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Washington University Experience | VASCULAR | Respirator Brain (In Vivo Autolysis) | 4A0 Case 4 History
Case 4 History ---- The decedent was a 31-year-old man with a history of type I diabetes mellitus who had experienced several days of nausea, vomiting, abdominal pain, and diarrhea in the setting of recent malfunctioning of his insulin pump. He was brought to the emergency department after witnessed syncope at home on 12/12. Per his family, the EMS arrived to find the patient with pulseless electrical activity and cardiopulmonary resuscitation was initiated. The patient was intubated in the field and arrived at the ER in asystole. Return of spontaneous circulation was attained after approximately 48 minutes of total downtime, but he subsequently developed ventricular tachycardia requiring defibrillation. Blood potassium was found to be 6.6 mmol/L upon arrival rising to 9.0 mmol/L within two hours of admission with an anion gap of 27 and blood glucose of 806 (mg/dL) consistent with diabetic ketoacidosis and suspected pseudohyperkalemia. Electrocardiogram showed T-wave inversion in leads V3-V5. Cardiology was consulted with low suspicion for acute coronary syndrome, and higher suspicion for electrolyte and metabolic abnormalities as the etiology for cardiac arrest. He received insulin, dextrose, albuterol, normal saline, furosemide, calcium chloride, and bicarbonate. Despite successful resuscitation, CT imaging of the head showed evidence of severe anoxic brain injury. Neurosurgery was consulted, but were unable to offer meaningful intervention. After metabolic abnormalities were corrected and sedation discontinued, a brain death examination was performed by the neurology critical care team and the time of the death was on 12/15, 3 days after admission.
