SUNDAY NIGHT FEVER: A CASE REPORT
Urgência / Cuidados Intermédios e Doente Crítico - E-Poster
Congresso ID: P851 - Resumo ID: 1453
Centro Hospitalar Universitário de Lisboa Central
Marília Andreia Fernandes, Rita Ventura Alves, Diogo Drummond Borges, Madalena Vicente, Sara Castro, Heidi Gruner, Francisco Farrajota
Introduction: Acute cardiac rhythm disturbances related to acute alcoholic intake, regardless of prior cardiac disease, are a common presentation to the emergency department and known as holiday heart syndrome (HHS). The arrhythmogenic effect of alcohol is dose dependent and does not have any relation with underlying structural heart disease. Atrial fibrillation (AF) is the most typical rhythm disorder connected to HHS.
Case report: Italian male student, aged 18 years old, on holiday in Lisbon, admitted to an emergency department on a Sunday night due to altered state of consciousness after being found unconscious in the street. Previously healthy. On admission, Glasgow Coma Scale of 5, hypothermic (34 ºC), tachycardic (170 beats per minute), hypotensive (99/77 mmHg) with oxygen saturation of 90% without supplemental oxygen. Pale and dehydrated. First and second heart sounds arrhythmic with no audible heart murmurs. No other physical examination findings.
The electrocardiograph showed AF with rapid ventricular response and no signs of structural damage. Chest radiograph showed normal cardiothoracic index. Bedside echocardiogram with no alterations. Blood tests revealed high level of ethanol (179 mg/dL; reference value: >100 mg/dL, for altered state of consciousness) and normal glucose. Anemia, alterations on corpuscular constants and elevation of infection parameters were excluded. Normal renal function and electrolyte balance, except for hypocalcemia (7.5 mg/dL; reference interval: 8.40 - 10.20 mg/dL). No alteration of international normalized ratio, liver enzymes even gamma-glutamyl transferase or pancreatic amylase were noted. Cardiac enzymes into reference range. No meth- or amphetamines, opioids nor cannabinoids were detected in urine.
The patient was re-warmed and hydrated. Administration of magnesium sulfate and correction of calcium were also performed. One hour and half after admission the patient was conscious and obeying simple commands. The cardiac rhythm converted into sinus rhythm three hours and half past the first evaluation. The patient left the emergency department 16 hours after admission.
Discussion: Binge drinking is the consumption of five or more alcoholic drinks on a single occasion, usually observed during the weekend or holiday. In patients without structural heart disease or common risk factors for AF. HHS should be suspected after ruling out life-threatening conditions. HHS usually resolves within 24 hours with spontaneous recovery once alcoholic abstinence is initiated.
Case report: Italian male student, aged 18 years old, on holiday in Lisbon, admitted to an emergency department on a Sunday night due to altered state of consciousness after being found unconscious in the street. Previously healthy. On admission, Glasgow Coma Scale of 5, hypothermic (34 ºC), tachycardic (170 beats per minute), hypotensive (99/77 mmHg) with oxygen saturation of 90% without supplemental oxygen. Pale and dehydrated. First and second heart sounds arrhythmic with no audible heart murmurs. No other physical examination findings.
The electrocardiograph showed AF with rapid ventricular response and no signs of structural damage. Chest radiograph showed normal cardiothoracic index. Bedside echocardiogram with no alterations. Blood tests revealed high level of ethanol (179 mg/dL; reference value: >100 mg/dL, for altered state of consciousness) and normal glucose. Anemia, alterations on corpuscular constants and elevation of infection parameters were excluded. Normal renal function and electrolyte balance, except for hypocalcemia (7.5 mg/dL; reference interval: 8.40 - 10.20 mg/dL). No alteration of international normalized ratio, liver enzymes even gamma-glutamyl transferase or pancreatic amylase were noted. Cardiac enzymes into reference range. No meth- or amphetamines, opioids nor cannabinoids were detected in urine.
The patient was re-warmed and hydrated. Administration of magnesium sulfate and correction of calcium were also performed. One hour and half after admission the patient was conscious and obeying simple commands. The cardiac rhythm converted into sinus rhythm three hours and half past the first evaluation. The patient left the emergency department 16 hours after admission.
Discussion: Binge drinking is the consumption of five or more alcoholic drinks on a single occasion, usually observed during the weekend or holiday. In patients without structural heart disease or common risk factors for AF. HHS should be suspected after ruling out life-threatening conditions. HHS usually resolves within 24 hours with spontaneous recovery once alcoholic abstinence is initiated.