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Over-diuresis or cardiac tamponade? An unusual case of acute kidney injury and early closure
An 84-year-old man with hypertension and a history of deep venous thrombosis (on warfarin) was admitted with shortness of breath presumed to be due to congestive heart failure. Echocardiogram performed the following day showed a low-normal ejection fraction with signs of elevated right-sided pressur...
Autores principales: | , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Co-Action Publishing
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4848428/ https://www.ncbi.nlm.nih.gov/pubmed/27124173 http://dx.doi.org/10.3402/jchimp.v6.31357 |
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author | Singh, Gurkeerat Sabath, Bruce |
author_facet | Singh, Gurkeerat Sabath, Bruce |
author_sort | Singh, Gurkeerat |
collection | PubMed |
description | An 84-year-old man with hypertension and a history of deep venous thrombosis (on warfarin) was admitted with shortness of breath presumed to be due to congestive heart failure. Echocardiogram performed the following day showed a low-normal ejection fraction with signs of elevated right-sided pressures but was otherwise normal. He improved with diuretic therapy but after a few days was found to be hypotensive with a concomitant rise in creatinine with decreased urine output. This was felt to be secondary to over-diuresis but he did not respond to small boluses of intravenous fluids as his kidney function continued to worsen and hypotension persisted. He was transferred to the intermediate care unit where a rapid, bedside ultrasound revealed a new, moderate-sized pericardial effusion with tamponade physiology. Pericardiocentesis, with removal of 750 cc of frank blood, led to dramatic improvement in blood pressure, kidney function, and urine output. Here, we demonstrate the utility of point-of-care ultrasound in a community hospital setting where urgent echocardiogram is not routinely available. We also report acute kidney injury due to pericardial tamponade reversed with therapeutic pericardiocentesis. |
format | Online Article Text |
id | pubmed-4848428 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Co-Action Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-48484282016-05-17 Over-diuresis or cardiac tamponade? An unusual case of acute kidney injury and early closure Singh, Gurkeerat Sabath, Bruce J Community Hosp Intern Med Perspect Case Report An 84-year-old man with hypertension and a history of deep venous thrombosis (on warfarin) was admitted with shortness of breath presumed to be due to congestive heart failure. Echocardiogram performed the following day showed a low-normal ejection fraction with signs of elevated right-sided pressures but was otherwise normal. He improved with diuretic therapy but after a few days was found to be hypotensive with a concomitant rise in creatinine with decreased urine output. This was felt to be secondary to over-diuresis but he did not respond to small boluses of intravenous fluids as his kidney function continued to worsen and hypotension persisted. He was transferred to the intermediate care unit where a rapid, bedside ultrasound revealed a new, moderate-sized pericardial effusion with tamponade physiology. Pericardiocentesis, with removal of 750 cc of frank blood, led to dramatic improvement in blood pressure, kidney function, and urine output. Here, we demonstrate the utility of point-of-care ultrasound in a community hospital setting where urgent echocardiogram is not routinely available. We also report acute kidney injury due to pericardial tamponade reversed with therapeutic pericardiocentesis. Co-Action Publishing 2016-04-25 /pmc/articles/PMC4848428/ /pubmed/27124173 http://dx.doi.org/10.3402/jchimp.v6.31357 Text en © 2016 Gurkeerat Singh and Bruce Sabath http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Case Report Singh, Gurkeerat Sabath, Bruce Over-diuresis or cardiac tamponade? An unusual case of acute kidney injury and early closure |
title | Over-diuresis or cardiac tamponade? An unusual case of acute kidney injury and early closure |
title_full | Over-diuresis or cardiac tamponade? An unusual case of acute kidney injury and early closure |
title_fullStr | Over-diuresis or cardiac tamponade? An unusual case of acute kidney injury and early closure |
title_full_unstemmed | Over-diuresis or cardiac tamponade? An unusual case of acute kidney injury and early closure |
title_short | Over-diuresis or cardiac tamponade? An unusual case of acute kidney injury and early closure |
title_sort | over-diuresis or cardiac tamponade? an unusual case of acute kidney injury and early closure |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4848428/ https://www.ncbi.nlm.nih.gov/pubmed/27124173 http://dx.doi.org/10.3402/jchimp.v6.31357 |
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