A 47-year-old man with long-standing type 2 diabetes treated with metformin (850 mg/8h) and glimeda (4 mg/day), active smoker and regular drinker.
He had had several episodes of non-lithiasis acute pancreatitis.
One week before his admission he had a syncope episode while working in the field.
Subsequently, she presented intense asthenia, hypoxia and general malaise with orthostatism.
She came to the health center with a blood pressure of 70/35 mmHg and capillary glycemia of 20 mg/dl, so IV glucagon was administered.
Hypotension persisted in the emergency room with signs of extracellular volume depletion and tachypnea.
Laboratory tests showed plasma Cr of 10.3 mg/dl, glucose of 287 mg/dl and lactic acid of 20 mmol/l.
Arterial gas showed a pH of 6.87 with bicarbonate of 2.2 mEq/l.
Orotracheal intubation was performed and she was admitted to the ICU with assisted ventilation and inotropic administration.
Hemodialysis was then performed for four hours followed by continuous venovenous hemostasis.
At discharge the patient had a Cr of 1.20 mg/dl, pH 7.46 and bicarbonate of 24.6 mEq/l.
