A 41-year-old male patient with a history of cocaine consumption since 1997, attempted suicide in 2005, who suffered several fractures and was sequeled with bladder and rectal incontinence.
Without drug consumption since 2005, she reported cocaine and alcohol consumption in early September 2008. She was transferred to the Hospital del Salvador, which on October 8, 2009, after a week of invasive mechanical ventilation with aggressive agitation, approximately six patients required mechanical ventilation.
On admission to the ICU, the physical examination revealed erosions in the cervical region and extremities, with stable vital signs.
Blood tests showed bUN/creatinine of 33 mg/dL/2.58 mg/dL, creatine kinase (cK) 34,686 U/L, urinary amylase of 1215 mmol/L, urinary pH 15
Test evolution is summarized in Table 1.
1.
He was treated with vigorous crystalloids, achieving adequate levels of central venous pressure and bicarbonate was administered to warm urine.
The patient had urinary outputs of 200 to 300 ml per day, with elevated cK levels and progressive deterioration of creatinine, so he started hemodialysis from the fifth day of hospitalization.
He did not require vasoactive drugs and was extubated 24 hours after admission to the ICU without incidents.
Renal ultrasound showed adequate size and corticomedullary differentiation and absence of obstructive elements in the pyelocaliceal system. Abdominal ultrasound showed liver and biliary tract with normal characteristics.
Echocardiography showed mild dilation of the atrium and left ventricle, moderate mitral regurgitation and ejection fraction of 54%.
A blood toxicology test was performed which was positive for cocaine at a concentration of 52 ng/ml.
This sample was taken approximately 36 hours after the last consumption.
The patient remained seated without other complications, with persistent renal failure, so he was transferred to a less complex unit on day 21, continuing hemodialysis three weeks.
Subsequently, renal function was preserved.
From a psychiatric point of view, it was concluded that the patient had bipolar disorder in addition to polyaddiction.
