An 87-year-old woman with a history of hypertension and long-standing type 2 diabetes mellitus.
In addition, she had chronic atrial fibrillation and severe pulmonary hypertension (which is why she was being anticoagulated with acenocoumarol) and polymyalgia rheumatica.
The patient was treated with metformin hydrochloride (6 mg/day), (850 mg/8 h),paglinide (2 mg/8 h), irbesartan/ hydrochlorothiazide (16.5 mg/day), canines (20 mg/day), and hydrochlorothiazide (20 mg/day).
Plasma Cr levels three months before admission were 1.22 mg/dl. Two days before admission, the patient developed severe diarrhea with nausea and vomiting and disorientation.
Blood glucose was obtained 45 mg/dl in the emergency room. Blood pressure was 101/79 mmHg, temperature was 38 oC and oxygen saturation was 98%.
He had dry mucous membranes and decreased level of mild consciousness with Glasgow 13.
The laboratory tests showed plasma Cr of 8.21 mg/dl, glucose 262 mg/dl, potassium of 6.2 mEq/l, leukocytes 19.220/μl, hemoglobin of 9.9 g/dl and lactic acid.
Prothrombin activity was 12%.
Arterial gas showed a pH of 6.6 with bicarbonate of 2.6 mmol/l.
Since admission to the ICU due to associated comorbidities was ruled out, treatment with intravenous bicarbonate and inotropic agents was started, with no improvement.
The patient died 10 hours after admission.
