Discover and read the best of Twitter Threads about #hemodynamicaki
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#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
📂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
On exam: BP 72/48, HR 82, O2Sat 95%.
CRT 7 sec, 🧠somnolent, confused. No edema, no obvious ascites.
Warm, swollen and erythematous knee: Tap with obvious purulent fluid🧫
Cr 2.8 mg/dl (baseline 0.5), K 6.7, Urine 🔬: hyaline casts, some urothelial cells
2/11
CRT 7 sec, 🧠somnolent, confused. No edema, no obvious ascites.
Warm, swollen and erythematous knee: Tap with obvious purulent fluid🧫
Cr 2.8 mg/dl (baseline 0.5), K 6.7, Urine 🔬: hyaline casts, some urothelial cells
2/11
Loos like hemodynamic AKI (AKA Pre-renal)
Usual causes in Cirrhosis:
🔷Distributive: Septic, "Hepatorenal physiology" 🔷Hypovolemic: Laxatives, vomiting, large volume paracentesis
🔷Congestive: Porto-pulmonary HTN, Co-existing cardiomyopathy
3/11
Usual causes in Cirrhosis:
🔷Distributive: Septic, "Hepatorenal physiology" 🔷Hypovolemic: Laxatives, vomiting, large volume paracentesis
🔷Congestive: Porto-pulmonary HTN, Co-existing cardiomyopathy
3/11
