[Massive intravascular hemolysis secondary to sepsis due to Clostridium perfringens]. / Hemólisis masiva intravascular secundaria a sepsis por Clostridium perfringens.

Massive hemolysis secondary to sepsis caused by Clostridium perfringens is a rare entity but appears fairly often in the literature. In nearly all published reports, the clinical course is rapid and fatal. We describe the case of a 75-year-old woman with diabetes who was admitted with symptoms consistent with acute cholecystitis. Deteriorating hemodynamics and laboratory findings were consistent with intravascular hemolysis, coagulation disorder, and renal failure. Gram-positive bacilli of the Clostridium species were detected in blood along with worsening indicators of hemolysis. In spite of antibiotic and surgical treatment, hemodynamic support and infusion of blood products, the patient continued to decline and died in the postoperative recovery unit 14 hours after admission. Mortality ranges from 70% to 100% in sepsis due to Clostridium perfringens, and risk of death is greater if massive hemolysis is present, as in the case we report. Only a high degree of clinical suspicion leading to early diagnosis and treatment can improve the prognosis. This bacterium should therefore be considered whenever severe sepsis and hemolysis coincide.

Pancreatitis hipertrigliceridémica y embarazo / Hypertriglyceridemic pancreatitis in pregnancy

Una mujer de 33 años, secundípara, con antecedentes de hipertrigliceridemia familiar que se agravó en el embarazo anterior y diabetes gestacional, fue ingresada en la 36 semana de gestación por dolor abdominal difuso, vómitos, febrícula y mal estado general. La muestra de sangre era de aspecto lipémico, lechoso-rosado, con una concentración de triglicéridos plasmáticos de 2173 mg/dl, colesterol de 320 mg/dl, amilasa de 801 U/l, LDH 650 U/l, creatinina 1,5 mg/dl, glucemia de 380 mg/dl y leucocitosis con desviación a la izquierda. Fue diagnosticada de pancreatitis aguda, y por signos de sufrimiento fetal se le realizó una cesárea bajo anestesia general con propofol, succinilcolina, sevoflurano y tras el pinzamiento del cordón rocuronio y fentanilo. El recién nacido nació sano y la paciente evolucionó favorablemente con tratamiento conservador. La incidencia de la pancreatitis en el embarazo es baja, pero de morbimortalidad elevada. La etiología más habitual es la patología del tracto biliar, aunque alteraciones metabólicas poco frecuentes como la hiperlipidemia pueden actuar ocasionalmente como factor desencadenante. Hay que destacar la importancia del diagnóstico y tratamiento precoz de estos procesos como clave para el mejor pronóstico en quirófano y en su seguimiento en la Unidad de Reanimación (AU)

[Hypertriglyceridemic pancreatitis and pregnancy]. / Pancreatitis hipertrigliceridémica y embarazo.

A 33-year-old secundipara with a history of gestational diabetes and familial hypertriglyceridemia exacerbated during her previous pregnancy was admitted in the 36th week of gestation with diffuse abdominal pain, vomiting, low-grade fever, and general malaise. A blood sample had a lipemic, milky-pink appearance and plasma concentrations were as follows: triglycerides 2173 mg/dL, cholesterol 320 mg/dL, amylase 801 U/L, lactate dehydrogenase 650 U/L, creatinine 1.5 mg/dL, glucose 380 mg/dL, and left-shifted white cells. Acute pancreatitis was diagnosed and owing to signs of fetal distress, a cesarean was performed under light general anesthesia with propofol, succinylcholine, and sevoflurane. After the umbilical cord was cut, rocoronium and fentanyl were administered. The neonate was healthy and the patient's condition evolved favorably with conservative treatment. The incidence of pancreatitis during pregnancy is low but related morbidity and mortality are high. The usual cause is biliary tract disease, although rare metabolic alterations such as hyperlipidemia may occasionally act as the trigger. Early diagnosis and treatment are the keys to successful surgery and postoperative recovery.