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Pt with advanced Cirrhosis

AKI, Oliguria + Encephalopathy

Initial treatment = Albumin + Lactulose enemas

🧂Na is now 158 (From Lactulose induced free water loss)

#POCUS ninja @tumleal noticed something was wrong! He got his probe and texted me

📱 #WhatsAppAKIConsult 1/5
#POCUS: Plethoric non collapsible IVC

Based on the clinical scenario, IVC, heart rate and Pulse Pressure...

What is the likely underlying pathophysiology? 2/5
@tumleal went ahead and confirmed his suspicion:

He 📲texted me this:

LVOT VTI = 38!

Some 🔢:

VTI of 38, assuming a LVOT diameter of 20 mm: Stroke Volume = 119 ml

119 ml x HR (93 bpm) = 11.1 L/min of CO!

This is High Output Heart Failure (Very common in Cirrhosis) 3/5
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