Patient was admitted in the ICU. The total leukocyte counts were 26250/cmm. Liver function and kidney function tests were within normal limits. CPK total was 6543. Over the next 7 hours, patient’s condition deteriorated, the blood pressure started dropping to 80/50mmHg. Patient was started on vasopressor support. Alkaline diuresis was initiated by giving 1meq/kg sodium bicarbonate in 0.9% normal saline, 100ml iv within the next 30 minutes and then supplemented with 75meq of sodium bicarbonate and 25meq of potassium in 500ml 5% dextrose within 8 hours. Inj Furosemide 20mg was given every 12hours intravenously. On the second day, patient’s laboratory investigations showed a rising trend in TLC, creatinine rose to 2.4mg/dl from 1.1mg/dl on the day of admission. Patient’s metabolic acidosis also worsened. Patient’s output dropped to 5-10ml/hr. Patient was then taken on haemodialysis. Patient’s urine output improved and GCS also improved. Three cycles of haemodialysis were done, the TLC showed a falling trend with normalising creatinine, metabolic acidosis also improved; pH normalised and patient was extubated on the fourth day. Patient was then shifted to ward and discharged subsequently on clinical improvement.
Author(s) Details:
Manjiri Naik,
Department of Medicine, MGM Medical College and Hospital, Aurangabad, India.
Shamisha Khade,
Department of Medicine, MGM Medical College and Hospital, Aurangabad, India.
