[Thrombotic microangiopathy mimicking a heparin-induced thrombocytopenia]. / Une microangiopathie thrombotique mimant une thrombopénie induite par l'héparine.

We report a case of a 47 years old woman. In her case of medical history, there were vein thrombosis and an allergic to tinzaparin. The patient entered in critical care unit under medical supervision for a multivisceral infarction due to an arterial mesenteric, renal and splenic thrombosis. An heparinotherapy was introduced. A laparotomy was realized because of an occlusion. Small intestine necrozed was removed. 8 days after the introduction of the heparin, there was a thrombocytopenia. Considering the background and the initiale situation, an heparin-induced thrombocytopenia of type II (HTI) was suspected. Whereas the heparinotherapy was stopped, the thrombocytopenia maked worse. Biological tests infirmed HIT's diagnosis. A recurrent anemia in spite transfusions associated to a renal failure suggest a thrombotic microangiopathy which was secondary confirmed. The intensivist is sensibilized to evoke an heparin induced thrombocytopenia when there is a thrombocytopenia under heparin. However, he must not forget diagnosis of thrombocytopenia which required specific investigations and emergency treatment such as thrombotic microangiopathy.

[Pharmacokinetics of biological tags in a case of acute valpromide self poisoning]. / Pharmacocinétique des marqueurs biologiques d'une intoxication médicamenteuse volontaire grave au valpromide.

We report the case of a 35-year-old woman hospitalized in intensive care unit after valpromide self-poisoning (Dépamide). The dose supposed to be taken was 15 g. The patient eleven hours after ingestion, presented, a coma with bilateral non-reactive mydriasis, justifying intubation and mechanical ventilation. An acidosis (pH = 7.24), a hyperlactatemia (2.72 mmol/L), a hyperammonemia (328.9 micromol/L), and were diagnosed valproic acid plasmatic concentration was 1190 microg/mL at 22 hours. Symptomatic treatment and L-carnitine therapy (50 mg/kg/12h) normalized the action of biological abnormalities and allowed disappearance of symptoms; the patient was extubated after 46 hours, and outcome from intensive care unit at 65 hours.