Management of an Unresponsive Patient with Severe Acidosis

摘要

Case Report Congestive heart failure (CHF) is a chronic medical condition whoseincidence is rising. The prevalence of CHF is approximately 1% to3% in Western countries.1 Despite innovations in medical therapy,CHF is associated with high morbidity and mortality rates.2 CHF patients commonly experience muscle weakness andfatigue as two major symptoms. An altered intracellularhandling of ionized calcium has been suggested to play a vitalrole in impaired myocardial contraction.3 In isolated myocytesfrom patients with end stage heart failure, systolic ionizedcalcium levels were markedly decreased, while diastolic levelswere elevated as compared to healthy controls.4 In addition,digitalis and beta-blocker medical therapy is frequently usedin CHF patients and is known to increase myocardial ionizedcalcium levels.5 The patient’s past medical history was notable for fibromyalgiaand migraine headaches, and her past surgical history includeda tonsillectomy. Her past psychiatric history was significant fordepression and a prior suicide attempt, involving wrist slitting.The patient had no known drug allergies and her medicationsincluded valium, topamax, oxycontin, percocet and lunesta asneeded. She did not take any over the counter medications orherbal supplements. The patient consumed alcohol occasionallyand smoked cigarettes, but did not use any illicit drugs. Herfamily history was unremarkable.