Septic patient with liver failure

[zzyzx]

I have little critical care experience. I would like some thoughts about how someone with liver cirrhosis and low albumin levels is best manged with they are septic and hypotensive. Thanks!

[Dranger]

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.

Sounds like the distended abdomen could have been related to the liver failure or worse, abdominal compartment syndrome secondary to sepsis with MODs. Untreated the bowels become ischemic and mortality is very very high. Not that it matters but were they do IAP monitoring?

[Larry3373]

No iap monitoring. As you say, it likely wouldn't have mattered anyway. She was likely too hypotensive to survive HD or surgical procedure. Even if she survived this ordeal her liver failure would have likely killed her soon.