[Severe lactic acidosis in a pregnant woman with partial HELLP syndrome and COVID-19]

The present report describes the case of a 23-year old pregnant woman who was in the 36.5th week of gestation of her second pregnancy. She was attended at the emergency room because of dry cough and progressive dyspnea, in association with headache and myalgia. The nasopharyngeal swab for SARS-CoV-2 polymerase chain reaction (PCR) was positive. Oxygen saturation and chest x-ray were normal. Laboratory tests showed elevated values of bilirubin, aminotransferases, alkaline phosphatase and lactic dehydrogenase, and mild thrombocytopenia. Shortly after being admitted she began with labor. Faced with the lack of progression, the termination of the pregnancy by cesarean section was decided. Arterial blood gases showed severe lactic acidosis. She never presented evidence of clinical signs of tissue hypoperfusion or sepsis that could explain it. The patient completed her postoperative period in the intensive care unit, undergoing supportive treatment. All laboratory parameters were normalized after 72 hours, evolving favorably from the clinical point of view. It was interpreted that she had a partial HELLP syndrome. Lactic acidosis is not a component of this syndrome. Nor can it be ascribed to a mild disease by SARS-Cov-2. It probably responded to a summation of causes, including hyperproduction of lactic acid during labor, as well as its reduced clearance because of liver dysfunction related to HELLP syndrome.

Analysis of the first 100 patients with COVID-19 admitted to internal medicine wards at the Hospital de Clínicas José de San Martin, Buenos Aires University

This retrospective descriptive study analyzes the clinical and epidemiological characteristics, the disease evolution and its association with laboratory markers of poor prognosis of the first 100 patients with COVID-19 admitted to internal medicine wards at the Hospital de Clínicas José de San Martín, University of Buenos Aires. Thirty-one patients were nursing home residents, the most common clinical manifestations were fever, cough and odynophagia. Regarding comorbidities, obesity was the most frequent one and hypertension was the most prevalent in patients with pneumonia. The most important predictors of mortality were age and pneumonia. Patients older than 70 years had higher acute phase reactants showing an exaggerated inflammatory response. Mortality was high (13%), compared to most reports (5%), probably because of the advanced age of our population and the unfavorable clinical conditions they presented at admission. Se analiza, en un estudio descriptivo retrospectivo, las características clínicas y epidemiológicas, la evolución de la enfermedad y su asociación con los marcadores del laboratorio de mal pronóstico, en los primeros 100 pacientes internados en clínica médica con COVID-19 en el Hospital de Clínicas José de San Martín de la Universidad de Buenos Aires. El 31% de los pacientes provenían de geriátricos, las manifestaciones clínicas más comunes fueron fiebre, tos y odinofagia. En relación a las comorbilidades, la obesidad fue la más frecuente y la hipertensión arterial la más prevalente en los pacientes con neumonía. La edad y la presencia de neumonía fueron los predictores más importantes de mortalidad. Los pacientes mayores de 70 años presentaron reactantes de fase aguda más elevados mostrando una respuesta inflamatoria exagerada. La mortalidad fue elevada (13%), en comparación con la mayoría de las comunicaciones (5%), probablemente como consecuencia de la edad avanzada de nuestra población y las condiciones clínicas desfavorables que presentaron a su ingreso.