ABSTRACT
Severe respiratory alkalosis is a life-threatening condition, as it induces hypo- calcaemia and extreme adrenergic sensitivity leading to cerebral and myocardial vasoconstriction. We report a 37-year-old woman with previous consultations for a conversion disorder. While she was infected with SARS-CoV-2 (without pulmonary involvement), she consulted in the emergency room due to panic attacks. On admission, she developed a new conversion crisis with progressive clinical deterioration, hyperventilation, and severe respiratory alkalosis (pH 7.68, Bicarbonate 11.8 mEq/L and PaCO2 10 mmHg). Clinically, she was in a coma, with respiratory and heart rates 55 and 180 per min, a blood pressure of 140/90 mmHg, impaired perfusion (generalized lividity, distal coldness, and severe skin mottling) and tetany. She also had electrocardiographic changes and high troponin levels suggestive of ischemia, and hyperlactatemia. She was managed in the hospital with intravenous benzodiazepines. The clinical and laboratory manifestations resolved quickly, without the need for invasive measures and without systemic repercussions.
Subject(s)
Humans , Female , Adult , Alkalosis, Respiratory/etiology , COVID-19/complications , Troponin , Benzodiazepines , Bicarbonates , Adrenergic Agents , SARS-CoV-2 , Hyperventilation/complicationsSubject(s)
Humans , Acidosis, Respiratory/etiology , Acidosis, Respiratory/physiopathology , Alkalosis, Respiratory/diagnosis , Alkalosis, Respiratory/etiology , Acidosis, Lactic/diagnosis , Acidosis, Lactic/etiology , Acidosis, Lactic/physiopathology , Acid-Base Imbalance/complications , Acid-Base Imbalance/diagnosis , Acid-Base Imbalance/etiologyABSTRACT
Descreve-se, no pós-operatório imediato, em cirurgia cardíaca, as quatro principais alteraçöes do equilíbrio ácido-básico que podem ocorrer e analisa os mecanismos desencadeantes de cada uma delas, os mecanismos de tamponamento e de compensaçäo orgânica, apresentando esquemas ilustrativos. Ao tratar da causa de cada alteraçäo, mostra exemplos detalhados de sua casuística pessoal e discute o tratamento e a normalizaçäo laboratorial dos parâmetros que caracterizam o desequilíbrio. As medidas preventivas, os sinais e sintomas de cada uma delas säo descritos com pormenores. Quanto ao tratamento, cita os dois princípios fundamentais que o norteiam: o afastamento da causa determinante e a necessidade de repetiçäo das dosagens para avaliaçäo da tendência evolutiva do processo. Ao finalizar, faz referências às dificuldades de diagnóstico clínico devido a incidência concomitante de alteraçöes de causas primárias independentes e a inconstância de certos sinais e sintomas