RESUMEN
A 53-year-old woman was admitted to a tertiary intensive care unit (ICU) with acute respiratory distress syndrome secondary to severe community-acquired pneumonia that necessitated maximum supportive care with venovenous extracorporeal membrane oxygenation. Her medical history included bipolar disorder on quetiapine and sertraline, as well as a previous ICU admission, approximately 2 years prior, for non-cirrhotic hyperammonaemic encephalopathy that was complicated by prolonged post discharge anxiety and post-traumatic stress disorder-like symptoms, consistent with post-intensive-care syndrome. Here, we present a case, and explore the outcomes for a patient who had two separate admissions with life-threatening illnesses, but had distinct differences in the psychological outcomes following each illness.
Asunto(s)
Infecciones Comunitarias Adquiridas/complicaciones , Encefalopatía Hepática/complicaciones , Unidades de Cuidados Intensivos/tendencias , Neumonía/complicaciones , Síndrome de Dificultad Respiratoria/etiología , Ansiedad/psicología , Infecciones Comunitarias Adquiridas/diagnóstico , Cuidados Críticos/psicología , Delirio/psicología , Oxigenación por Membrana Extracorpórea/métodos , Femenino , Encefalopatía Hepática/sangre , Hospitalización/tendencias , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Persona de Mediana Edad , Alta del Paciente/tendencias , Síndrome de Dificultad Respiratoria/psicología , Síndrome de Dificultad Respiratoria/terapia , Trastornos por Estrés Postraumático/psicología , Resultado del TratamientoRESUMEN
A 51-year-old female presented with acute confusion associated with a non-specific headache and lethargy. The patient's history included bipolar disorder on valproate and recent travel to northern Vietnam. The patient was subsequently found to have hyperammonaemia as well as a urinary tract infection and bacteraemia with Klebsiellapneumoniae The patient was presumed to have a multifactorial non-cirrhotic hyperammonaemic encephalopathy due to a combination of a urinary tract infection and bacteraemia with K. pneumoniae, a urease-producing bacteria, and also valproate use, a medication known to interfere with ammonia elimination. The patient's treatment included supportive care, ceasing valproate, empiric then rationalised antibiotics, N-acetylcysteine and L-carnitine. We present a case of non-cirrhotic hyperammonaemic encephalopathy and explain why it is multifactorial in origin.