RESUMEN
El SDRA severo es un síndrome clínico de relativa frecuencia en las unidades críticas y de elevada morbi-mortalidad, la que no ha sido modificada significativamente a pesar de los avances en la investigación clínica. Un conocimiento profundo de su fisiopatología y las condiciones particulares de cada caso permiten un manejo adecuado. Un número importante de estrategias de manejo han sido investigadas, con variable resultado, pero es improbable que una sola de ellas conduzca a resultados clínicos exitosos. Al revés, una combinación juiciosa e informada de las diferentes alternativas terapéuticas disponibles es la única opción conocida hoy día para el manejo de estos pacientes. La transferencia precoz de estos casos a centros de referencia con experiencia y equipamiento en el manejo de esta patología puede salvar vidas.
Severe ARDS is a relatively common clinical syndrome in critical care units and carries a high morbi-mortality, which has not been significantly modified despite advances in clinical research. A thorough understanding of its pathophysiology and the particular conditions of each case allow proper management. A significant number of therapeutical strategies has been investigated, with variable results, but it is unlikely that one of them alone leads to successful clinical outcomes. Conversely, an informed and judicious combination of the different therapeutic options available is the only strategy known today for the management of this patients. An early referral of this cases to centers with expertise and equipment in the management of this disease can save lives.
Asunto(s)
Humanos , Mecánica Respiratoria/fisiología , Síndrome de Dificultad Respiratoria/fisiopatología , Síndrome de Dificultad Respiratoria/terapia , Fármacos Neuromusculares/uso terapéutico , Oxigenación por Membrana Extracorpórea , Óxido Nítrico/uso terapéutico , Ventilación de Alta Frecuencia/instrumentaciónRESUMEN
We report a 72 years old hypertensive female, treated with enalapril 10 mg/day and hydrochlorothiazide 25 mg/day during three years. She presented a depressive disorder and cytalopram was prescribed in a dose of 10 mg/day. Two weeks before admission, a serum electrolyte analysis disclosed normal results and the cytalopram dose was increased to 20 mg/day. The patient was admitted with a hyponatremic encephalopathy with a plasma sodium of 100 mEq/L and a plasma potassium of 2.0 mEq/L. cytalopram, enalapril and hydrochlorothiazide were discontinued, hypertonic NaCl and KCl were administered. The patient had a favorable evolution with a remarkable improvement of her symptoms