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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

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Interesting case 10/29/09

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  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

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