Case Study - Adult - Hypotension - Renal Disease
3 likes2,026 views
A patient presented to the emergency department with hypotension due to taking too much of their beta-blocker medication for end-stage renal disease. They were treated with glucagon to reverse the beta-blocker effects, albumin for volume expansion, and norepinephrine. Monitoring showed that treatment improved their blood pressure, cardiac output, and stroke volume index by 50%.
Case Study - Adult - Hypotension - Renal Disease
- 1. Hypotension Renal Disease Presentation Emergency Dept. with hypotension History of end stage renal disease Taking 硫-blockers Family states probably taking too much HR 80bpm BP 60/40 mmHg Treatment Norepinephrine www.uscom.com.au The Measure of Life
- 2. Hypotension Renal Disease Treatment Glucagon (硫-blocker reversal) Albumin 25 g (volume expansion) www.uscom.com.au The Measure of Life
- 3. Hypotension Renal Disease Results HR = 80 bpm - unchanged BP = 60/40 -> 81/55 MD = 8 -> 13 SV = 34 -> 49 SVI = 18 -> 26 CO = 2.5 -> 4.1 CI = 1.3 -> 2.1 Post Fluid expansion 50% improvement! Conclusion Rapid, non-invasive assessment and confirmation of therapy. www.uscom.com.au The Measure of Life
Editor's Notes
- #2: Norepinephrine is also used as avasopressormedication (for example, brand name Levophed) for patients with criticalhypotension. It is given intravenously and acts on both 留1and 留2adrenergic receptors to cause vasoconstriction. Its effects are often limited to the increasing of blood pressure through agonist activity on 留1and 留2receptors, and causing a resultant increase inperipheral vascular resistance. At high doses, and especially when it is combined with other vasopressors, it can lead to limbischemiaand limb death. Norepinephrine is used mainly to treat patients in vasodilatory shock states such asseptic shockandneurogenic shock, while showing fewer adverse side-effects compared todopaminetreatment.[44]http://en.wikipedia.org/wiki/Norepinephrine
- #3: Hypodynamic after Norepinephrine (vasoconstrictor) Low MD - 8 (Typical 14-22) Low SV 34(Typical 0.9 - 1.75 ml/kg)Low SVI 18 (Typical 30-55)Low CO 2.5 (Typical 2.5-6.0)Low CI 1.3 (Typical 2.4-3.6)Norepinephrine reduced the CO due to increasing of the SVR.After Fluid expansion 50% improvement!Low MD -13 (Typical 14-22)Low SV 49(Typical 0.9 - 1.75 ml/kg)Low SVI 26 (Typical 30-55)Low CO 4.1 (Typical 2.5-6.0)Low CI 2.1 (Typical 2.4-3.6)Glucagon can enhance myocardial contractility, heart rate, and atrioventricular conduction; many authors consider it the drug of choice for beta-blocker toxicity. Because a glucagon bolus can be diagnostic and therapeutic, the clinician can empirically administer glucagon and check for a response. An upper dose limit has not been established.http://emedicine.medscape.com/article/813342-treatment#aw2aab6b6b2
- #4: SVI 18 -> 26After Fluid expansion 50% improvement!Low MD -13 (Typical 14-22)Low SV 49(Typical 0.9 - 1.75 ml/kg)Low SVI 26 (Typical 30-55)Low CO 4.1 (Typical 2.5-6.0)Low CI 2.1 (Typical 2.4-3.6)