#AKIConsultSeries 👵➡️🏥 w necrotizing fasciitis s/p debridement. Significant 🩸 during surgery ➡️ intensive resuscitation (transfusions + crystalloid)

48 hrs later 💧📈 =+13 L, Edema +++, Hypoxemia, pleural effusion.

Now anuric unresponsive to high dose IV diuretics 1/10

#AKIConsultSeries :👨w T2DM➡️🏥 for fever, dysuria and CVA tenderness. On arrival: ⬇️BP, ⬆️Glucose, ⬆️AGMA. Dx UTI + DKA. Tx: Abx + Insulin Pump + 4 L Crystalloid + NE

After resus, pt still oliguric, Cr 3.2. NE 0.7 ug/kg/min,🧠confused, BP 85/62, HR 123, 2L O2. CRT 4 sec

1/12

#AKIConsultSeries Middle-aged male ➡️🏥 for painful knee and fever. Now in shock 🚨

📂Chart review: PMH EtOH Cirrhosis, right knee arthroplasty.

It is always a good practice review previous PACS images🩻: Nodular liver, colateral vessels and prosthetic right knee

1/11

#AKIConsultSeries

Pt transferred from outside hospital

👴➡️🏥 with altered mental status, 🧠CT ➡️ Intracerebral hemorrhage. Intubated and transfered to our ICU

Oliguric, BUN 160 mg/dl and Cr 3.3 mg/dl

BP 110/81, CRT 2-3 sec, no edema

#POCUS ➡️large IVC (2.8 cm)

1/11

#AKIConsultSeries 👨 w PMH of Kidney Transplant 5y ago. Came w severe ⬆️Ca+ and AKI. CT scan and liver biopsy revealed Post-transplant lymphoproliferative disease. Initially resuscitated with generous IV crystalloid with improvement in Cr and Ca+.

Rituximab was started 1/12

#AKIConsultSeries 👵 w renal cell carcinoma and suspected heart failure. BNP 1279 pg/ml. Now with oliguric hemodynamic AKI. A lasix gtt was started for suspected cardiorenal however next day patient became hypotensive and lasix was stoped. BP 97/44, CRT 5 sec 1/

#AKIConsultseries 40 y ♂️ with advanced liver Cirrhosis (Secondary sclerosing cholangitis) 🏥 for encephalopathy. Now with rising Cr. Tx w IV albumin for the last 48 hrs with no improvement.

I like to review recent imaging studies to confirm signs of advanced cirrhosis👇

1/9

#AKIConsultSeries 👵 with HFpEF ➡️ worsening dyspnea, hypoxemia and abdominal distension

Initially treated with IV Diuretics

🚨Developed Oliguria + Hypotension🚨

#POCUS performed to evaluate residual congestion

doi.org/10.1093/ehjcr/…

1/3

#AKIConsultSeries

👴 w Advanced Cirrhosis, hemorrhagic portal hypertension and hx of a heart block (w pacemaker).

Came to the ED w diarrhea 2/2 severe C. Diff.

Now in shock...

Initial resus with Norepinephrine 0.3 ug/kg/min, Crystalloid and albumin. Cr 3.8

1/7

Top EM stories: Eduardo R Argaiz: ' #AKIConsultSeries :👨w T2DM➡️🏥 for fever, dysuria and CVA tenderness. On arrival: ⬇️BP, ⬆️Glucose, ⬆️AGMA. Dx UTI + DKA. Tx: Abx + Insulin Pump + 4 L Crystalloid + NE

After resus, pt still ol… , see more tweetedtimes.com/v/9201?s=tnp

Madhusudananes Hi, Your thread is ready to read. #AKIConsultSeries 👵➡️🏥 w necrotizing fasciitis s/p debridement. Significant 🩸 during surgery ➡️ int rattibha.com/thread/1504283…
Have a good day!

MedTweetorial: #Tweetorial
Author: Eduardo R Argaiz
Type: #Case #Physiology
Specialty: #POCUS #Neph rology #Neph #Cardiology
Topics: #AKI ConsultSeries #AKI #VolumeOverload #AIN #AcuteInterstitialNephritis #AIN #PPIinducedAIN #TubularInjury #VExUS

Kingston Hi, here is your unroll: #AKIConsultSeries 👴 w Advanced Cirrhosis, hemorrhagic portal… threadreaderapp.com/thread/1414745… See you soon. 🤖