A 65-year-old man with type 2 diabetes with a history of revascularized ischemic heart disease with mild systolic dysfunction and generalized atheromatosis.
She was receiving enalapril (40 mg/day), atenol (50 mg/day), acetylsalicylic acid (300 mg/day), fenofibrate (200 mg/day) and a fixed combination of rosiglitazone/metformin (2/500 hours).
He was admitted to the emergency room due to acute deterioration of general condition, decreased level of consciousness and tachypnea.
She had presented five days before epigastric pain associated with nausea, vomiting and diarrhea, continuing her usual treatment.
Physical examination revealed blood pressure of 100/60 mmHg, oxygen saturation of 84%, and auscultation revealed crackles on the right lung base and abdominal vascular murmur.
Blood tests showed plasma Cr of 21.4 mg/dl, glucose of 126 mg/dl, potassium of 6.6 mEq/l, creatine phosphokinase (CPK) of 315 with normal troponin I, and lactic acid of 10.2 mmol/l
In addition, he had leukocytes of 16.210/μl, with hemoglobin of 13.3 g/dl and platelets of 407 x 1,000/μl.
The chest X-ray showed condensation on the right base.
She was admitted to the ICU and underwent orotracheal intubation, mechanical ventilation and vasoactive drugs treatment, despite which she presented cardiorespiratory arrest and was reanimated.
Continuous intravenous hemolytic therapy was started and maintained for five days with progressive improvement. The patient was discharged from the ICU with plasma Cr of 3.5 mg/dl, potassium 3.3 mEq/l, pH of 7.39 and bicarbonate.
