Lessons from two weeks on the frontlines of Detroit as a #COVIDwarrior.
We are winning some of these battles. We are pushing ultrafiltration and diuretics to keep these people dry.
These x-rays are consistent with reductions in paCO2, FiO2 and PEEP.
When we go the other way, have patients consistently in positive balance, they do worse.
Over and over we are seeing people present in advanced AKI, with creatinines of 6, 8, 17 with no previous CKD. They show up with Cr of 8 and potassium of 7, and are like check-mate time for dialysis. I have never started so many people on dialysis on the day of admission.
This is not all over Detroit, talking to docs at other hospitals, they are seeing AKI on hospital day 7 or 8. I suspect this has more to do with social determinants of health than viral pathology.
Kidneys and Lungs seem to be the 2 organs most targeted. ‼️ Selection Bias‼️
Kidneys are not failing just as part of multi organ failure. This doesn’t feel like run of the mill septic ATN.
And yes we are seeing a ton of clotting. We are going through CRRT cartridges fast.
Here is a patient who has been in persistant positive balance
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