A case of traumatic shock complicated by methamphetamine intoxication

A case of a 38-year-old male with traumatic shock complicated by methamphet amine intoxication is presented. The patient was involved in an assault whi ch resulted in cardiac tamponade and right ventricular outflow laceration. Pericardiocentesis was immediately performed. However, profound metabolic a cidosis greatly in excess of that expected from the short duration of the s hock was revealed by arterial blood gas analysis. Another cause of the meta bolic acidosis was suspected. The patient subsequently admitted to intraven ous use of methamphetamine. Following hemodynamic and metabolic stabilizati on by continuous pericardial drainage and intravenous administration of sod ium bicarbonate, the patient underwent cardiac surgery. His postoperative c ourse was uneventful. There is a substantial association between methamphet amine users and traumatic accidents. In such cases, early identification of drug use is important. Marked metabolic acidosis, which conflicts with the diagnosed cause of shock, may be a clinical clue to methamphetamine intoxi cation.