A Case of Multiple drug abuser with severe metabolic acidosis

Dr Tamanna Yasmin,  Dr Mir Atiqur Rahaman (Sajal), Dr Md. Maniruzzaman

A 36 year old normotensive, nondiabetic multiple drug abuser was admitted to the ER on 13/01/2012. He had H/O reluctance to feed for last few days, altered level of consciousness and restlessness for 6 hours . On admisson he was semiconscious, having  respiratory distress and severely dehydrated. His Pulse was 44 b/min, BP : 70/40 mm of Hg and CVP was 2.

He was  resuscitated with IV fluid therapy. Soon after admission the patient went into cardiac arrest. CPR was started immediately, he was intubated, put on ventilator and all three ionotropes started. ABG showed severe metabolic acidosis (PH: 6.9 and HCO3: 3 ) and CRRT was initiated. Lab investigations revealed TC-17, Urea-102 mg/ dl, Creatine-2.45, Na-98 mmol/L, K: 6.4mmol/L, Builirubin-3.7 mg/dl, SGPT:1474 U/L, PT-47,INR-3.5, S.Lactate: 19., EF:55%

 Ventilator weaning was started on the next day and after 2 days patient was extubated. Urine output had become normal and after 36 hours of planned time, CRRT was stopped . His blood pressure became normal and inotropic support was tapered off.  NG tube feeding was started. After that he  became restless and withdrawal syndrome being suspected,  he was started on Anti- psychotic drugs.Then he developed noncardiogenic pulmonary oedema and  was reintubated. Tracheal aspirate  C/S showed  growth of pseudomonas and I/V antibiotics were started. He developed ARDS which responded  well to methylprednisolone and he was extubated successfully on 12^th February. His withdrawal was managed with tapered dose of I/V diazepam.

The rest of his ICU stay was uneventful. His nutrition was maintained, physiotherapy, mobilization and counseling was given. The patient was discharged on 20.02.12  with stable haemodynamic condition  with advice to contact a Drug Rehabilitation center.