Fulminante Laktatazidose bei kokaininduziertem agitiertem Delir

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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