Re: What is the diagnosis?
From: art fougner, md (evsono@pipeline.com)
Fri Oct 25 12:00:55 2002
good luck el for you and your patient -
we once carried a woman on ventilator therapy after deep sedation for
status epilepticus til 35 wks when she ruptured membranes. labor
proceeded uneventfully while mom remained ventilated with good gases
until second stage which was shortened by forceps.
not the same case but sounds very similar to your plan. at some point
then, your plan is to get a CT/MRI?
art
At Fri, 25 Oct 2002, Eberhard Lisse wrote:
>
>John,
>
>Syphylis is negative, cryptococcus is negatie. the others I can't test
>:-)-O
>
>The low Potassium here is endemic due to diet.
>
>I am going to park her in ICU for a while so the baby can grow. If she
>needs ventilation, we'll ventilate her and do the C/S. Otherwise we'll
>cut her at 34/40 or later if she wakes up :-)-O
>
>The baby will get a dose of Nevirapine and be moved into the orphan
>unit, so we can feed it.
>
>el
>
>--
>Dr. Eberhard W. Lisse \ * / Managing Member, NA-NiC (cc)
><el@lisse.NA> el108 / | NA-NiC is the the .NA ccTLD Registry
>Private Bag X5501 \ / NA-NiC, not just like that!
>Oshakati, Namibia ;____/ Telephone: +264 81 124 6733 (cell)
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>
>In message <200210250234.g9P2YdM05235@mail.medispecialty.com>, Dr. John Provato
>poulos B.Sc. M.D.C.M. F.R.S.C. writes:
>> At Thu, 24 Oct 2002, Eberhard Lisse wrote:
>> >
>> >LP showed no bacteria, no white cells 3 red cells (I haven't done an
>> >LP for 5 years, so I needed two attempts, my SMO (Resident) found
>> >several excuses not to do it herself :-)-O) Protein was elevated,
>> >glucose low. Indian Ink negative. Direct Microscopy to come today.
>> >
>> >HIV was reactive and has been sent for confirmation.
>> >
>> >I feel this is Tuberculous Meningitis or HIV encephalitis.
>> >
>>
>> Lisse I forgot you are working in an environment with limited
>> resources.If
>> she turns out to have HIV the current guidelines would recommend
>> c-section if
>> she had not received multi agent therapy for most of the pregnancy, as
>> it would
>> definitely decrease the rate of transmission to the baby, these
>> guidelines are
>> fine and dandy for western medicine, I am not sure they are very
>> practical
>> in terms of the strain they would put on medical resources in your neck
>> of the
>> Woods.
>> If she has HIV; then T.B., syphilus,CMV,herpes,cryptococos, mycoplasma
>> and
>> more are all possible in varying combinations. Was the the low K+ from
>> vomitting
>> and/or diarrehea, maybe she has G.I. involvement with giaradia or
>> crytosporidia,
>> some P.O. Flagyl may do her some good.
>>
>> --
>> Take care, John
>>
--
art fougner, md
ich bin ein New Yorker
