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!
Specializes in PACU, CARDIAC ICU, TRAUMA, SICU, LTC.
I would say Gram negative Urosepsis. Offending bacteria E Coli causing UTI. Initially, diaphoresis from elevated temp; pt. then becomes hypothermic. Respiratory alkalosis initially coinciding with hyperthermia. Leukocytosis and thrombocytopenia commonly seen.
Used to see this picture quite often in the ICU in elderly men from LTC facilities..sicker than s***.
How would he get the endocarditis then? Just a result of the sepsis?
Yeah I've had several patients who developed endocarditis from blood borne infections. Come to think of it all were young males. The cause of the infection was a central line in all cases but IV drug use has the same risks, I would imagine more as they are less concerned with sterility.
Specializes in multispecialty ICU, SICU including CV.
How would he get the endocarditis then? Just a result of the sepsis?
Endocarditis is highly correlated with illicit IV drug use. Generally the solutions they shoot up are not sterile. Bacteria travels to their heart valves and gets stuck on them and continues to grow (vegetation). Any of those veggies break off -- you're screwed. It's a huge bacterial load in minutes. That is probably why the guy drenched the bed like you said he did.
Yeah, I was trying to give him the benefit of the doubt since he said he was on the Suboxone ONLY at this point. Then again, when has a druggie patient ever been honest with me? Never. So..
Specializes in multispecialty ICU, SICU including CV.
Yeah, I was trying to give him the benefit of the doubt since he said he was on the Suboxone ONLY at this point. Then again, when has a druggie patient ever been honest with me? Never. So..
He might not have been lying to you...could have been clean for some time, living with vegetation on his valves, and not known it.
Specializes in ICU, PICU, School Nursing, Case Mgt.
Also, back in the day---a long time ago--before I became a nurse, I was a Registered Dental Hygienist. We were very careful to premedicate anyone with any hint of heart valve problems. During scaling the subgingival bacteria get "injected" into the bloodstream and can cause what we always called SBE. Sub Acute Bacterial Endocarditis.
Saw a couple cases in the hospital, but thankfully never caused any!
Sounds like Endocarditis/sepsis to me...also the suboxone is the dead give away for drug use of some sort. I think the antenna should have come up when that was mentioned. That's the only thing it's prescribed for--opiates, I mean, not necessarily IV use, but it's a good assumption.
I wish we could find out what happened. I'm curious.
caliotter3
38,333 Posts
I'm sorry he was transferred, because now we won't find out what happened.