Septic patient with liver failure

Lev, MSN, RN, NP · Jul 23, 2015

The way any septic and hypotensive patient is managed..abx, fluid resucitation, volume expanders, and pressors. Homework?

Mavrick, BSN, RN · Jul 23, 2015

The way any septic and hypotensive patient is managed..abx fluid resucitation, volume expanders, and pressors. Homework?[/quote']
OOOOO. I want you as my nurse.

Lev, MSN, RN, NP · Jul 24, 2015

OOOOO. I want you as my nurse.

Was that a compliment?? :woot:

Mavrick, BSN, RN · Jul 24, 2015

Was that a complement??

Yes it was.

But this is a dig, not a compliment.

Sorry I couldn't help it. Can you forgive me?

Lev, MSN, RN, NP · Jul 24, 2015

Yes it was.
But this is a dig, not a compliment.
Sorry I couldn't help it. Can you forgive me?

Yes. Because I don't mind correction (where it is due).

Mavrick, BSN, RN · Jul 24, 2015

The way any septic and hypotensive patient is managed..abx fluid resucitation, volume expanders, and pressors. Homework?[/quote']
Seriously, I think you are absolutely right, cut straight to the chase and I was impressed with your succinctity (sic).

Lev, MSN, RN, NP · Jul 24, 2015

Thank you. I guess I'm a bit paranoid. Me with my measly couple years of experience and you with your 20+.

zzyzx · Jul 27, 2015

I'm not an ICU nurse; I work in the ER. The other night I took care of a pt with liver cirhhosis, and I realized that of all the septic pt's I've taken care of, I have never had one with liver failure. So, I guess my question is how likely it is that when you give 2 or 3 liters of IV fluid, it ends up in their belly. The pt had a low albumin. We first gave her albumin replacement. Another nurse told me that this would not much help keep the fluid intravascular. Anyway, excuse my ignorance, I just haven't had a pt like this before and wanted to learn about your experiences.

zzyzx · Jul 27, 2015

I'd also like to hear about experiences with taking care of septic dialysis patients. Thanks!

Dranger · Jul 27, 2015

Albumin increases the oncotic pressure gradient. Patients with liver failure lack the protein albumin and thus have no way of keeping fluids in the vasculature. In general, severely symptomatic septic patients (febrile, lactic acidosis, tachy, hypotensive etc) are given a fluid trial of usually 3ish liters of a hypotonic solution normally NS plus antibitoics. If that fails, generally the patient is started on pressors to keep them hemodynamically stable. In liver failure, albumin is depleted thus the fluid would just leak out into the extravascular/tissue space rendering the fluid resuscitation useless and not improving the metabolic acidosis nor the hemodynamic status of the patient. Albumin is given to fix this issue....temporarily. If the sepsis doesn't kill them the liver failure will eventually, it's a terrible disease state to have and is usually self-induced.

Albumin is a 100% solution even in the acute situation. Sepsis or GI bleeds in liver patients have a high mortality rate and make up the bread and butter of many ICUs. Sure we can give fluids or blood but impending flash pulmonary edema occurs (especially if they have CHF) often with the patient getting vented and going into full blown respiratory distress.

Drinking and drugs (and drug related diseases) are bad.

Larry3373 · Jul 28, 2015

I had a patient similar to this. She was in her mid 30's and a nurse by profession. She was a chronic alcoholic who drank a fifth of liquor every day and had also consumed too much tylenol. I met her when she was septic, vented, liver failure, and responsive to pain only. After tons of fluid, neo and vaso (tachy in 150's), bicarb, and albumin, she remained severely hypotensive and her pupils blew. Her abdomen had become very distended with all the fluid, and her lung compliance was getting worse. Her X-ray was nearly completely whited out. Pulmonologist thought she had cerebral edema. The husband withdrew care and she passed away shortly thereafter. This was on July 4th of all days, very sad.