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/fisiopatologiaAssuntos
Alcalose/diagnóstico , Antiácidos/intoxicação , Overdose de Drogas/diagnóstico , Fármacos Gastrointestinais/intoxicação , Bicarbonato de Sódio/intoxicação , Taquicardia Ventricular/etiologia , Alcalose/induzido quimicamente , Alcalose/fisiopatologia , Alcalose/terapia , Antiácidos/antagonistas & inibidores , Diagnóstico Diferencial , Overdose de Drogas/fisiopatologia , Overdose de Drogas/terapia , Gastrite/tratamento farmacológico , Fármacos Gastrointestinais/antagonistas & inibidores , Azia/tratamento farmacológico , Humanos , Masculino , Medicina Tradicional/efeitos adversos , Pessoa de Meia-Idade , Automedicação/efeitos adversos , Índice de Gravidade de Doença , Bicarbonato de Sódio/antagonistas & inibidores , Taquicardia Ventricular/prevenção & controle , Taquicardia Ventricular/terapia , Resultado do TratamentoRESUMO
Oral ingestion of baking soda (sodium bicarbonate) has been used for decades as a home remedy for acid indigestion. Excessive bicarbonate ingestion places patients at risk for a variety of metabolic derangements including metabolic alkalosis, hypokalemia, hypernatremia, and even hypoxia. The clinical presentation is highly variable but can include seizures, dysrhythmias, and cardiopulmonary arrest. We present two cases of severe metabolic alkalosis in patients with unsuspected antacid overdose. The presentation and pathophysiology of antacid-related metabolic alkalosis is reviewed.