Case Report Paciente de sexo femenino de 21 aos de edad, residente en la ciudad de Medelln con diagnostico de lupus eritematoso sistmico

hace 6 aos asociado a nefropata lpica estadio 3 medicada con Azatioprina, Prednisona, Losartan y Omeprazol, y en tratamiento por Psiquiatria por un cuadro de ansiedad asociado a su enfermedad de base en manejo con Venlafaxina y Clonazepam. La paciente en su tercer intento suicida, decide tomarse 10 pastillas de Micofenolato Mofetil y es llevada al servicio de urgencias en donde se le realizo lavado gstrico y aplicacin de carbn activado, refiri gastritis, dolor abdominal en epigastrio, nauseas, vomito, diarrea y cefalea al momento del ingreso. Luego la paciente es remitida a la Clinica Universitaria bolivariana en donde se le encuentran cifras tensionales altas por lo cual se traslado a UCE y se le inicio hidratacin, nitroprusiato de sodio y proteccin gstrica con ranitidina. La paciente a las 7 horas continua con una presin de 137/90 mmHg a pesar de la infusin de nitroprusiato y presento un cuadro de ansiedad. Al segundo dia de hospitalizacin la paciente continuo con cifras tensionales altas (140/100 mmHg) por lo cual se le continuo la infusin de nitroprusiato y se le reinicia losartan y ademas se le adiciono tiosulfato de sodio como medida preventiva frente a posible intoxicacin por cianatos. Al tercer dia de hospitalizacin se desmonto el nitroprusiato de sodio, se le inicio manejo antihipertensivo oral a dosis altas y por disminucin de sus sifras tensionales a 130/81 mmHg se traslado a piso en donde se alcanzo posteriormente presiones normales por lo cual se le da de alta a la paciente el quinto dia.

A 21 years old female patient who lives in Medellin city with a diagnosis of systemic lupus erythematosus 6 years ago associated with lupus nephritis stage 3 and medicated with Azathioprine, Prednisone, Losartan and Omeprazole; besides she is treated in order to anxiety disorder with Venaflaxin and Clonazepan. The patient in her third suicide attempt, decides to take 10 pills of Mycophenolate Mofetil and she is taken to the emergency room where she was underwented to gastric lavage and application of activated carbon. She referred gastritis, epigastric abdominal pain, nausea, vomiting, diarrhea and headache. Then the patient was transfered to the Bolivarian University Clinic where she was found with high blood pressure so she was moved to UCE and recived hydration, sodium nitroprusside and gastric protection with ranitidine. At 19:00 the patient continued with a pressure of 137/90 mmHg despite the infusion of nitroprusside and presented an anxiety state. On the second day of hospitalization the patient continued with high blood pressure (140/100 mmHg) whereby the nitroprusside infusion continued, also losartan was restarted and sodium thiosulfate was added as a preventive measure against possible poisoning by cyanate . On the third day of hospitalization were dismounted sodium nitroprusside and was started oral antihypertensive at high doses because the blood preassure decreasing to 130/81 mmHg. the patient was moved to hospitalitation floor where subsequently she reached normal pressures. That s the reason which she was sent home at five day of hospitalization.