Current history: woman, 84 years old, remained in good general condition, autonomous for her usual activities.
He was admitted on 12/31/04 through Emergency Service for presenting a week before a clinical picture characterized by decay and unspecific general malaise.
The day before admission she had 3 episodes of semi-liquid stools and mild colic abdominal pain.
The day of admission was observed by her medical child at home who found her compromised consciousness, lack of reactivity to verbal orders, fixed gaze, mydriasis and hypoventilation, which evolved to spontaneous ventilation, due to apnea.
Morbid history: stable angina pectoris of several years of evolution, cerebellar stroke without sequelae, 5 years earlier.
Lymphoma was treated five years ago, with no recurrence for two years.
Chronic hypertension (HTN) difficult to manage and severe mitral regurgitation with a history of dyspnea on moderate exertion.
Usual therapy: carvedilol 6.25 mg/day, lasartan 50 mg/day, halothane 25 mg/day, hydrochlorothiazide 25 mg/day, amlone 12.5 mg/day.
He had regular medical and laboratory controls.
His previous tests showed a baseline creatinine of 1.2 mg/dl, creatinine clearance 35 ml/min and electrocardiogram sinus rhythm.
Physical impairment: sporadic, no focal neurological deficit, blood pressure: 146/76 mmHg, pulse 30 to 40 per min, Sa02 >95%.
Normal jugular venous pressure.
Cardiac auscultation revealed regular sounds, holosystolic murmur intensity III/VI in mitral focus.
No pulmonary congestive signs, no limb edema.
The abdomen was depressible and painless.
1.
Laboratory at admission: electrocardiogram: idioventricular rhythm 50/min, poorly defined intraventricular conduction disorder with QRS 0.12 s and increased voltage T waves.
Plasma electrolytes: K: 8.4 mEq/l, Cl: 109 mEq/l, Na: 132 mEq/, pH 7.24, PCO2: 27, HCO3 12 mEq/, anion gap 10.
BE: -14.4.
Urine Nitrogen 61 mg/dl, creatinine 2.63 mg/dl, hematocrit 33%, hemoglobin 0.7 mg/dl, white blood cells 8.660, blood glucose 137 mg/dl, troponins T < urinary normal
Chest radiography without pulmonary congestion.
Echocardiogram: mitral and tricuspid myxomatosis, mitral stenosis and severe tricuspid regurgitation, mild concentric left ventricular hypertrophy with normal systolic function, moderate biauricular dilation.
No diarrhea developed during hospitalization.
There was no response to the usual medical measures to control hyperkalemia, so emergency hemodialysis was performed after admission.
During CP, the fraction of sinus rhythm 13% F/dl 102 per min, initially systolic hypertensive up to 208/63 mmHg and then with myocardial prolosion maintenance was normal in 384 patients, in these circumstances she presented angina pectoris
The patient normalized potassium and diuresis before 24 h, maintained normal blood pressure levels, with creatinine levels of 1.3 m/dl, urea nitrogen 24 mg/dl and was discharged on the fifth day in good condition.
