RESUMO
En los servicios de emergencias que atienden a una gran población, muchas veces se encuentran cuadros aislados, como deshidratación severa, hipernatremia o hiponatremia, injuria renal aguda, trastorno de sensorio, entre otras. Sin embargo, muchos de estos cuadros forman parte de una sola patología, y si no se hace una unidad clínica en el momento adecuado, la morbimortalidad se puede incrementar drásticamente. Sobre todo, en enfermedades con baja frecuencia, muy raras o poco habituales, como la que se narrará a continuación, podría empeorar el estado crítico del paciente si no se detecta a tiempo o no se maneja adecuadamente. Este caso clínico es el de una paciente mujer de 74 años, con antecedente de patología psicótica con tratamiento irregular que, tras ingerir carbamazepina y risperidona, presenta los síntomas típicos y poco frecuentes del síndrome neuroléptico maligno (SNM).
In emergency rooms with large numbers of assigned population, we often see isolated conditions, such as severe dehydration, hypernatremia or hyponatremia, acute kidney injury, sensory disorder, among others. However, many of these conditions are part of a single disease and, if they are not gathered together as a medical unit at the right time, morbidity and mortality may drastically increase, especially in the event of diseases with a very rare or unusual frequency. Such is the case of the following disorder, which could worsen the critical condition of the patient if it is not detected on time or not treated appropriately. This clinical case addresses a 74-year-old female patient who reports a history of psychotic disorder with irregular treatment and, after the intake of carbamazepine and risperidone, presents the typical and infrequent symptoms of neuroleptic malignant syndrome (NMS).
Assuntos
Humanos , Síndrome Maligna Neuroléptica , Rabdomiólise , Antipsicóticos , Rigidez MuscularRESUMO
Paciente varón de 21 años, sin antecedentes de importancia que ingresa a Emergencia por presentar deposiciones rojo oscuras, tendencia al sopor e hipotensión, con anemia importante procediéndose a realizar sucesivamente transfusión sanguínea, endoscopia digestiva alta, angiotomografía abdominal y arteriografía que, con diagnóstico clínico de lesión de Dieulafoy, motivó laparotomía exploratoria encontrándose una lesión vascular a nivel yeyunal con sangrado activo. Se discute el manejo de hemorragia digestiva severa con compromiso hemodinámico y la causa poco común de malformación arteriovenosa a nivel yeyunal hallada por patología.
A 23-year old male patient with no history of importance was admitted to Emergency because of dark red stools, tendency to lethargy and hypotension, with significant anemia proceeding to perform on blood transfusion, upper endoscopy, abdominal angiotomography and arteriography with clinical diagnosis of Dieulafoy lesion motivated exploratory laparotomy finding injury vascular, the jejunum with active bleeding. The management of severe gastrointestinal bleeding with hemodynamic compromise and uncommon cause of arteriovenous malformation in the jejunum is discussed.
Assuntos
Humanos , Masculino , Adulto Jovem , Malformações Arteriovenosas/complicações , Hemorragia Gastrointestinal/etiologia , Jejuno/irrigação sanguínea , Malformações Arteriovenosas/cirurgia , Malformações Arteriovenosas/diagnóstico , Malformações Arteriovenosas/patologia , Anastomose Cirúrgica , Hemodinâmica , Jejuno/cirurgia , Divertículo Ileal/cirurgia , Divertículo Ileal/complicaçõesRESUMO
A 23-year old male patient with no history of importance was admitted to Emergency because of dark red stools, tendency to lethargy and hypotension, with significant anemia proceeding to perform on blood transfusion, upper endoscopy, abdominal angiotomography and arteriography with clinical diagnosis of Dieulafoy lesion motivated exploratory laparotomy finding injury vascular, the jejunum with active bleeding. The management of severe gastrointestinal bleeding with hemodynamic compromise and uncommon cause of arteriovenous malformation in the jejunum is discussed.
