A report describes a case of a 37-year-old previously healthy male patient with a history of prolonged exposure (many hours) to the sun, who presented with complaints of epigastric and lower chest pain associated with sweating, vomiting, generalized body aches, and cramps. These symptoms started approximately 90 minutes before arrival to ED. He described no significant past medical history and was not on any regular medications.

His vital signs on arrival were-

• blood pressure (BP)= 143/112 mmHg
• body temperature= 37.1 °C (98.8 °F) (tympanic),
• respiratory rate= 24 breaths per minute,
• blood oxygen saturation (SpO2)= 96%,
• body mass index (BMI)= 19.49 kg/m². 

Clinical examination showed dehydration with dry skin and lips and no clinical signs of heart failure.

Initial resting ECG showed sinus rhythm with ST-segment elevation in anterolateral leads; thus, he received a loading dose of dual antiplatelet therapy and was thrombolysed with Tenecteplase (TNK) in combination with enoxaparin according to the international protocol. 

His initial laboratory tests revealed significant leukocytosis and polycythemia along with deranged renal function, so he received normal intravenous saline.

ECG at 90 minutes post-TNK showed failed thrombolysis. The rescue coronary angiogram revealed an occluded distal left anterior descending (LAD) artery with a minor lesion in proximal LAD and right coronary artery (RCA), approximately 30%-40%. So, the patient did not undergo coronary angioplasty. His Coronary angiogram was completed using the lowest necessary dose (about 40 mL) of nonionic, water-soluble radiographic contrast medium with coverage of continuous intravenous infusion of normal saline.

His transthoracic echocardiogram showed normal left ventricular (LV) size and moderately impaired LV systolic function with an ejection fraction (LVEF) of approximately 40%. Presence of apical LV hypokinesis and impaired relaxation as indicated by the diastolic filling pattern. 

Blood tests revealed elevated peak troponin T, peak creatine kinase MB isoenzyme (CK-MB), peak creatine phosphokinase, and N-terminal pro-brain natriuretic peptide (NT-proBNP). It also described an increased Total fasting cholesterol, triglycerides, low-density lipoprotein (LDL), and decreased high-density lipoprotein (HDL). 

Further, the lab tests showed increased Initial serum creatine with decreased glomerular filtration rate (eGFR), increased urea, slightly decreased sodium, normal potassium, increased phosphate, and calcium. 

His initial white blood cell (WBC) count was 32.3*103/µL, red blood cell (RBC) count was 8.06*106/µL, hemoglobin level was 21.4 g/dL, and hematocrit was 66.0%. His SARS-CoV-2 report was negative.

The next day, due to acute kidney injury and reduced urine output (around 200 mL/day), he received continuous venovenous hemodialysis (CVVHD) for 18 hours, along with proper hydration, after which he made a good recovery. His kidney function normalized, and he passed a good amount of urine. Predischarge follow-up laboratory tests improved, and he received a discharge after full recovery of kidney function and normalization of his laboratory tests.

Zaky H, Tabatabai S, Zarger PA, Al Hashmi JM. A Case Report of Severe Dehydration Associated With Acute Kidney Injury Causing Acute ST-Segment Elevation Myocardial Infarction. Cureus. 2022 May 22;14(5):e25226. doi: 10.7759/cureus.25226. PMID: 35747000; PMCID: PMC9213782.