Monday, March 16, 2015

Spent 2 hours in the SCSU “Hot Zone” with Bob Danner (ICU specialist) and Kwan (ID Fellow). went into renal shutdown likely due to Acute Tubular Necrosis (ATN). We spent the time trying to balance the pushing of fluids with giving Lasix diuretic. Now at 24 hours after intubation, his pulmonary situation is fine. He is on 35% with 5 PEP and his Sats are 95-100%. His BP and cardiovascular function are fine. Labs are all about the same and a little better except for one disturbing trend. His creatinine has gone from 0.8 to 1.0 to 1.3 to 1.6 to 1.9 just 1 hour ago. From 6:00 to 7:00 PM he put out no urine after having put out about 40 cc the prior hour. We pushed fluids and he has only put out about 25 cc/hour over the past 3 hours. Diarrhea is still profuse. We are going to continue to push fluids to see if he opens up. Looks like ATN, which is puzzling since he has always had good perfusion with good BPs. The people at Emory tell us that this is exactly what they saw with their sickest patient, i.e. patient’s numbers look good, then unexpected ARDS, the latter corrected by intubation/respirator, then unexplained ATN requiring dialysis, followed by prolonged and slow recovery. Strange disease this Ebola. We will continue to push fluids during the night and then (depending on his creatinine), consider the option of dialysis. Hopefully, we will not have to go there.