Recurrent Intractable Iliofemoral Dvts In Young Individuals; The Phenomenon To Keep In Mind 'Ivc Agenesis'

This chapter explores two distinct medical scenarios within general internal medicine: inferior vena cava agenesis (IVCA) and the emergency management of toxicological cases. In young patients presenting with recurrent, unprovoked iliofemoral deep vein thromboses (DVTs), IVCA is a rare but critical vascular anomaly to consider. The condition, linked to defective embryonic development or perinatal thrombosis, often leads to postthrombotic syndrome due to chronic venous hypertension and valvular damage. While Doppler ultrasonography provides initial clues regarding proximal involvement, CT venography remains the noninvasive gold standard for diagnosing absent or hypoplastic IVC segments and identifying dilated collateral pathways. Management typically involves long-term anticoagulation and compression stockings, though stockings may exacerbate acute symptoms if IVCA is present. Separately, treating acute poisoning in the emergency department (ED) poses substantial diagnostic challenges due to unreliable patient histories and overlapping symptoms with other diseases. Management relies on immediate stabilization of airways, breathing, and circulation, followed by physical examinations and decontamination methods like activated charcoal or whole-bowel irrigation. Specific protocols are outlined for common overdoses, emphasizing targeted antidotes and supportive care, such as N-acetylcysteine for acetaminophen, sodium bicarbonate for cyclic antidepressants, and naloxone for opioids.