A case-based discussion from the Medical Intensive Care Unit of Sahloul University Hospital of Tunisia: an unusual cause of alveolar hypoventilation in a patient with COPD

Arterial blood gas (ABG) analysis on room air disclosed severe respiratory acidosis with hypercapnia and high bicarbonate level (pH=7.14, pCO2=11 kPa, [Formula omitted. Subsequently, because of a rapid deterioration of the level of consciousness, as assessed by a fall in Glasgow coma score (GCS) to 6/15, the patient required intubation, sedation and mechanical ventilation. [...]Retama raetam is known for its quinolizidine alkaloid properties and for its pharmacological and toxicological activity with diuretic, hypoglycaemic, hypotensive, hallucinogenic and respiratory depressant effects. 5 6 The clinical presentation of our patient, the absence of the usual causes of COPD exacerbation, the presence of quinolizidine alkaloid metabolites in the urine and the spontaneous favourable outcome with symptomatic treatment alone (mechanical ventilation, vasoactive agents and fluid resuscitation), without any specific therapy, are strong arguments supporting our hypothesis.