Multiple drugs
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Multiple drugs Heparin-induced thrombocytopenia and lack of efficacy: case report
A 78-year-old man developed heparin-induced thrombocytopenia (HIT) during treatment with heparin for lung embolism and exhibited lack of efficacy during treatment with dopamine, hydrocortisone, norepinephrine and Ringer’s lactate for hypotension or acute respiratory distress syndrome (ARDS) [not all dosages and routes stated; time to reaction onset not stated]. The man was admitted to the emergency department due to generalised chest pain, specifically in the left hemithorax. He also had shortness of breath during the daily activities, but had no complaints regarding abdominal problems. His medical history included hypertension and use of opium and cigarettes. He was found to have ischaemic heart disease. Thus, he received aspirin, clopidogrel [Plavix], enoxaparin sodium [enoxaparin], atorvastatin and nitroglycerin [nitroglycerine]. He was found to have three diseased vessels involving coronary arteries. He underwent coronary artery bypass grafting (CABG) surgery. During the surgery, due to the opening of the left pleural space, a chest tube was inserted into the left hemithorax. He received heparin during the operation. He was transferred to the ICU after the operation. His heparin was switched to enoxaparin sodium. He was extubated 24 hours after the surgery, and started receiving oral nutrition. Due to constipation, he was prescribed magnesium hydroxide [milk of magnesia]. On post-operative day 2, he defecated, and his only complaint was irritation of the urethra due to the presence of a urinary catheter. He was prescribed phenazopyridine, and his burning sensation was relieved. On the next day, he complained of severe hypogastric pain, fever, nausea and vomiting. He was found to have colon distension. Thus, sigmoid volvulus was diagnosed. Initially, he received fluid therapy, and appropriate urine output was obtained. He was prescribed antibiotics including ceftriaxone and metronidazole. He underwent laparotomy and the dilated colon was pulled out of the abdomen. He had no evidence of gangrene in the small intestine and the colon, but due to his inappropriate general condition, sigmoid resection and primary anastomosis were avoided. Thus, his sigmoid colon was resected, and Hartmann colostomy was embedded. Following the surgery, he was transferred to the ICU and intubated. His condition was stable in the ICU. He received enoxaparin sodium and potassium chloride [KCl] and extubated. He started oral food intake. Next day, he underwent rapid atrial fibrillation. He was prescribed amiodarone and atrial fibrillation rhythm was controlled. He had significant pleural effusion in the right hemithorax; thus, chest tub No.28 was inserted in the right hemithorax, serous fluid was alternately evacuated and both hemithoraxes were cleared. He was completely stable in the ICU. Two days later, he suffered from respiratory distress. He complained of severe shortness of breath. He was found to have lung embolism in the vascular branches of th
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