A 55-year-old woman presented to the Emergency Department of the hospital with vomiting and intolerance to food in the previous 3 days and no response to antiemetic treatment.
He had a syncope episode in his home with spontaneous recovery and, after a few minutes in the emergency room, suffered cardiorespiratory arrest requiring 25 minutes of advanced cardiopulmonary resuscitation, including 5 minutes of home resuscitation.
Of the first laboratory results obtained in the emergency department stands out sodium 131 mEq/l, potassium 1.8 mEq/l, creatinine 4.74mg/dl, urea 115mg/dl, pH 7.22 (venous), bicarbonate 18.9 mEq/l.
The patient was admitted to the Intensive Care Unit (ICU) where, after nasogastric tube placement, 2,000 cc of gastric contents were removed.
After initial stabilization, abdominal computerized axial tomography (CAT) was performed, showing a very distended stomach with abundant gas as a result of intragastric balloon impaction in the antrum and presence of minimal gastric air bubbles.
The patient returned to the ICU with an impacted intragastric balloon in the antrum that was extracted without complications and antral endoscopy showed numerous antral erosions with mucosa.
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Therapeutic hypothermia was initiated as a post-resuscitation measure, which was suspended after 10 hours due to deep shock with myocardial involvement and depressed left ventricular ejection fraction (LVEF) (<25%) requiring vasoactive use.
On the days after stopping sedation, the patient had a Glasgow Coma Score (GCS) of 8 points.
Cranial CT, electroencephalogram (EEG) and evoked potentials showed data consistent with severe post-anoxic encephalopathy.
Percutaneous closure was performed and the patient was transferred to Internal Medicine ward after 12 days in the ICU, with GCS maintained at 9 points.
