A 71-year-old man with no morbid history brought by relatives to the Emergency Department of the Hospital «Dr. Leonardo Guzmán» in Antofagasta.
The family members described a five-day picture of progressive compromise of their general condition and a painful lesion on the back that appeared after the bite of a corner.
Three days before admission, the patient presented consciousness compromise, vomiting, polypnea, jaundice, low-volume urine, dark brown.
On physical examination at admission, a painful, violaceous skin lesion of 10 cm was observed, located in the interscapular region.
The patient was stunned, agitated, 13 points on the Glasgow scale, with mild withdrawal symptoms.
Vital signs: blood pressure of 127/87 mmHg, Fc 150 x', axillary temperature of 38.5°C, F. resp 30 x' and saturation of 95% at room air.
Cardiac and pulmonary examinations were normal.
Neurological examination showed no focal deficit and no meningeal signs.
The laboratory revealed impaired renal function, severe metabolic acidosis, coagulation disorders, intense hemolysis and presence of hemoglobinuria.
The patient was admitted to the ICU with the diagnosis of severe CVL, oliguric ARF and severe hemolytic anemia.
Management included parenteral hydration with crystalloids, correction of acid-base disorder by infusion of sodium bicarbonate, administration of calcium gluconate and transfusion of blood products.
Corticosteroids and antihistamines were started parenterally.
She presented persistence of the spore, anuria and greater nitrogen retention, which required repeating the procedure on the third and sixth day.
The neurological evaluation of the patient concluded that the commitment of consciousness was derived from their metabolic disorders.
Computed axial tomography of the brain was normal.
On the ninth day of hospitalization the first conventional hemodialysis was performed, being good.
The patient remained stable, although with superficial murmur, allowing his transfer to the Intermediate Treatment Unit (IMT).
The patient continued on hemodialysis for three weeks.
During the second hemodialysis, performed in IMT, the patient presented complete tachyarrhythmia due to atrial fibrillation, so the dialysis procedure was performed and intravenous amiodarone was indicated, sinus conversion was achieved.
In subsequent hemodialysis, no incidents were reported.
Hematocrit became ill and did not require new transfusions.
Cutaneous lesion located towards a necrotic neoplasm with erythematous borders was treated locally with cures.
After ten days the patient was stable, so he was admitted to the medical ward.
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On the second day of stay in the ward, a clinical and radiological diagnosis of pneumonia was made, which was interpreted as of aspiration cause, so the patient received antibiotic treatment with ceftriaxone and clindamycin, with good response.
After one month of hospitalization, the patient was suffering from constipation and drowsiness, with poor tolerance to oral feeding, requiring feeding through a nasojejunal tube.
The persistence of anuria was observed.
During the fourth week, the patient developed hemodynamic instability in the last hour of dialysis (three and a half-hour procedure), with paroxysms of atrial fibrillation despite treatment with antiarrhythmic drugs.
Finally, after a 5-week stay, the patient died due to an irreversible cardiorespiratory arrest in asystole after an episode of rapid atrial fibrillation with hypotension.
