A 61-year-old morbidly obese woman first presented to a community hospital with complaints of feeling “unwell” for 2 weeks. Her family reported that she had been having increasing fatigue, diarrhea, nausea, and vomiting for that period, as wellas “dusky” fingers and toes. Prior to this time, she had noticed a runny nose, cough, and “bluish” toes for about 3 weeks. On presentation, she was hypotensive with a systolic blood pressurein the 50’s mmHg and tachycardic to 115 beats per minute(bpm), but afebrile. Her creatinine was found to be 12 mg/dL from an unknown baseline. Treatment was initiated in the Emergency Department with fluids and antibiotics, and she was admitted to the Medical Intensive Care Unit for management of septic shock. The patient was also found to have a urinary tract infection, with negative blood cultures. Stool was checked for Clostridium difficile infection, which was also negative. After 7 days of treatment for septic shock in the ICU including 2 days of hemodialysis, she was transferred to our tertiary center for further management.
Shah, MD, Gunjan L. and Ndicu, MD, Susan
"Use of Transpulmonary Thermodilution to Measure Extravascular Lung Water Index in a Ventilated Patient,"
The Medicine Forum:
Vol. 11, Article 18.
Available at: http://jdc.jefferson.edu/tmf/vol11/iss1/18