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Lack of efficacy: case report A 34-year-old woman exhibited lack of efficacy during treatment with magnesium, unspecified bronchodilators and steroids for bronchospasm. The woman, who had a history of persistent asthma and cocaine abuse, presented to hospital with respiratory distress caused by exacerbation of asthma. Her condition rapidly deteriorated, and she required mechanical ventilation. Subsequently, she was treated with magnesium, unspecified bronchodilators and IV steroids [not all routes stated, dosages not stated], but the bronchospasm remained refractory to therapy, and she had a prolonged episode of hypercapnia. On day 3 of hospitalisation, her condition became more complicated due to sepsis secondary to methicillin-sensitive Staphylococcus aureus pneumonia [aetiology not specified]. Hence, she was given vasopressor [specific drug not stated] support. On day 4, she developed polyuria and unilateral mydriasis, along with a sudden increase in pressor requirements. A brain CT scan showed diffuse cerebral oedema, with preservation of the grey white matter differentiation, which quickly led to fatal herniation. El Husseini I, et al. Status asthmaticus leading to fatal herniation. American Journal of Respiratory and Critical Care Medicine 199: (plus poster) abstr. A6632, No. 9, May 803447146 2019. Available from: URL: http://doi.org/10.1164/ajrccm-conference.2019.199.1_MeetingAbstracts.A6632 [abstract]

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Reactions 18 Jan 2020 No. 1787