Table of Contents
Washington University Experience | VASCULAR | Respirator Brain (In Vivo Autolysis) | 2A0 Case 2 History
Case 2 History ---- The patient was a 4 year old female who developed a fever, sore throat and cough treated by an antibiotic regimen. Her high fever continued, she began vomiting and was taken to SLCH ER where she was found to have orthostatic hypotension (treated with fluids) and respiratory distress for which she was intubated. During the intubation process she had an episode of asystole lasting less than a minute. Following intubation her blood pressure was 87/50 with a heart rate of 162. Twenty four hours later she developed nuchal rigidity, ankle clonus, bilateral Babinski signs and diffuse hyperreflexia. The patient was given Decadron and Amicar. At approximately 8:00 PM, the patient's mental status deteriorated markedly with decerebrate posturing and clonic seizure activity. An emergency CT scan revealed no changes. A bolt was placed and demonstrated extremely high intracranial pressures. An ammonia level rose from 7 on January 26th, the day of admission, to 150 on January 29th. Liver function tests remained elevated throughout her hospitalization. Her prothrombin time was below 20% despite administration of vitamin K. She eventually became hyperosmolar, with serum osmolarity as high as 400 and serum glucose values as high as 915. On January 31st the patient suffered respiratory arrest and required Dopamine and salt-poor albumin to maintain adequate blood pressure. Her examination after the arrest revealed no brain function and the respirator was discontinued on February 5. ---- Autopsy findings were consistent with Reye syndrome with cerebral edema and microsteatosis of the liver. Brain weight was not recorded.
