Case 8 History ---- The patient was a 29-year-old woman neurologically devastated since a very young age with a static encephalopathy (“cerebral palsy”), who presented to BJC after the family noted decreased responsiveness, decreased urine output and respiratory difficulties at home. On admission, she was severely hypothermic at 31.9 degrees, and was in shock with a blood pressure of 60's over palpable. She was put on pressors and was treated for sepsis. Since admission, she had been mechanically ventilated in the ICU, on intravenous fluids, pressors, and broad-spectrum antibiotics. CT scan revealed pneumonia and a pancolitis. Throughout her admission, she had an anion gap metabolic acidosis and a rising lactic acid. On July 1, she became more tachypneic and arterial blood gases revealed a decreased hydrogen ion concentration to 7.08. She was treated with intravenous bicarbonate and increases to her mechanical ventilation, with slow improvement in her blood gas values. At the request of surgery, she was taken for an abdominal computed tomography scan. While being scanned, she developed hypoxemia and lost her pulse. Chest compressions were performed. She was still without a pulse after several rounds of epinephrine and atropine had been given. Code was stopped per family agreement. The cause of death was septic shock secondary to severe pneumonia and pancolitis. ---- Autopsy demonstrated microcephaly (500g), porencephaly, status marmoratus, and cortical ulegyria.
