The patient denied smoking or drinking, but admitted to marijuana use.
Examination (ICU) showed a sedated, profusely diaphoretic man.
BP ranged from 85/55 to 290/170 mm Hg, pulse was 140 to 180 beats/min,
and temperature was 40.1.°C (104.1°F). He required 100%
fraction of inspired oxygen and positive end-expiratory pressure of 15
mm Hg. A pulmonary artery catheter yielded the following: right atrial
pressure, 9 mm Hg; pulmonary artery pressure, 30/22 mm Hg; mean
pulmonary capillary wedge pressure, 22 mm Hg; and cardiac index, 2.1
L/min/m2. Lungs had diffuse crackles bilaterally.
There was a soft systolic murmur at the left sternal border. Abdomen
was soft; no discrete masses were appreciated. Laboratory values
included the following: bicarbonate, 22 mg/dL; anion gap, 18 mg/dL;
urea nitrogen, 15 mg/dL; creatinine, 1.2 mg/dL; glucose, 270 mg/dL;
creatine kinase, 385 mg/dL; MB fraction, 14.7 mg/dL; and leukocyte
count, 14,800 cells/μL. Room-air arterial blood gas measurements
(preintubation) revealed a pH of 7.4;
Pco2, 32 mm Hg;
Po2, 61 mm Hg; and bicarbonate, 21
mg/dL. Toxicology screens were positive for tetrahydrocannabinol. ECG
showed sinus tachycardia. Echocardiography revealed normal left and
right ventricular size and wall thickness, but severe biventricular
dysfunction (left ventricular ejection fraction, 20%).