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NOTARZT 2019; 35(06): 329-334
DOI: 10.1055/a-1011-3525
Kasuistik
Georg Thieme Verlag KG Stuttgart · New York

Fulminante Laktatazidose bei kokaininduziertem agitiertem Delir

Cocaine-Induced Excited Delirium with Severe Lactic Acidosis
Gerald Wellershoff
Kardiologie und konservative Intensivmedizin, Vivantes Klinikum Am Urban, Berlin
› Author Affiliations
Further Information

Publication History

Publication Date:
25 October 2019 (online)

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Zusammenfassung

Das agitierte Delir ist ein medizinischer Notfall mit signifikanter Mortalität. Schwere Laktatazidosen bei Patienten, die gegen eine Fixierung kämpfen, wurden beschrieben. Die vorliegende Kasuistik präsentiert eine fulminante Laktatazidose (initialer pH 6,58) im Rahmen eines kokaininduzierten Delirs. Klinische Symptomatik, pathophysiologische Erklärungsansätze und Hinweise zur Therapie werden erläutert.

Abstract

Excited delirium is a medical emergency with a significant mortality. Severe lactic acidosis is sometimes found in these patients, especially when they are struggling against restraining. This case report presents a fulminant lactic acidosis in a patient with cocaine-induced excited delirium. Initial arterial pH was 6,58. Clinical presentation, suspected pathophysiology of the condition and therapy are outlined.

Fazit für die Praxis / Take Home Message

  • Das kokaininduzierte agitierte Delir ist ein lebensbedrohlicher Notfall.

  • Plötzliche Todesfälle wurden vielfach beobachtet, insbesondere beim „Kampf gegen die Fixierung“.

  • Schwere Laktazidosen wurden vielfach beschrieben.

  • Eine Fixierung des Patienten darf dessen Respiration nicht behindern.

  • Ein plötzliches Sistieren des aktiven Widerstandes kann den Kollaps des Patienten ankündigen.

Schlüsselwörter

Kokain - agitiertes Delir - Laktatazidose - Rhabdomyolyse - Fixierung

Key words

cocaine - excited delirium - lactic acidosis - rhabdomyolysis - restraining
 

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