A 78-year-old woman with a history of hypertension, type 2 diabetes mellitus, generalized arthrosis, congestive heart failure in NYHA stage II and chronic atrial fibrillation.
She was being treated with metformin (850 mg/8 hours), glipizide (5 mg/day), lercaniline (10 mg/day), lysinopril-hydrochlorothiazide (20/12.5 mg/day), ibuprofen (10 mg/day), or
Two days before admission due to increased bone pain, he received ibuprofen (600 mg/8 hours), starting with general deterioration, vomiting and decreased level of consciousness.
The patient was hypotensive and poorly pre-fused in coma in the emergency department (Glasgow 6/15) and blood tests showed plasma creatinine of 1.79 mg/dl, blood glucose of 215 mg/dl and prothrombin time.
Arterial gas was pH 7.03 with bicarbonate of 10 mEq/l and lactic acid plasma of 14 mmol/l.
Chest X-ray revealed an infiltrate in the left base.
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She was admitted to the intensive care unit (ICU) and underwent orotracheal intubation with mechanical ventilation and administration of vasoactive drugs and antibiotics.
Lumbar puncture was indicated and the result was compatible with pneumococcal meningitis.
Hemodialysis was performed with bicarbonate bath and subsequently showed an analytical improvement with plasma creatinine (Cr) of 1.2 mg/dl and serum bicarbonate of 22 mEq/l.
However, the patient became comatose with EEG with low voltage waves and died 72 hours after admission.
