1 / 12

Interesting case 10/29/09

Interesting case 10/29/09. BMH-GT Dr.Huxford,DrBusch,Dr.Alnas, Dr.Witty,Dr.Khan. 28 YO WF in 3 rd trimester. Presents with RUQ pain and tenderness Raised LFT Thrombocytopenia Eclempsia Anemia Acute renal failure. Events post C-section. Renal shut down

misha
Download Presentation

Interesting case 10/29/09

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Interesting case 10/29/09 BMH-GT Dr.Huxford,DrBusch,Dr.Alnas, Dr.Witty,Dr.Khan

  2. 28 YO WF in 3rd trimester • Presents with RUQ pain and tenderness • Raised LFT • Thrombocytopenia • Eclempsia • Anemia • Acute renal failure

  3. Events post C-section • Renal shut down • Multiple IVF plus mannitol drips • Magnesium sulfate drips • Edema /anasarca • Pt transferred from NewAlbany to BMHGT

  4. Situation on arrival • Intubated • Bilateral lung infiltrates • Wbs 32000; platelets 90,000 to 150,000 • Mg 10 • Creatinine 5.7 • Hemoglobin 10 • D-dimer >20 • ALT 3000 down to 130; LDH 1530

  5. HELLP • 3 per 1000 pregnancies( 3rd trimester/postartum) • Complement activation ; endothelial injury • Coagulation cascade activation • LDH >600; ALT >70; PLT <50; SCHISTOCYTES ON SMEAR; RENAL FAILURE PROTEINURIA • Maternal mortality 1-3% • Fetal mortality 10-35%

  6. Management of HELLP • Fetal maturity ; iv steroids • Prompt delivery • Treat renal and pulmonary according to situation • IV Magnesium to prevent seizures • Plasmaphresis if persists >72 hours post partum • DIC treatment ; platelets for counts<20,000 or bleeding diasthesis

  7. How did this patient do here ? • Urgent Hemodialysis for volume overload • Diaysis was difficult due to hemodynamic compromise ; had to use IV albumin ; blood transfusion ; suffered severe bradycardia during HD • After 2 HD Rx started IV lasix drip with good diuresis • Lung infiltrates slowly improved • ADAM TS 13____ 43 %

  8. Course of events • On lasix drip lung infiltrates slowly improved • Extubated • Needed supports of BIPAP • Fever due to lines • Hypernatremia • d/c on biaxin • Drug rash due to biaxin

  9. Follow up issues • WBC COUNT >20,000 • RENAL FAILURE • RASH • ANEMIA

More Related