Abstract
Objectives: Coma, hypothermia and hypotension caused by alcohol and benzodiazepine intoxication can be successfully treated with the use of continuous veno-venous hemodialysis (CVVHD). It eliminates small molecules, corrects pathological laboratory parameters and gradually heats the blood. Methods: We present a case report of a female patient suffering from depression who attempted suicide with benzodiazepine, karbamazepine and alcohol ingestion. She was brought into the intensive care unit in a comatous state (GCS score–3), with an arterial blood pressure of approximately 40 mmHg, body temperature less than 30°C, blood alcohol concentration of 550 mg/dL, and positive assessments for benzodiazepines and karbamazepine. The nefrologist indicates that CVVHD is necessary. Results: Alcohol blood levels fell to 170 mg/dL after 10 hours of CVVHD, while blood pressure and body temperature rose. After CVVHD, alcohol blood levels dropped to 0.002 mg/dL, body temperature measured 35.5°C, and blood pressure, diuresis and electrolite status were of normal levels. Conclusion: CVVHD (along with measures of intensive treatment) had a positive outcome on a patient that was vitally endangered by suicide attempt. This is based on the fact that CVVHD gives adequate clearance of alcohol and benzodiazepines, corrects electrolite status, and gradually raises body temperature by extracorporal circulation.
Highlights
Alcohol-induced coma, hypothermia and hypotension are a result of a chain of events, including vasodilatation of central origin, and hypoglycemia due to a decrease in muscle glicogen stores
Hypothermia carries a high risk of mortality, most commonly associated with cardiac arrhythmia, and one of the most successful ways of treating hypothermia in vital indications is hemodialysis
Hemodialysis can be an option in treatment of accidental poisoning or attempted suicide using alchohol, especially if the intoxication is combined with other vitally endangering conditions, such as coma, osmolality imbalance, hypothermia, acidosis, etc
Summary
Alcohol-induced coma, hypothermia and hypotension are a result of a chain of events, including vasodilatation of central origin, and hypoglycemia due to a decrease in muscle glicogen stores. Hypothermia carries a high risk of mortality, most commonly associated with cardiac arrhythmia, and one of the most successful ways of treating hypothermia in vital indications is hemodialysis. Hemodialysis can be an option in treatment of accidental poisoning or attempted suicide using alchohol, especially if the intoxication is combined with other vitally endangering conditions, such as coma, osmolality imbalance, hypothermia, acidosis, etc. The patient was unconscious, cyanotic, with occasional shallow respiration and without palpable arterial pulsations. Her pupils were dilated with no pupillary light reflex, as well as being in total areflexia. The ECG registered sinus bradycardia with a frequency of 40 bpm
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