Case 1A 60-year-old woman was found

Case 1
A 60-year-old woman was found unconscious at
home with an unknown cause and duration of unconsciousness.
The patient was admitted to the intensive
care unit (ICU) at a regional hospital. A computed
tomography (CT) scan of her brain showed no abnormalities,
but the patient had severe metabolic acidosis
(pH, 6.83; base excess, -27.3) with a high anion gap,
although no toxic substances were detected in the
blood or urine. One hour after admission the patient’s
condition deteriorated quickly, and bilateral mydriasis
and brainstem unresponsiveness developed. Brain CT
was repeated, with findings of massive subarachnoid
hemorrhage and malignant brain swelling. The patient
was transferred to our department for diagnosis of
brain death and consideration for organ donation.
A second toxicology investigation focused on the
most common causes of metabolic acidosis was performed,
but no toxic substance, including methanol or
other alcohols, was found.
The patient was not registered in the National
Registry of Organ Donation Refusal; her family was
fully informed, and brain death was diagnosed properly
thereafter. A consultant from the Center of Transplantations
indicated donation of kidneys only. The
patient remained hemodynamically stable, and urine
output remained normal until organ procurement. The
last level of creatinine in the blood was 1.52 mg/dL (to
convert to micromoles per liter, multiply by 88.4), and
the acid-base status was fully corrected to a pH of 7.35.
A biopsy of the kidney during procurement showed
incipient atherosclerotic nephrosclerosis, resulting in
a Remuzzi score of 3.
Retrospective toxicological analysis of the first
blood samples obtained revealed a formic acid level of
1061 mg/L. Analysis of the blood obtained during
autopsy revealed a formic acid level of 84 mg/L.

ผลลัพธ์ (อังกฤษ) 2:

Case 1
A 60-year-Old Woman Found Unconscious was at
Home with an Unknown Cause and Duration of Unconsciousness.
The Patient was admitted to The intensive
Care Unit (ICU) at a Regional Hospital. A computed
Tomography (CT) Scan of Her Brain showed no abnormalities,
but had severe metabolic acidosis The Patient
(pH, 6.83; Base Excess, -27.3) with a High anion Gap,
although no Toxic Substances were detected in The
Blood or urine. One hour Admission After The Patient's
condition Deteriorated Quickly, and bilateral Mydriasis
and brainstem unresponsiveness developed. Brain CT
was repeated, with findings of Massive subarachnoid
hemorrhage and malignant Brain swelling. The Patient
was Transferred to our Department for diagnosis of
Brain Death and consideration for Organ Donation.
A Second toxicology Investigation Focused on The
Most Common causes of metabolic acidosis was performed,
but no Toxic Substance, including methanol or
Other alcohols, was Found.
The Patient. Not was registered in The National
Registry of Organ Donation Refusal; Her Family was
Fully Informed, and Brain Death was diagnosed properly
thereafter. A consultant from The Center of Transplantations
indicated Donation of kidneys only. The
Patient remained hemodynamically Stable, and urine
output remained normal until Organ procurement. The
Last Level of creatinine in The Blood was 1.52 mg / dL (to
convert to micromoles Per liter, Multiply by 88.4), and
The acid-Base Status was Fully corrected to a pH of 7:35.
A Biopsy of The Kidney during procurement showed
incipient. atherosclerotic Nephrosclerosis, resulting in
a REMUZZI Score of 3.
Retrospective analysis of toxicological The First
Blood samples obtained Revealed a Level of formic acid
in 1061 mg / L. The Blood obtained during analysis of
a formic acid Autopsy Revealed Level of 84 mg / L.