A 74-year-old man with a history of DM2, hypertension and recent coronary revascularization surgery for severe three-vessel coronary artery disease, diagnosed after an acute coronary event.
He had left ventricular dysfunction with ejection fraction 40% and renal dysfunction with creatininemia of 1.49 mg/dL.
Two weeks after discharge, the patient was admitted to the intensive care unit with abdominal pain, nausea, vomiting and lipothymia.
The family reported that in addition to cardiac treatment (bisoprolol 1.25 mg/day, aspirin 100 mg/day; atorvastatin 40 mg/day; holes metformin 20 mg every 12 mg every 1,000 mg/day, metformin 50 mg).
At admission, the patient was disoriented and agitated with signs of poor perfusion, blood pressure of 68/38 mmHg, heart rate of 40 creatinine mEq/min, respiratory rate of 20 breaths/min and temperature of 118 pg/ml
Arterial gasses l (ox wave ms QT2 and lactate 3L/min) metabolic acidosis: pH 7.08; PCO2 22.2 mmHg; PO2 < 60 mmHg, bicarbonate 6.4 mEq/L, prominent sinus bradycardia -23.7
Therapy included administration of hypertonic glucose plus insulin, vasoactive ventilation, continuous ventilating.
Two days later, the patient experienced significant clinical improvement with normalization of acid-base status and plasma potassium, in addition to improvement of other laboratory parameters.,
On the ninth day, the patient developed diuresis and was discharged from the Intensive Care Unit.
At 15 days of evolution, the patient is asymptomatic with urinary volume > 1,500 ml/day, creatininemia of 1.08 mg/dL and uremia of 32.1 md/dL.
