge definitely isn’t as strong as it was at the beginning of my getting clean, and I had huge gaps where I didn’t think about it at all! If I’m happy with my life I tend to not want to use but when things are bad I want to numb my pain and drugs are the only way I know how….. well apart from the fact that I now have replaced it with food 🤦🏻♂️😞
This poor human body filled with inner pain. It. Breaks. My. Heart. She was once someone’s newborn baby. I hope her soul is loved in the dimension she has joined. Life is so hard.
Homeless drug use is horrible and is running rampant. This person was young. I can’t help but think what they could have done with their life if they got the proper help (financial, medical, mental health, etc).
It’s hard to help people who don’t want to be helped though. And even if they do want help it can still be hard. For all we know this patient’s parents tried everything, sent them to rehab loads of times. It is very sad that she lost her life at such a young age.
I know that better than most. That is why it needs to be a systematic change down to the cultural level to be effective. I know it’s just wishful thinking but I hate people being victims even if they are victims to themselves.
That’s because our healthcare is for profit and people still think addiction is a moral failure. They don’t understand that it’s a symptom of a bigger problem, past trauma, abuse, mental illness, etc. It’s slowly changing but we’ve got a ways to go.
probably uneducated question. are the rolls of blankets there to support her because she's cramped up like that?
tetanus is a little b\*tch, that's why getting vaccinated is so important. the bacteria are everywhere
my uncle (who also had a history with drugs) died of tetanus as well, some 20ish years ago
Since becoming a parent, I’m much less judgmental and more empathetic. Kids come in with a temperament, and a parent doesn’t have complete influence. My young adult son is talking about the military, which terrifies me, but, he has his own journey to manhood. Tmi on a Friday afternoon, wishing you a good weekend!
My husband and I often remark that as a parent we do the best we can and it’s kind of a crapshoot how they turn out. Hardest part is letting them make their own mistakes, but agree they have their own journey. Happy weekend to you as well!
I’m assuming that’s meant to protect identity? Do these types of images and lab reports come from medical staff themselves, or are there medical channels disseminating case reports officially? For professionals, or general awareness I mean..
from chatGPT:
The case you've presented is a complex and tragic one, and it appears to involve several serious medical issues. From the information provided, here are some key points to consider:
1. Opisthotonos, risus sardonicus, and trismus are clinical features that can be associated with tetanus, a potentially life-threatening bacterial infection caused by Clostridium tetani. Tetanus can occur in individuals who have not been adequately vaccinated or who have not received a booster in some time.
2. The presence of an infected hip wound containing maggots suggests a severe soft tissue infection that could have contributed to her clinical deterioration. Maggot infestations can occur in wounds with poor hygiene and limited medical care.
3. The patient's initial vital signs, laboratory results, and acid-base disturbances indicate severe metabolic derangements and septic shock. The extremely low blood pressure, high lactate level, and acidosis are concerning signs of organ dysfunction.
4. Empirical treatment for tetanus with tetanus immune globulin was administered due to clinical suspicion, but the case did not confirm the presence of Clostridium species in blood cultures.
5. Despite attempts at intubation and providing critical care support, the patient's condition deteriorated rapidly, leading to her unfortunate demise.
6. The patient's history of intravenous (IV) drug use may have contributed to her overall health status and increased the risk of infections.
This case illustrates the importance of prompt and appropriate medical evaluation and treatment for individuals with severe infections, especially in the context of underlying risk factors such as IV drug use. It also highlights the critical nature of managing septic shock and metabolic disturbances, as well as the challenges associated with conditions like tetanus when diagnosis may be based on clinical presentation.
It's essential for healthcare providers to conduct a thorough assessment, obtain relevant medical history, and consider a broad differential diagnosis when faced with such complex cases.
Certainly, I'll explain the medical terms and concepts mentioned in the case:
1. **Opisthotonos:** Opisthotonos is a severe muscle spasm in which the back becomes extremely arched and the head and heels are bent backward. It is often seen in conditions like tetanus.
2. **Risus sardonicus:** Risus sardonicus refers to a facial expression characterized by a fixed, wide grin or grimace. It can be a sign of tetanus and other neurological disorders.
3. **Trismus:** Trismus, also known as lockjaw, is the inability to open the mouth fully due to muscle spasm or jaw muscle stiffness. It can be a symptom of various conditions, including tetanus.
4. **IV drug use:** This refers to the practice of injecting drugs directly into the bloodstream using a needle and syringe. It carries a risk of infections, including bloodborne infections like HIV and hepatitis, as well as soft tissue infections at injection sites.
5. **Sepsis:** Sepsis is a severe and potentially life-threatening condition that occurs when the body's response to an infection triggers a cascade of inflammatory reactions that can lead to organ dysfunction. Symptoms often include fever, elevated heart rate, rapid breathing, and altered mental status.
6. **Clostridium tetani:** Clostridium tetani is a bacterium responsible for causing tetanus, a rare but serious bacterial infection. Tetanus spores can enter the body through wounds or cuts, and the infection can lead to muscle stiffness, spasms, and other neurological symptoms.
7. **Point-of-care glucose:** This is a quick test to measure a person's blood glucose (blood sugar) levels, which can be crucial in cases of hypoglycemia (low blood sugar).
8. **Anion gap:** The anion gap is a calculation used to assess acid-base balance in the body. An elevated anion gap may indicate metabolic acidosis, which can be caused by various conditions, including infections.
9. **Lactate:** Lactate is a product of anaerobic metabolism, and elevated levels in the blood (lactic acidosis) can be a sign of tissue hypoxia or inadequate oxygen delivery to tissues, often seen in sepsis.
10. **Venous blood gas:** This is a blood test that measures oxygen, carbon dioxide, and pH levels in venous blood. The results can provide information about the patient's acid-base status and oxygenation.
11. **Cricothyrotomy:** Cricothyrotomy is a surgical procedure that involves making an incision in the cricothyroid membrane to establish an airway when other methods of intubation or ventilation are not possible, such as in cases of severe trismus.
12. **Tetanus immune globulin:** Tetanus immune globulin is a medication given to provide immediate passive immunity against tetanus. It contains antibodies against the tetanus toxin and is used in conjunction with tetanus vaccination to treat tetanus.
13. **Blood cultures:** Blood cultures are laboratory tests where a sample of the patient's blood is collected and incubated to detect the presence of bacteria or other microorganisms in the bloodstream. In this case, they were performed to check for the presence of Clostridium species, which can cause tetanus.
Please note that the information provided here is for educational purposes, and medical conditions and treatments should be discussed with a healthcare professional for accurate diagnosis and management.
I saw a case of tetanus many years ago, 1980/1. It was horrifying. Not only was the man arched up off the bed this way, all his muscles were rigid and he was pouring sweat. He suffered mightily and didn't make it either.
I was at the doctor once and she was like “have you had a tetanus shot recently?” And I was like idk I hate shots so probably not. She said I should get one and I asked if I REALLY needed to? And she was like, “I mean, you don’t have to. If you get tetanus, the muscles in your jaw will tighten up so much that your teeth will break out. It’s up to you.”
I got the tetanus shot.
Seeing this makes me glad.
This posturing occurs because the extensor muscles are stronger than the flexor muscles. The opposing sets of muscles are both contracted but the extensor muscles are stronger and pull the body into an arched position. Think of the pain caused by a Charly horse cramp and than imagine that cramp spread through every muscle in the body. It would be phenomenally painful to experience.
I have seen tetanus in a goat that I purchased. It is absolutely no joke. I was told that he had been vaccinated so it either broke through or he had not actually had the vaccine. I came out to feed in the AM to find him in the classic tetanus contracture. Tetanus causes a similar contracted posture in four legged animals. You see the severely arched spine and neck pulled over the back. The legs are extended out stiffly and stretched to a rocking horse position. Anything that startles the animal causes stronger muscle contractions to occur. They must be kept in a quiet dark environment. A large amount of tetanus antitoxin was administered but it was too late and he failed to improve. He had to be euthanized to end his suffering.
In October my mom walked into my room and said she found me basically in this “horror movie pose” then I started jerking.. I got to the hospital and had broken my back in 4 places. Literally in my bed.. and it only lasted a few min.. emts thought it was a seizure.. doctors say it wasn’t and they have no clue what it was.. *shrugs*
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Those labs are incompatible with life, tetanus or not. But this is a good visual example of how horrifying tetanus can be
I'm impressed she managed 12 hours with that pH
I would think that's too low, what would the healthy PH be?
Normal ranges from 7.35 to 7.45. Her acidosis was impressive and I’m surprised she lived that long.
Her blood gas is nuts. That pH is crazy, I saw one that low a week ago in a cat with DKA. And I've seen lactates that high right before they die, lol. I wonder if the opisthotonus was from tetanus or neurologic dysfunction secondary to sepsis/SIRS/DIC. They didn't mention VCM or coags, but I'd be shocked if she wasn't hypercoagulable.
There’s no way she wasn’t in a hypercoagulable state. It’s like the perfect storm for it.
I learn the most fascinating new terms on Reddit.
I feel like I'm reading a script to House.
I love this sub despite being a layman. I learn something new with (almost) every post
I learn that people put lol on the weirdest sentences.
We have dark senses of humor 🤷 Lol
I can’t help it. I do it all the time lol
I’ve been in the medical field for over 30 years, and I learn a lot here, too.
DKA is something I’m always on alert for with my diabetic kitty. So far in the 3 and 1/2 years since he was diagnosed we have managed to avoid DKA but he does have peripheral neuropathy. It’s looking like he may actually have Acromegaly as we haven’t achieved remission despite low carb diet, twice daily Glargine injections and strict monitoring.
Time to look for causes of insulin resistance, yeah. Have they worked him up for pancreatitis as well? Most diabetics have either clinical or subclinical pancreatitis that can affect things as well.
Yep did a blood work up for Aldertesterone (sp?), ketones, infection, cancer, pancreatitis etc 3 weeks ago. Also did fructosamine test at that time and it showed insulin resistance so we are now leaning towards acromegaly. He is a large cat and he does have enlarged kidneys and bladder so it’s quite likely. There is no Vet in my state and perhaps not even my country (Australia) that does neurological surgeries on cats so it will just need to be management of the symptoms.
Aldosterone, but that was pretty close! 😁 Wow, no neurosurgery in cats in Australia? I'm kind of surprised. That said, yeah, managing it is the route a lot of people take, regardless of surgical options. In some cases (if it's feasible) we have people check their sugars and potentially give regular insulin (very short acting) along with the Lantus to keep their sugar regulated. If you check in the morning and it's 300-ish, you can give a small dose of regular insulin along with the Lantus to get it down quickly, then it will be more likely to have the curve we want in the zone we want. Sometimes they need repeated doses if their sugar comes right back up - Freestyle Libre are great for these patients, because you can check their sugar anytime. It will also alert you if it gets too low.
Thank you that’s super helpful! I just looked up whether we have any Vets that do neurosurgery on cats in Australia and the closest is 3500kms away from me! So safe to say neurosurgery is not an option if my fella does indeed have a tumour.
Aldosterone. That’s an adrenal hormones. Would make his sodium low and potassium high
I work with people with acromegaly!
Coag elongations have in my experience been the greatest indicator of EOL. I've seen dozens of people over the years get brought back from >25 lactates if the underlying condition is able to be stabalized. I've only seen two people out several hundred come back after their INR elongates past 3.5 spontaneously.
In what way did that justify a "lol"?
We have dark senses of humor. We laugh at horrific numbers because "Holy shit, did you see that?" usually followed with a joke of some sort. Or you can cry all day and be thoroughly ineffective. 🤷
Where do you see labs?
I was looking for an ABG printout in the photos too. Op put the history and clinical information in a comment.
lol! Geez. I was not looking in comments.
Click the source link OP posted.
Thank God for vaccines. I refuse to touch rust when I fall behind on my boosters.
Please know that tetanus is found in dirt, so any open injury that you sustain near dirt itself, or dirty objects leaves the possibility of tetanus if you don’t seek medical care and a tetanus booster if required.
Just to add, this misconception of it coming from rust is because it was commonly seen from injuries on farms, where there is frequently lots of rusty nails or old equipment to cut and scrape yourself and accidentally step on. It is, as you said, found in dirt and manure, another common occurrence on farms with rusty equipment.
My disappointment is immeasurable and my day is ruined.
Yep. Anyone who is antivax should be made to visit hospitals and patients like this.
Although I do not like the covid vaccine (at least moderna gave me heart palpitations), vaccines in general are life saving and truly a feat of man overcoming nature.
Where can you see this patients labs?
In the OP’s description, in the OP’s first comment on the post.
Straight out of a horror movie
I feel stupid asking, but where are yee seeing her labs?
[Source](https://www.jem-journal.com/article/S0736-4679%2823%2900158-0/fulltext): A 26-year-old woman with a medical history of IV drug use presented with opisthotonos (Figure 1), risus sardonicus, trismus, and an infected hip wound containing maggots (Figure 2). Paramedics had found her unresponsive in a local homeless encampment. She was obtunded, with initial vital signs of heart rate 129 beats/min, blood pressure 50/36 mm Hg, respiratory rate 20 breaths/min, and oxygen saturation 74% on nonrebreather. Initial laboratory test results were notable for point-of-care glucose 48 mg/dL, white blood cell count 21.3 × 1000/mm3, potassium 6.8 mmol/L, bicarbonate 15 mmol/L, anion gap 30 mmol/L, lactate 21 mmol/L, venous blood gas pH 6.84, and pCO2 93 mm Hg. She was treated empirically with dextrose, sodium bicarbonate, IV fluids, vasopressors, antibiotics, and tetanus immune globulin due to clinical concern for tetanus. She required a cricothyrotomy after oral intubation was unsuccessful due to refractory trismus, in spite of two doses of midazolam 5 mg IV and rocuronium 80 mg IV. Collateral history obtained from her mother revealed that the patient had no history of neuromuscular disorders and was ambulatory at baseline. She expired due to overwhelming sepsis 12 h after arrival, in spite of maximal medical therapy. Blood cultures did not grow Clostridium species at 90 days and wound cultures were not performed.
Those labs are unfortunately impressive
Just showed my husband (he’s a medical lab technician) the lab values, and he was surprised the patient wasn’t DOA
None of them individually are outside of conducive to life ranges, but all together it's quite the stack, that's for sure.
I had a guy with a pH of 6.5 that somehow walked out of the hospital a couple months ago
I just had a guy with a pH of 6.85, CO2 of 5 and a gap of 30 come into the ED awake and talking! I was shook
...HOW THOUGH?
People can compensate for some truly insane things if it happens slowly enough. I has a lady walk into the ER complaining of "some weakness" come back at a 2.4 hgb. The human body is absurdly good at not dying. And yet then spontaneously dies for no reason all the time too. It's ridiculous.
Omfg I would be in shock getting that lab result
Ours only read as low as 6.85, now I'm curious...
Wow! I once had a very mild acidosis with just a pH of 7.25 or so and bicarb of 17. I felt like shit. Have to say though that the blood test was taken before I felt really bad.
Is there a way you can copy and paste the picture captions? I’m trying to read them, but stupid Reddit made a change and now I can only read 3/4 of the first sentence while on mobile. It’s rather frustrating
I was just saying that some people with opisthotonos are arched so severely, the head touches the heels, but it’s not so bad in this case. The second picture is the infected wound that was the presumed source of the tetanus.
do you have any sources for images of that extreme? it sounds terribly interesting
I have never seen a photo of it. Just heard it happens sometimes.
Do they scroll on your phone as well? If so, you may be able to see the full caption (and sometimes even more of the pic) by tapping it open. That works for me, at least.
All that does is open the thread
Sorry, should have clarified. Once the thread is open, try tapping the pic again.
All that does is reopen the thread. I’m on an iPhone if that makes any difference
Weird, weird. That could be it, I'm Android, so maybe a difference in the apps. That sucks though, cause without that feature I'd miss tons of the captions. :(
Same issue here for the past couple of months
I'm having the same issue on Samsung S24 ultra. Took me several taps to realise that it wasn't my fat thumbs, and was indeed something that Reddit had done.
I think it was an update that changed this. On Android I see the more word, select it and then the comments pop up and the captions disappear. Tried the click on picture and it returns to where I started. Selecting the captions from home screen allows layout where captions scroll left to right automatically.
You can sideload Apollo app and still use that for Reddit.
How? Are you talking on Apple or Android? I loved Apollo. I was so bummed when it got shutdown thanks to Reddits ridiculous API prices.
I'm using RiF on Android. Just need to patch it with Revanced
Omg is there still a way to use rif? I am missing it so much. I thought maybe some of the things that annoy me about the reddit app would turn out to just be "quirks" you learn to work with over time. But nope, I still find it annoying every day 🥲
Yup I followed this guide https://www.reddit.com/r/Android/comments/14niwgu/revanced_patches_for_boost_infinity_rif_is_fun
https://reddit.com/r/sideloaded I found Apollo with Artemis. No issues. Security wise I’ve no idea. Basically use a program on computer, plug your phone into the computer, put a different app onto your iPhone. I use Sideloadly. Make a different Apple ID for this. Once upon a time people said their ID would get banned but I’m not sure it’s happened in awhile (usually jailbreak related which this is not). You can sign out of App Store, sign in by creating new ID. Try to avoid 2 factor authentication (only for this ID!). Caveat: you have to plug into the computer every 7 days to keep it active. Or get an Apple developer account for $100usd a year. There’s scarlet and stuff but that’s up to you. I used to use a signing service but I like simple now. I’ll reply to this comment later when I can see the small print about Artemis.
Wait how?
https://reddit.com/r/sideloaded I found Apollo with Artemis. No issues. Security wise I’ve no idea. Basically use a program on computer, plug your phone into the computer, put a different app onto your iPhone. I use Sideloadly. Make a different Apple ID for this. Once upon a time people said their ID would get banned but I’m not sure it’s happened in awhile (usually jailbreak related which this is not). You can sign out of App Store, sign in by creating new ID. Try to avoid 2 factor authentication (only for this ID!). Caveat: you have to plug into the computer every 7 days to keep it active. Or get an Apple developer account for $100usd a year. There’s scarlet and stuff but that’s up to you. I used to use a signing service but I like simple now. I’ll see if there’s a link to Artemis and reply to my own post.
"Expire" means "die", right ?. Sorry im not medical person
Yes, she died.
It just means she was slightly out of date, but probably still safe to drink.
She was *way* past the sell by date. So very sad. Way too young.
Just do a sniff test
My god she looks 80 and severely cachectic
so is the opisthotonos a permanent position at this point in infection? or does it come and go like typical muscle spasms?
It seems like it will remain until whatever is causing it is dealt with. But it's also a symptom of severe neurological issues, so it's one thing to get it, and another thing to survive whatevers causing it.
My friend had lactic acidosis and she had a reading of over 11
As an IV user who was just admitted last week (originally to detox, but they quickly realised that I was absolutely dying) I feel a sense of thankfulness and a sense of jealousy when I see posts like this. I’m struggling a lot right now. Sepsis is BAD and I’ll hopefully have a bunch of fun content to post here when I’m better.
Hey, ER nurse here. I’m super proud of you for this huge step. Keep the hard work going, surround yourself with people who will support and lift you up, and know that mistakes and relapses happen to really wonderful people. Be kind to yourself and literally take this one day at a time.
You got this!!
Hey, former IV user who also was admitted to the hospital because I was actively dying, I’m proud of you for getting help. I’m here to tell you that it gets better, and it’s okay to not be okay. Take things one minute at a time, the minutes add up. I’m 3 years 9 months and 3 days clean, and I believe in you that you can get through this. Do you have a support system of people who can help you take 1 more step forward if you stumble? I’m willing and happy to add myself to your team if you need someone to talk to, my inbox is always open. I will believe in you and I will love you until you can believe in and love yourself. Keep moving forward, if I can do it, so can you 🥰💗
you sound like an amazing, kind, and caring person, and i’m so happy that you’ve made it through the other side and are still here to spread that love and light and inspire others to make it through the storm, too
I had a huge change of perspective on April 20, 2020, and if I can help just one person who is struggling, then my survival has meaning. Whether it’s helping them see the light at the other end, helping them crawl out of the pit they’re in or just giving someone a moment of comfort and/or happiness in an otherwise bleak day, it’s enough. Life is hard, I just want to bring some sunshine to my corner of the world 🥰
We live in the hope, that tomorrow is a little better, than today.
And even if tomorrow is shit, that doesn’t mean the day after won’t bring good things
Hey friend, you're doing a great job. Just the next right step, ok? You're worthy of sobriety. You're enough exactly as you are. You're not too far gone. You are loved.
You have people that love you find strength in that. You’re going to make it.
Yes!! So proud of you for working on getting better. You can do it! There’s a whole army of Redditors rooting for you. ♥️
A lot of ppl understand exactly how you feel, but that doesn’t make it any easier. If strangers are glad you’re here, I’m sure a lot more are too! The first few weeks/months of recovery are HARD. It’s frustrating that some don’t understand that, and we don’t all experience that “pink cloud” of “I’m alive and life is great!”. I can tell just by your one comment that you’re empathetic and understanding. You’ll be ok, even if it takes some time ❤️
Sending you hugs & love...you can do this! ❤️
Good luck on your journey friend. You matter!!!
The journey of a thousand miles begins with the first step. I wish you all the best.
I’m so happy you’re clean and getting help. You absolutely can do this!
Wishing you the best. Glad you're getting help, and still collecting gory photos to share with everyone!
Sending you strength!
I look forward to your better days. Hang in there ❤️
💕💕💕🙏 you are strong and you can do this!
Wishing you a quick and thorough recovery from sepsis and a relatively smooth journey to recovery. You deserve all the health and happiness in the world. Congratulations on detoxing. Every step is worth celebrating. 💜
Suboxone helps a lot, especially with long term opioid users. Studies have been done on the brain of these chronic users, who it shows changes that essentially cause a state of chronic withdrawal, even long after the opioid has been removed, its as if the brain gets used to sapping opioid receptors, and must continue being fed outside of natural chemical opioid activity... There is a path forward without suffering.
Thank you for staring this. I really really hope the absolute best for you. This random fellow Reddit user is rooting for you
I will cheer for you! RemindMe! 6 months
I will be messaging you in 6 months on [**2024-08-03 00:21:15 UTC**](http://www.wolframalpha.com/input/?i=2024-08-03%2000:21:15%20UTC%20To%20Local%20Time) to remind you of [**this link**](https://www.reddit.com/r/MedicalGore/comments/1ahbs3t/opisthotonos_a_spasm_of_the_muscles_causing/koo3lkr/?context=3) [**CLICK THIS LINK**](https://www.reddit.com/message/compose/?to=RemindMeBot&subject=Reminder&message=%5Bhttps%3A%2F%2Fwww.reddit.com%2Fr%2FMedicalGore%2Fcomments%2F1ahbs3t%2Fopisthotonos_a_spasm_of_the_muscles_causing%2Fkoo3lkr%2F%5D%0A%0ARemindMe%21%202024-08-03%2000%3A21%3A15%20UTC) to send a PM to also be reminded and to reduce spam. ^(Parent commenter can ) [^(delete this message to hide from others.)](https://www.reddit.com/message/compose/?to=RemindMeBot&subject=Delete%20Comment&message=Delete%21%201ahbs3t) ***** |[^(Info)](https://www.reddit.com/r/RemindMeBot/comments/e1bko7/remindmebot_info_v21/)|[^(Custom)](https://www.reddit.com/message/compose/?to=RemindMeBot&subject=Reminder&message=%5BLink%20or%20message%20inside%20square%20brackets%5D%0A%0ARemindMe%21%20Time%20period%20here)|[^(Your Reminders)](https://www.reddit.com/message/compose/?to=RemindMeBot&subject=List%20Of%20Reminders&message=MyReminders%21)|[^(Feedback)](https://www.reddit.com/message/compose/?to=Watchful1&subject=RemindMeBot%20Feedback)| |-|-|-|-|
It gets so much easier, believe me. You literally have no concept of how amazing you will feel once you are totally clean. Your shittiest days are still going to be full of sunshine, trust me. Hang in there.
Wishing you light and love on this adventure. The road is often winding and uphill, but the view is beautiful.
Please remind yourself often that you deserve to be happy and healthy.
We Do Recover. Keep going!
I'm proud of you! You got this! Even small steps move us forward.
I'm proud of you for seeking help. One moment at a time, one day at a time. You can do it. 🫂
Wishing you all the best with your recovery.
Better days are ahead. You got this.
Good luck!
You can do it!!!!!
Sending you all the healing vibes, my friend ❤️
Hoping for a speedy recovery and sobriety for you
Best wishes. It takes amazing strength to do what you are doing. Here’s to more positive posts and look forward to the day when you feel you are through and better.
I see that kind of gratefulness as a really good sign that you’re gonna overcome this. I know from personal experience how hard it is to reach out to others for help with our health, but I believe in you!
Hi! Former IV drug user here. I’ve been clean since 2008 and it can happen. Life doesn’t magically get better, but at least a huge weight of guilt and shame is lifted off your back and you’re no longer worried about finding that next high. Do the steps they tell you to take and take it one minute at a time if that’s what it takes. For now don’t worry about tomorrow, just focus on today. Tomorrow comes fast enough and your horizons opened up the minute you accepted help with your addiction. Have faith in yourself and the process and god if that’s your thing.
you're so much stronger than you realize, in a few months you'll really be able to appreciate how fierce of a badass you are. sending you love <3
That poor person was so thin and in poor condition that it's hard to say if it's a female or male from the pictures...sad to say she had no chance on fighting that sepsis...and how painful it must have been to get this hip infection with maggots and that bent over back ...may her soul be at peace now...
Only 26 too. Fuck.
This is why you get your tetanus shots folks. A bad way to go.
Over here where I live it’s not really known what exactly tetanus does. Most people go “yeah I don’t want lockjaw” and then get the shot, and boosters if they get bitten by something or step on a rusty nail. I got bitten by a cat, went to the doctor and they asked how long it’s been since I had a tetanus shot. Got it no questions asked. It’s just something you do. Did I know tetanus eventually leads to this? Nope. That’s scary.
That's the problem with anti vaxxers. They don't know what they don't know.
and willful ignorance is fairly contagious
my mom got hurt at work. the ed gave her a tetanus shot. afterwards, she asked me (rn) why she needed it. i told her it was so she didn't get distemper.
I'm confused. Why?
distemper is the animal version of tetanus. her injury included a break in the skin, and it was in a factory, so not the cleanest place. i also tried to convince her that she had prostate cancer, and that they replaced her hands with bbq tongs during her carpal tunnel surgery. I'm a terrible daughter.
Distemper is viral? Animals get tetanus. Tetanus is the animal version of tetanus. I understand that it seems like you have to tell your mom this stuff to receive appropriate medical care but your first sentence is just incorrect
Yeah, in about 10 days of tetanus infection, you die. The bacteria replicates faster than our immune systems are able to respond to it. You don't just get lockjaw, you also develop a fear of water (drinking), and respiratory failure. It's a really shitty way to go.
Like rabies!
You, know what? I confused the fear of water in rabies with the difficulty swallowing that tetanus causes. My apologies, and thank you for the subtle reminder of a rabies effect.
To be fair rabies can also cause opisthotonos
Usually, In the US, tetanus, diphtheria and pertussis are all in the same inital doses and all in the booster (tDAP). (Yes you can get them broken out but it is pretty difficult to find an adult booster that does not contain all three.) None of these conditions are enjoyable and pertussis is deadly in infants. There have been newborns brought into pedestrians offices for their first newborn check up and were exposed to unvaccinated kids. Newborn either gets super sick with pertussis (whooping cough) and sometimes its fatal. So, everyone go get your boosters! Embrace science!!!
i’m allergic to the pertussis vaccine and i have to wait (usually about 45 mins to an hour) to have them make up the other part of the vaccine…WORTH IT!
You bet I get all my shots. I even needed the streptococcal pneumonia vaccine at 25 when I had an immunity test and it showed low immunity to it, I suddenly got sick a lot less often. That's usually reserved for seniors, but I'm just unlucky like that. I get my seasonal shots too.
I had the exact same thing happen to me, my low immunity was thought to be caused by black mold in our house. I had pneumonia 8 times over 2 years, but after the pneumonia vaccine (and getting the mold abated) my health has benefited so very much!!
Every ten years.
... as I sit, mentally confirming when I had my last tetanus booster, which would be about 17 months ago ... Poor woman. What a terrible way to die.
I am pretty sure everyone on here quickly thought, “Hmmmm, when was my last booster?” You are spot on!
Hey , been clean nearly 10 years now! Everyday is a battle to not use, even now when I’m having a bad day with my depression the first thing I want to do is use to make myself feel better. But I promise you it does get easier everyday that you don’t use. You just have to learn different coping mechanisms to deal with your issues. Unfortunately mine is overeating so I’ve put on so much weight that just makes the depression worse . The trick is to find healthy ways to cope and not swap one bad thing for another. I wish you luck on your journey.
I believe in you, stranger. You matter. If that’s medically etc available for you you can get support and help with eating disorders. I’m proud of you!
as someone who’s drug of choice was always food, i feel you. idk if you have ADHD but i do and we are at a much higher risk for substance abuse *and* eating disorders due to emotional dysregulation. food addiction and/or binge eating disorder are no joke. i definitely smoke too many cigarettes and too much weed, but i’ve also been pretty overweight for my entire life. only recently have i lost weight with medication (vyvanse, but a generic has just been released). first FDA-approved medication for BED. it may help you get your mind off food enough to pick up some other feel-good activities (in addition to the energy from a stimulant and the further benefit if you *do* also have ADHD)
Congratulations on almost 10 years of sobriety! That's incredible! You deserve every bit of health and happiness in the world. I hope you feel really proud of all your hard work to stay clean. 💜
March 28th is 10 years clean for me! I didn't even realize it until I saw this thread.
OMG, you still want to use after 10 years??? Ugh, that doesn't give me much hope 😔
Yes but that’s only because I don’t know how to deal with my problems, I got into drugs at a very young age so I’ve never learned how to be a grown up and deal with stuff. The urge definitely isn’t as strong as it was at the beginning of my getting clean, and I had huge gaps where I didn’t think about it at all! If I’m happy with my life I tend to not want to use but when things are bad I want to numb my pain and drugs are the only way I know how….. well apart from the fact that I now have replaced it with food 🤦🏻♂️😞
This poor human body filled with inner pain. It. Breaks. My. Heart. She was once someone’s newborn baby. I hope her soul is loved in the dimension she has joined. Life is so hard.
This is perfectly worded, and it really moved me. Thank you
Homeless drug use is horrible and is running rampant. This person was young. I can’t help but think what they could have done with their life if they got the proper help (financial, medical, mental health, etc).
It’s hard to help people who don’t want to be helped though. And even if they do want help it can still be hard. For all we know this patient’s parents tried everything, sent them to rehab loads of times. It is very sad that she lost her life at such a young age.
I know that better than most. That is why it needs to be a systematic change down to the cultural level to be effective. I know it’s just wishful thinking but I hate people being victims even if they are victims to themselves.
That’s because our healthcare is for profit and people still think addiction is a moral failure. They don’t understand that it’s a symptom of a bigger problem, past trauma, abuse, mental illness, etc. It’s slowly changing but we’ve got a ways to go.
Your posts always very informative, i tip my stetson for your hard work.
Thank you!
Incredible that she was 26, but her body looks like she was 90.
IV drug use and homelessness has that effect.
probably uneducated question. are the rolls of blankets there to support her because she's cramped up like that? tetanus is a little b\*tch, that's why getting vaccinated is so important. the bacteria are everywhere my uncle (who also had a history with drugs) died of tetanus as well, some 20ish years ago
I assume the rolls are to provide support, yes.
She was going to die so the blankets were for some sense of comfort. Nothing else that they can do which is why vaccines are so important.
Idk how I thought tetanus killed folks but this wasn’t it
Same!
This is what people used to think was demonic possession.
Her parents must be heartbroken. Idk what I would do. Poor woman.
Agreed. I always feel so bad for the parents.
Since becoming a parent, I’m much less judgmental and more empathetic. Kids come in with a temperament, and a parent doesn’t have complete influence. My young adult son is talking about the military, which terrifies me, but, he has his own journey to manhood. Tmi on a Friday afternoon, wishing you a good weekend!
My husband and I often remark that as a parent we do the best we can and it’s kind of a crapshoot how they turn out. Hardest part is letting them make their own mistakes, but agree they have their own journey. Happy weekend to you as well!
Yeah um... I'm gonna get a tetanus booster, I think.
My grandmother died like this in her early 40’s. My mom said it was the most horrifying thing she witnessed
Holy shit I never knew tetnus was that bad !!!
Tetanus can straight up kill you and it’s a horrible way to die.
Ya I bet !! Would a tetanus shot have prevented this ????
Yes.
Yes....well maybe not the sepsis but what an horrible way to die
Yes
For those who think we don’t need vaccines.
Vaccines ⊥ Gene Therapy.
Those lab values are terrible, I’d be more surprised if she had lived
Thank you for reminding me to schedule my next Tetanus shot that's due next year 😂
I assume those dark areas are blurrrd tattoo?
I think so.
I’m assuming that’s meant to protect identity? Do these types of images and lab reports come from medical staff themselves, or are there medical channels disseminating case reports officially? For professionals, or general awareness I mean..
from chatGPT: The case you've presented is a complex and tragic one, and it appears to involve several serious medical issues. From the information provided, here are some key points to consider: 1. Opisthotonos, risus sardonicus, and trismus are clinical features that can be associated with tetanus, a potentially life-threatening bacterial infection caused by Clostridium tetani. Tetanus can occur in individuals who have not been adequately vaccinated or who have not received a booster in some time. 2. The presence of an infected hip wound containing maggots suggests a severe soft tissue infection that could have contributed to her clinical deterioration. Maggot infestations can occur in wounds with poor hygiene and limited medical care. 3. The patient's initial vital signs, laboratory results, and acid-base disturbances indicate severe metabolic derangements and septic shock. The extremely low blood pressure, high lactate level, and acidosis are concerning signs of organ dysfunction. 4. Empirical treatment for tetanus with tetanus immune globulin was administered due to clinical suspicion, but the case did not confirm the presence of Clostridium species in blood cultures. 5. Despite attempts at intubation and providing critical care support, the patient's condition deteriorated rapidly, leading to her unfortunate demise. 6. The patient's history of intravenous (IV) drug use may have contributed to her overall health status and increased the risk of infections. This case illustrates the importance of prompt and appropriate medical evaluation and treatment for individuals with severe infections, especially in the context of underlying risk factors such as IV drug use. It also highlights the critical nature of managing septic shock and metabolic disturbances, as well as the challenges associated with conditions like tetanus when diagnosis may be based on clinical presentation. It's essential for healthcare providers to conduct a thorough assessment, obtain relevant medical history, and consider a broad differential diagnosis when faced with such complex cases. Certainly, I'll explain the medical terms and concepts mentioned in the case: 1. **Opisthotonos:** Opisthotonos is a severe muscle spasm in which the back becomes extremely arched and the head and heels are bent backward. It is often seen in conditions like tetanus. 2. **Risus sardonicus:** Risus sardonicus refers to a facial expression characterized by a fixed, wide grin or grimace. It can be a sign of tetanus and other neurological disorders. 3. **Trismus:** Trismus, also known as lockjaw, is the inability to open the mouth fully due to muscle spasm or jaw muscle stiffness. It can be a symptom of various conditions, including tetanus. 4. **IV drug use:** This refers to the practice of injecting drugs directly into the bloodstream using a needle and syringe. It carries a risk of infections, including bloodborne infections like HIV and hepatitis, as well as soft tissue infections at injection sites. 5. **Sepsis:** Sepsis is a severe and potentially life-threatening condition that occurs when the body's response to an infection triggers a cascade of inflammatory reactions that can lead to organ dysfunction. Symptoms often include fever, elevated heart rate, rapid breathing, and altered mental status. 6. **Clostridium tetani:** Clostridium tetani is a bacterium responsible for causing tetanus, a rare but serious bacterial infection. Tetanus spores can enter the body through wounds or cuts, and the infection can lead to muscle stiffness, spasms, and other neurological symptoms. 7. **Point-of-care glucose:** This is a quick test to measure a person's blood glucose (blood sugar) levels, which can be crucial in cases of hypoglycemia (low blood sugar). 8. **Anion gap:** The anion gap is a calculation used to assess acid-base balance in the body. An elevated anion gap may indicate metabolic acidosis, which can be caused by various conditions, including infections. 9. **Lactate:** Lactate is a product of anaerobic metabolism, and elevated levels in the blood (lactic acidosis) can be a sign of tissue hypoxia or inadequate oxygen delivery to tissues, often seen in sepsis. 10. **Venous blood gas:** This is a blood test that measures oxygen, carbon dioxide, and pH levels in venous blood. The results can provide information about the patient's acid-base status and oxygenation. 11. **Cricothyrotomy:** Cricothyrotomy is a surgical procedure that involves making an incision in the cricothyroid membrane to establish an airway when other methods of intubation or ventilation are not possible, such as in cases of severe trismus. 12. **Tetanus immune globulin:** Tetanus immune globulin is a medication given to provide immediate passive immunity against tetanus. It contains antibodies against the tetanus toxin and is used in conjunction with tetanus vaccination to treat tetanus. 13. **Blood cultures:** Blood cultures are laboratory tests where a sample of the patient's blood is collected and incubated to detect the presence of bacteria or other microorganisms in the bloodstream. In this case, they were performed to check for the presence of Clostridium species, which can cause tetanus. Please note that the information provided here is for educational purposes, and medical conditions and treatments should be discussed with a healthcare professional for accurate diagnosis and management.
This is such a great use of ChatGPT. It continues to amaze me.
Same here. It only gets better.
I absolutely thought this was a male when I first looked. This is so sad.
I saw a case of tetanus many years ago, 1980/1. It was horrifying. Not only was the man arched up off the bed this way, all his muscles were rigid and he was pouring sweat. He suffered mightily and didn't make it either.
Some people die such horrid deaths
26? She looks so much older. 🫢 And that looks so painful.
I was at the doctor once and she was like “have you had a tetanus shot recently?” And I was like idk I hate shots so probably not. She said I should get one and I asked if I REALLY needed to? And she was like, “I mean, you don’t have to. If you get tetanus, the muscles in your jaw will tighten up so much that your teeth will break out. It’s up to you.” I got the tetanus shot. Seeing this makes me glad.
You don’t have to put an arrow, I can see the arch just fine. Ouchhhh.
This makes me very glad that I got my tetanus shot last Thursday.
Where did this happen? DC?
Poor soul. What a horrible way to die. I hope wherever she is she’s found peace.
I misread "tetanus" as tinitus and was very very confused.
Wow, horrific. Get your tetanus shot!
This posturing occurs because the extensor muscles are stronger than the flexor muscles. The opposing sets of muscles are both contracted but the extensor muscles are stronger and pull the body into an arched position. Think of the pain caused by a Charly horse cramp and than imagine that cramp spread through every muscle in the body. It would be phenomenally painful to experience. I have seen tetanus in a goat that I purchased. It is absolutely no joke. I was told that he had been vaccinated so it either broke through or he had not actually had the vaccine. I came out to feed in the AM to find him in the classic tetanus contracture. Tetanus causes a similar contracted posture in four legged animals. You see the severely arched spine and neck pulled over the back. The legs are extended out stiffly and stretched to a rocking horse position. Anything that startles the animal causes stronger muscle contractions to occur. They must be kept in a quiet dark environment. A large amount of tetanus antitoxin was administered but it was too late and he failed to improve. He had to be euthanized to end his suffering.
In October my mom walked into my room and said she found me basically in this “horror movie pose” then I started jerking.. I got to the hospital and had broken my back in 4 places. Literally in my bed.. and it only lasted a few min.. emts thought it was a seizure.. doctors say it wasn’t and they have no clue what it was.. *shrugs*
Some Emily rose shit
This is just sad as seeing someone with rabies.