Clinical summary: A 20-y-old, African-American woman with a history of sickle cell disease and frequent painful crises was admitted to the hospital for pain in December. Four days previously she had the onset of an upper respiratory tract infection accompanied by nausea, vomiting, and sore throat. The night before admission she developed pain in her legs, back, and arms. She had a past history of asthma. She did not smoke cigarettes but occasionally smoked marijuana. Medications included albuterol and folic acid. Physical examination on admission showed T 37.8°, BP 116/80 mm Hg, HR 96/min, RR 24/min. Oxygen saturation on room air was 96%. She had a systolic flow murmur, and her extremities were tender. Laboratory results: WBC 19.5 k/µl, Hb 8.6 g/dl, Hct 26.6%, and platelets 366 k/µl. Urine had white cells, 3+ blood, and 3+ bacteria. A chest radiograph was unremarkable. The impression was acute sickle cell pain crisis and urinary tract infection. She was treated with intravenous fluids, oxygen, and dilaudid. During the next morning, she was somnolent, tachypneic, and dyspneic. Narcan led to improvement. At 12:30 pm, she was found lifeless but responded to CPR. The trachea was intubated (arterial blood gases were pH 6.8, PaCO2 47 mm Hg, and PaO2 164 mm Hg). A chest radiograph showed diffuse alveolar opacities. At 3:15 pm, asystole occurred, and she did not respond to 30 min of resuscitative efforts.
An autopsy was performed.
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