We report the case of a 33-year-old male with a past medical history of exADVP treated with methadone, a regular cocaine and cannabis user, diagnosed with CVH (with liver biopsy performed), injured right shoulder fracture.
As a previous treatment she had Tranxilium 50 mg 1/2 tablets every 8 hours.
She was admitted after being found at home by family members in a situation of decreased level of consciousness with remnants of food vomiting and edema in the left upper limb. She reported having previously consumed cocaine intranasally and concomitant alcohol consumption the hours before.
He also reported pain and inflammation in the SSI.
On physical examination, the patient had a fever of 37.5 oC, BP 120/90, conscious and oriented with low level of consciousness without neurological focus, edema and pain with edema in the ESI.
When performing the first evaluation, she had a low urine output.
On ECG, sinus rhythm was 105 bpm.
The chest X-ray showed mild cardiomegaly.
In the blood test CPK 33,255 U/L (normal 10-80), ASAT 1421 U/L (normal 0-18), ALAT 596 U/L (normal 0-22), urease 135-196 mg/dL
Urinary sediment was normal.
Urine toxicology was positive for cannabinoids, methadone, benzodiazepines and cocaine.
Ethanol levels in blood in unmeasured amounts.
It is commented with Nephrology Service that performs several hemodialysis sessions until entering the polyuria phase and recovery of renal function (creatinine 1.6 mg/dL), improving liver enzymes parameters, ALAT 95 U.
At 6 days, the patient was brought back by family members due to confusion and psychomotor agitation with a fever of 39.5oC.
She reported having smoked the previous hours 50gr of cocaine mixed with cocaine.
The patient had a fever of 40 °C, tachypnea at 47 rpm and psychomotor agitation. At pulmonary auscultation bilateral crackles, heart auscultation revealed tachycardia without pink bumps, lung auscultation revealed mild sinus rhythm.
Chest X-ray showed bilateral interstitial infiltrate with mild cardiomegaly.
Blood tests revealed leukocytes 13,100 (normal 3.5-10.5), ALAT 221 U/L (normal 0-22), ASAT 338 U/L (normal 0-18), creatinine 2.9 mg/dL, normal calcium 88 mg/dL).
Also in urine was determined positivity for cannabinoids, methadone and cocaine.
Ethanol levels in blood were 0.1 mg/L (normal 0-0.5).
Treatment with antiventilation therapy, broad empirical sputum and antibiotic therapy was initiated. Ventilator challenge with 10 L (does not require mechanical ventilation), with a favorable outcome, requiring sedation while initially agitation persists.
At discharge, the chest X-ray showed resolution of bilateral infiltrate. Laboratory tests showed creatinine 0.9 mg/dL, ASAT 41 U/L, ALAT 149 U/L, leukocytes 7,000, urea 32.
