![]() ![]() Although the patient’s initial clinical picture was not consistent with community acquired pneumonia, and the isolation of S. Sputum cultures obtained on admission were positive for pan-sensitive Streptococcus pneumoniae, for which intravenous ceftriaxone was initiated. Hospital course was complicated by the development of acute respiratory distress syndrome, in the setting of a possible aspiration event during the episode of bulbar paralysis and subsequent intubation, resulting in the use of prolonged mechanical ventilation and paralytics. Repeat CT chest was consistent with multi-lobar pneumonia and air bronchograms ( figure 2). Repeat chest radiograph revealed bilateral alveolar infiltrates ( figure 1). However, over the proceeding 24 hours, the patient acutely decompensated and had to be re-intubated. ![]() Physical exam was pertinent for confusion and somnolence, as well as garbled speech, decreased muscle strength on all extremities and absent reflexes bilaterally.Īfter approximately 24 hours, the patient regained muscle strength and was successfully extubated. Vital signs were notable for an elevated blood pressure of 268/164 mm Hg, with no fever or tachycardia. Social history was notable for occasional cocaine ingestion, however, he denied alcohol or tobacco use. His home medications were nifedipine and hydralazine. The patient’s grandmother, who consumed a smaller portion of the same pufferfish, also presented to our institution with dizziness and lower extremity weakness. He reported ingesting canned food and cocaine 3 days prior. Four hours prior to presentation, he ingested pufferfish liver. He had associated chest pain, which was tearing in nature. These hardy fish thrive in brackish environments, even though they are usually kept in freshwater.A 43-year-old African American man with history of hypertension (HTN) and chronic kidney disease presented with vomiting, abdominal pain, bilateral leg numbness, difficulty speaking and weakness. The Endler’s livebearer is another great nano brackish fish. Water salinity/specific gravity: 1.001-1.025.Diet: Feed dried and live/frozen foods, spirulina/vegetable matter.Check out my complete guide for more details on these awesome beginner brackish aquarium fish! 2. There are a few different species and many different breeds available in the fish-keeping hobby. ![]() In fact, these inexpensive livebearers thrive in brackish conditions! Molly fish are highly adaptable fish that can be kept in anything from hard freshwater all the way to full marine conditions.
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