RESUMO
A 59-year-old woman was found unresponsive at home. Initial neurologic examination revealed aphasia and right-sided weakness. Laboratory results demonstrated a serum calcium level of 17.3 mg/dL (corrected serum calcium for albumin concentration was 16.8 mg/dL). Extensive workup for intrinsic aetiology of hypercalcemia was unrevealing. Further discussion with family members and investigation of the patient's home for over-the-counter medications and herbal supplements revealed chronic ingestion of calcium carbonate tablets. CT angiogram of the brain revealed multifocal intracranial vascular segmental narrowing, which resolved on a follow-up cerebral angiogram done 2 days later. These findings were consistent with reversible cerebral vasoconstriction syndrome.Appropriate blood pressure control with parenteral agents, calcium channel blockade with nimodipine and supportive care therapies resulted in significant improvement in neurologic status. By discharge, patient had near-complete resolution of neurologic symptoms.
Assuntos
Antiácidos , Encéfalo , Carbonato de Cálcio , Hipercalcemia , Vasoespasmo Intracraniano , Feminino , Humanos , Pessoa de Meia-Idade , Antiácidos/intoxicação , Encéfalo/diagnóstico por imagem , Carbonato de Cálcio/intoxicação , Bloqueadores dos Canais de Cálcio/uso terapêutico , Angiografia Cerebral , Angiografia por Tomografia Computadorizada , Hipercalcemia/induzido quimicamente , Hipercalcemia/complicações , Imageamento por Ressonância Magnética , Nimodipina/uso terapêutico , Vasoespasmo Intracraniano/diagnóstico por imagem , Vasoespasmo Intracraniano/tratamento farmacológico , Vasoespasmo Intracraniano/etiologia , Vasoespasmo Intracraniano/fisiopatologiaRESUMO
E-cigarette, or vaping, product use-associated lung injury (EVALI) has become an epidemic that is increasingly affecting patients across USA. Recently, over 2100 cases have been reported in 49 states, resulting in at least 42 deaths. We present a case of rapid respiratory failure in an otherwise healthy and young patient who used a vaporiser containing tetrahydrocannabinol (THC) during the month prior to admission. The patient eventually required mechanical ventilation. There were significant challenges in achieving the appropriate level of sedation during intubation and mechanical ventilation. As more EVALI cases are being diagnosed in recent months, we highlight an aspect that may be unique to the population of patients who vaporise THC-high sedative and analgesic requirements during intubation and mechanical ventilation.