Run or Die: A Didactique Case Report of a Rare Cause of Lactic Acidosis in Emergency Medicine

Abstract

Introduction. Acidosis with traumatic brain injury is a common and serious cause of consciousness disorders in emergency medicine. Extreme acidosis is significantly associated with high mortality (more than 67% if pH levels are under 7). Case Presentation. We describe the case of a 23-year-old man with unknown medical history who was found near the entrance of the emergency department sweat with a tachypnea (55 per minute), a lot of blood around him, and confused. The initial hypothesis was a hemorrhagic shock after a fight, but he did not have any hemodynamic trouble. The initial venous gazometry showed a major lactic acidosis (pH less than 6,8, HCO3 incalculable and lactate up to 20 mmol/L). A Focused Assessment with Sonography in Trauma-echography (FAST-echo) and secondly a body-tomodensitometry were conducted and did not reveal any anomaly. The team was now thinking that the patient situation was caused by an epileptic seizure (association of lactic acidosis and confusion), and the bleed was a consequence of the head trauma. The patient was treated only by NaCl 0,9%. One hour after his admission, the tachypnea began to decrease and he could speak and explain what was happen. He had to run as fast as possible to escape to a fight. The last gazometry, realized 2 hours after his admission, finds a normal pH at 7,35, HCO3 24,5 mmol/L and lactate 2,6 mmol/L. He was authorized to going home. Conclusion. We report here a rare case of major lactic acidosis in emergency medicine caused by a supramaximal effort.