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Kaitlyn Hitch, Alyssa Becerra and Megan Mixer
This case study 22 year old brian Smith was on vacation with his family in California for a week when he suddenly became ill. he was having diarrhea, abdominal pain, and fever. He went to an ED where they gave him a liter of NS 0.9% and Tylenol. He was then discharged and he and his family boarded their plane to continue their travels to Las Vegas, NV. Still having diarrhea to the ED with bloody diarrhea, abdominal pain and low grade fever. He states that his symptoms started three days ago and have not gotten any better even after his ED visit in California. Initial vital signs showed BP 105/72, HR 110, RR 14 T 99.8, O2 100% on room air and pain 7/10 in abdomen. The doctor ordered a CBC, CMP, urine and stool culture, EKG, NS 0.9% fluid bolus, Tylenol IV 650 q 4 hours PRN fever, and Tramadol IV 50 mg q 4 hours PRN pain. Results showed dysrhythmias on the EKG monitor, stool was positive for E. coli O157:H7, urine showed hematuria. Lab results came back as follow: BUN 40, Creatinine 2.0, GFR 35, Na 150, K 3, CI 110, CO2 31, Ca 7.8, WBC 7, RBC 2.7, H/H 9/37, Platelets 80, Mg 2.2. Brian was diagnosed with post-diarrheal hemolytic uremic syndrome due to E. coli infection and was transferred to the ICU where he continued to receive care.
Questions
- What is your priority of care for this patient?
- What is the benefit of CRRT versus hemodialysis for this patient?
- Based on the patient’s labs, why would there be a need for cardiac monitoring?
