HEPATOPULMONARY SYNDROME

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Specializes in CardiacStep-down/Progressive Care Unit.

Has anyone encounter this term Hepatopulmonary syndrome due to liver cirrhosis?

There was a patient situation where he came in due to ascites, generalized edema, had pmHx of TIPS, +meth/cocaine on urine drug screen.  Stable vital signs and mentation wise though look drunk. Inpatient lactulose and rifaximin bid given. The next day, crea went up from 1.6 to 1.9, ammonia went up from 118 to 130. Lactulose dose was increased and given IV lasix. Pt gets SOB on sitting upright and standing and look comfy when laying down. Not sure what happened but, pt coded after given another Lasix, Ativan, Albuterol/Duoneb breathing treatments due to some agitation and SOB though lungs were clear, VS, SpO2 wete fine before but drop to 60s after those treatments. I heard pt started to develop stridor. Pt then got intubated.

I wonder if the pt develop that term Hepatopulmonary syndrome? Pt declined pretty quick. Not sure if he was not able to protect the airway due to facial and periorbital edema and grogginess and was given Ativan? 

What do you think might your theory? Or anyone had an experience with liver disease? 

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Specializes in Critical Care.

Think his ammonia level was so high that he crashed after the ativan was given then became too sedated and wasn't breathing adequately.  Ammonia level was critical.  Should have been in the ICU.  Tips isn't working.  Sounds like he needs a liver transplant to live, but doubt he is a candidate given his drug use.  What is causing his worsening liver failure?  Is he septic?  Looks like he is developing hepatorenal syndrome which usually has a bad outlook.  Apparently there is hepatopulmonary syndrome too.

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