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Papers by Ranjita Pallavi

American Journal of Therapeutics, Mar 1, 2016

Hyperammonemia is most commonly associated with liver disease. Nonhepatic causes of hyperammonemi... more Hyperammonemia is most commonly associated with liver disease. Nonhepatic causes of hyperammonemia are uncommon. We present a case of nonhepatic hyperammonemia that turned fatal within a short period of time and discuss the possible treatment modalities for the same.

Bilateral strokes of the corpus callosum are uncommon because of the rich blood supply of this st... more Bilateral strokes of the corpus callosum are uncommon because of the rich blood supply of this structure from three main arterial systems.

Eosinophilic esophagitis is often misdiagnosed as gastroesophageal reflux disease but does not re... more Eosinophilic esophagitis is often misdiagnosed as gastroesophageal reflux disease but does not respond to acid suppression therapy. Here, a close-to-textbook case.

A 59-year-old woman with a history of peptic ulcer disease (PUD) was seen in a clinic with compla... more A 59-year-old woman with a history of peptic ulcer disease (PUD) was seen in a clinic with complaints of pain in the epigastrium of several days’ duration. She described the pain as mild, burning, and nonradiating and noted that it worsened with food intake.

American Journal of Therapeutics, Mar 1, 2016

Lactic acidosis is a rare and potentially lethal complication of metformin therapy. We present a ... more Lactic acidosis is a rare and potentially lethal complication of metformin therapy. We present a case of a middle-aged diabetic man with metformin-induced acute lactic acidosis successfully managed with timely hemodialysis.

Journal of gerontology and geriatric research, Aug 28, 2014

A 44-year-old African American woman was evaluated for symptoms of worsening cough, shortness of ... more A 44-year-old African American woman was evaluated for symptoms of worsening cough, shortness of breath, chest tightness, and fatigue of 6 months’ duration.

Eosinophilic esophagitis is often misdiagnosed as gastroesophageal reflux disease but does not re... more Eosinophilic esophagitis is often misdiagnosed as gastroesophageal reflux disease but does not respond to acid suppression therapy. Here, a close-to-textbook case.

fecal occult blood were negative. Urinalysis showed urinary tract infection (UTI). Despite treatm... more fecal occult blood were negative. Urinalysis showed urinary tract infection (UTI). Despite treatment with multiple anticonvulsants, the jerky movements continued and she was ultimately intubated for airway protection and started on propofol. CT brain on admission was unremarkable. Blood ammonia concentrations were obtained because of persistent altered mental status and were found to be elevated at 299 umol/L( range 11-32). An EEG at bedside was normal. She was started on antibiotics to treat the urinary tract infection. She was also started on lactulose to help lower ammonia levels. However within the next 2-3 hours, she suddenly became hypertensive and tachycardic and subsequently hypotensive requiring vasopressors.Pupils were dilated and fixed to light. Urgent repeat CT Brain showed diffuse cerebral edema and uncal herniation. Ammonia levels sent at the time of acute decompensation were markedly elevated at 1257 umol/L. Hemodialysis was immediately started. Unfortunately she prog...

A 32-year-old man with no significant medical history presents with multiple scrotal lesions that... more A 32-year-old man with no significant medical history presents with multiple scrotal lesions that he claims have been present for 2 years. They are non-tender and he reports no overt symptoms. The full case, here.

Presenting complaints were fever, nausea, and lower abdominal pain that worsened with walking. Os... more Presenting complaints were fever, nausea, and lower abdominal pain that worsened with walking. Osteomyelitis is not commonly included in a differential for abdominal pain. This case is different.

A young woman was admitted at 36 weeks' gestation with severe preeclampsia. During delivery, ... more A young woman was admitted at 36 weeks' gestation with severe preeclampsia. During delivery, she experienced generalized seizures. She remained postictal throughout the normal vaginal birth.

Worsening respiratory symptoms and fatigue of 6 months’ duration brought a 44-year-old woman in f... more Worsening respiratory symptoms and fatigue of 6 months’ duration brought a 44-year-old woman in for evaluation. Diagnosed with asthma 2 years earlier, she was compliant with, but unresponsive to treatment. Your impressions?

American Journal of Therapeutics, Mar 1, 2016

Hyperammonemia is most commonly associated with liver disease. Nonhepatic causes of hyperammonemi... more Hyperammonemia is most commonly associated with liver disease. Nonhepatic causes of hyperammonemia are uncommon. We present a case of nonhepatic hyperammonemia that turned fatal within a short period of time and discuss the possible treatment modalities for the same.

Bilateral strokes of the corpus callosum are uncommon because of the rich blood supply of this st... more Bilateral strokes of the corpus callosum are uncommon because of the rich blood supply of this structure from three main arterial systems.

Eosinophilic esophagitis is often misdiagnosed as gastroesophageal reflux disease but does not re... more Eosinophilic esophagitis is often misdiagnosed as gastroesophageal reflux disease but does not respond to acid suppression therapy. Here, a close-to-textbook case.

A 59-year-old woman with a history of peptic ulcer disease (PUD) was seen in a clinic with compla... more A 59-year-old woman with a history of peptic ulcer disease (PUD) was seen in a clinic with complaints of pain in the epigastrium of several days’ duration. She described the pain as mild, burning, and nonradiating and noted that it worsened with food intake.

American Journal of Therapeutics, Mar 1, 2016

Lactic acidosis is a rare and potentially lethal complication of metformin therapy. We present a ... more Lactic acidosis is a rare and potentially lethal complication of metformin therapy. We present a case of a middle-aged diabetic man with metformin-induced acute lactic acidosis successfully managed with timely hemodialysis.

Journal of gerontology and geriatric research, Aug 28, 2014

A 44-year-old African American woman was evaluated for symptoms of worsening cough, shortness of ... more A 44-year-old African American woman was evaluated for symptoms of worsening cough, shortness of breath, chest tightness, and fatigue of 6 months’ duration.

Eosinophilic esophagitis is often misdiagnosed as gastroesophageal reflux disease but does not re... more Eosinophilic esophagitis is often misdiagnosed as gastroesophageal reflux disease but does not respond to acid suppression therapy. Here, a close-to-textbook case.

fecal occult blood were negative. Urinalysis showed urinary tract infection (UTI). Despite treatm... more fecal occult blood were negative. Urinalysis showed urinary tract infection (UTI). Despite treatment with multiple anticonvulsants, the jerky movements continued and she was ultimately intubated for airway protection and started on propofol. CT brain on admission was unremarkable. Blood ammonia concentrations were obtained because of persistent altered mental status and were found to be elevated at 299 umol/L( range 11-32). An EEG at bedside was normal. She was started on antibiotics to treat the urinary tract infection. She was also started on lactulose to help lower ammonia levels. However within the next 2-3 hours, she suddenly became hypertensive and tachycardic and subsequently hypotensive requiring vasopressors.Pupils were dilated and fixed to light. Urgent repeat CT Brain showed diffuse cerebral edema and uncal herniation. Ammonia levels sent at the time of acute decompensation were markedly elevated at 1257 umol/L. Hemodialysis was immediately started. Unfortunately she prog...

A 32-year-old man with no significant medical history presents with multiple scrotal lesions that... more A 32-year-old man with no significant medical history presents with multiple scrotal lesions that he claims have been present for 2 years. They are non-tender and he reports no overt symptoms. The full case, here.

Presenting complaints were fever, nausea, and lower abdominal pain that worsened with walking. Os... more Presenting complaints were fever, nausea, and lower abdominal pain that worsened with walking. Osteomyelitis is not commonly included in a differential for abdominal pain. This case is different.

A young woman was admitted at 36 weeks' gestation with severe preeclampsia. During delivery, ... more A young woman was admitted at 36 weeks' gestation with severe preeclampsia. During delivery, she experienced generalized seizures. She remained postictal throughout the normal vaginal birth.

Worsening respiratory symptoms and fatigue of 6 months’ duration brought a 44-year-old woman in f... more Worsening respiratory symptoms and fatigue of 6 months’ duration brought a 44-year-old woman in for evaluation. Diagnosed with asthma 2 years earlier, she was compliant with, but unresponsive to treatment. Your impressions?