Recently had a bizarre case on my unit where I was acting as charge. I have never seen anything like this- and am dying to hear ideas as to what it might have been!
Male patient in 30's originally came into ER to detox from Suboxone(apparently), but was found to be in a bit of alkalosis, with a uti. Appeared very ill on arrival to our floor, and we ended up calling a rapid response team on him a couple hours later when he drenched the bed with sweat(so much so that none of us, including the docs had ever seen anyone THIS diaphoretic). MD determined that he must have simply been in withdrawals, but felt something else was going on- but couldn't figure it out. Vitals were stable, labs decent(no changes), sat's 100%. We were all stumped. So he remained on our floor, in very poor condition.
This is the bizarre part.. Within a THREE hour timeframe.. his labs did the following..
K+ from 6.0 to 7.0 (Note: this is after patient received insulin, calcium, bicarb to treat the high K, it continued to climb!)
WBC from 23 to 78!
Mag was high, but I cannot recall the number.
Platelets from 99 to 33!
pH from 7.4 to 7.0
Temperature from 101 to 94!!
Sats from 100% on NC to 80% on NRB
So we transferred to ICU, and he was intubated. The docs remained stumped last I heard.
I have never seen anything like this, and am dying to know what would cause such bizarre changes in such a short period of time. Any ideas/thoughts would be helpful, I'd love to discuss this!
Can't get you anything that doesn't cost $$. Pity I'm not at work where I could get you a dozen articles in less than 5 minutes (huge academic setting) but alas I won't be back there until Monday.
When I've had lab values change so quickly and to such extremes, 99% of the time, the lab got the values wrong. It looks like that probably wasn't the case here because of the simultaneous change in temperature.
The last time I took care of a patient with bizarre symptoms, they gave him a dx I'd never heard of. I asked one of the MDs about it and he said, "That dx was coined two days ago by Dr. X here at xxxxx hospital center."
Have you ruled out an infectious disease like ehrlichiosis?
Specializes in multispecialty ICU, SICU including CV.
I've seen this before in the ICU. I would pin this on a bloodstream infection of some type causing a severe cold sepsis. Severe sepsis often goes hand in hand with ARF (high K) and DIC (plt count) so that would be consistent. Are you sure patient wasn't injecting drugs? Did patient get blood cultures? That might help pinpoint a cause. The UTI would also be an obvious place to point a finger -- could have gone systemic as well.
The few patients I have seen get sick to this magnitude with symptoms like this usually don't live. The one patient that I did see survive ended up on dialysis and lost several fingers/toes to microvascular clotting with the DIC.
In the unit, we call this type of scenario TTD -- Trying To Die. I know, not so PC, but it's accurate. A pH of 7.0 is very scary and near dead.
Keep us updated, will be interesting to find out what is found out.
That's interesting. It makes sense in this scenario.. As far as I know, he did not shoot drugs-- then again, we were going off of his parent's word as he was unable to tell us much. So no telling..
Why in someone so young, would a UTI get to this point in a healthy young male? Unless he's not actually healthy..
Ok- so I found out a couple more details.. Apparently he had a history of IV drug use, but apparently was on the Suboxone for treatment from that.
The docs decided he has some sort of infection in a heart valve, and he was flown to a bigger hospital. That's all I know at this point.. But I'm glad they have "A" diagnosis. Definitely an interesting case, hope it turns out well.
Did the patient have any heparin? It could be HIT along with sepsis. It's too bad you likely won't find out more details now that he's been transferred.
Specializes in multispecialty ICU, SICU including CV.
Ok- so I found out a couple more details.. Apparently he had a history of IV drug use, but apparently was on the Suboxone for treatment from that.
The docs decided he has some sort of infection in a heart valve, and he was flown to a bigger hospital. That's all I know at this point.. But I'm glad they have "A" diagnosis. Definitely an interesting case, hope it turns out well.
That sounds about right. IV drug use --> endocarditis --> severe sepsis.
Patient will likely need valve replacement if he doesn't die first. Gotta love it when 30 year olds slowly kill themselves.
Specializes in Dialysis,M/S,Home Care,LTC, Admin,Rehab.
Has he had a nephrology consult? This guy is screaming renal failure.
While that does not address all of his issues, dialysis will definitely adjust many of his labs as well as his temperature, by increasing the temperature of the dialysate solution. He seems to be in complete metabolic crisis!
FlyingScot, RN
2,016 Posts
Can't get you anything that doesn't cost $$. Pity I'm not at work where I could get you a dozen articles in less than 5 minutes (huge academic setting) but alas I won't be back there until Monday.