Case Study - Page 2

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  1. Apr 10, '09 by
    Quote from MN BigJ
    I was just giving you crap about the afib sinus tach at the same time thing.

    Besides his renal failure and possible pneuomia/chf (though the BNP isn't real high) and possible meningitis and anemia I'm starting to lose track of it all without seeing the guy and being there. He is trying to compensate though. What's his K+? Seems almost like he has gone to far and it's time for a preist if the dialysis doesn't help much and we don't get a LP to r/o meningitis (which he is being covered for). Of course I could be missing something here and could be way off.
    That's cool. And it is tough to lose track without being there and seeing it. You're right he's trying to compensate. His K+ is 4.4
    Once he's sedated and tolerating the vent an LP is obtained and the HSV PCR is sent off. Also the nephrologist requests emergent placement of dialysis catheter, which is accessed in his RIJ.

    What's his serum lactate? 1.0
    What's his BMP? all abnormal values are listed BUN, Cr, eGFR is 12. Ca++ is a little low but not major.
    Are we monitoring CVP? yes, central line in and CVP is around 24-26
    Has blood, urine, and a BAL been sent yet? yes, blood cxs reveal no growth. UA has high WBCs and RBCs. no BAL.
    What was the admission CBC compared to the most recent? his Hgb has dropped 2 grams to 8.4, other than that it's essentially unchanged
    Despite having the AMS, what is his neuro exam like? off the diprivan he's extremely sluggish. before being sedated he was confused, restless, combative at times.

    hemodialysis pulls off 5.2L of fluid. He is still anasarcous with 2-3+ pitting edema. His urine output markedly improves.
    You've mentioned CHF, a-fib (which he's being anticoagulated and diuresed) and pneumonia (which he did not have). What do you think is going on with his kidneys?
    CaseManager1947 likes this.
  2. Apr 10, '09 by
    Quote from CaseManager1947
    TRAVASOL and DECREASED renal function.... he's also got a line..... what about line sepsis... this or a drug interaction....
    Very good thought process, What else has he received that could cause this problem?
    And good thinking about the line sepsis, but cultures reveal no growth. He's not septic.
  3. Apr 10, '09 by
    Quote from getoverit
    He's not septic.
    You can be septic with no growth with viral or fungal infection.
  4. Apr 10, '09 by
    You're right, you can be septic without growth but I was just saying that he wasn't septic. Not a blanket statement.
    This gentleman had developed acute crystal nephropathy from Acyclovir. He subsequently developed ARDS, began going in and out of v-tach and DIC. To compound this he also developed an ileus.
    His case continues with a bleak prognosis. I thought he was a very interesting and unique case.
  5. Apr 16, '09 by
    This was very interesting... I like these Case study postings.
    getoverit likes this.
  6. Apr 19, '11 by
    good case study..i was on track too eventhough i did response