老年学と老年医学の研究

概要

A Fatal Case of Triple Whammy in an Elderly Patient

Pietro Gareri, Giovanni Ruotolo, Alberto Castagna, Valeria Graziella Laura Manfredi, Alfonso Merante, Norma Maria Marigliano, Andrea Corsonello, Luca Gallelli, Amalia Cecilia Bruni, Santo Gratteri and Giovambattista De Sarro

Triple whammy is a drug-induced renal failure which in patients treated with ACE-inhibitors or angiotensin II
receptor blockers, diuretics and non-steroidal anti-inflammatory drugs.
We report a case of a 79-year-old woman affected with hypertension, depression and arthritis that was
hospitalized for abdominal pain and discharged with normal renal function and with poly-treatment: furosemide,
aspirin, carvedilol, omeprazole and ramipril. Few days later she was visited for depressive symptoms, pain in the
right shoulder and cystitis and treatment with oral ketoprofen and ciprofloxacin was prescribed.
One week later she experienced loss of appetite, asthenia and swelling of the face. Blood analyses showed acute
renal failure, whereas clinical examination showed heart failure and pleural effusion. She was again hospitalized in a
geriatric ward for metabolic acidosis. Drug treatments and hemodialysis did not improve clinical conditions and she
died thirteen days after her hospitalization.
History suggested the onset of drug-related acute renal failure probably due to the combination of furosemide,
ketoprofen and ramipril, defined as triple whammy.