A 58-year-old woman presented to the hospital complaining of popliteal hollow pain and vomiting for 48 hours.
Their history included DM, hypertension, dyslipidemia, hyperuricemia, congestive heart failure and depression.
On admission vital signs were normal and examination showed signs of deep venous thrombosis.
Blood tests showed normal ionic and renal and hepatic function.
The patient was diagnosed with deep venous thrombosis of the lower extremities by ultrasound and received treatment with insulin NPH, metformin (850 mg/12 hours), enoxaparin, torasemide, enalapril, clorazepzapine dipotassium, to
During the first two days the patient continued to vomit and not to drink only liquids and, 24 hours later, complained of abdominal pain with asthenia, vomiting, visual disturbances and oliguria.
On the fifth day of admission, the patient suffered a cardiac arrest due to ventricular fibrillation and, after being resuscitated by the intensive care physician, she remained with mydriasis, anuric and a Glasgow scale of 3 points.
Blood pressure was 120/45 mmHg (with noradrenaline), heart rate was 115 beats/minute and temperature was 36oC. The most significant analytical data are shown in Table 2.
During the first hours, the patient received fluids, 500 mEq of sodium bicarbonate and noradrenaline, and diuresis recurred, but arterial gas did not improve (pH 6.90 and bicarbonate 7.1 mEq/l).
A hemodialysis session improved metabolic acidosis (pH 7.28 and bicarbonate 16 mEq/l) and hyperkalemia (5.2 mEq/l).
After overcoming aspiration, the patient developed pneumonia due to a vegetative state and died on the nineteenth day of admission.
