Case 44: Next Steps

Case 44 Index

Case continued…


After astutely recognizing that this patient was not receiving adequate anticoagulation, you increase concentration of citrate in the replacement fluid. Over the next 48 hours, the cartridge remains patent.

Blood cultures are positive for MRSA and the patient is maintained on intravenous (IV) vancomycin with adequate levels. On day 3 of his ICU stay,  he requires increased vasopressors and a higher rate of calcium repletion to maintain a target ionized calcium of > 1 meq/L.

Repeat vital signs:
Temp 98.2F, HR 45 bpm, BP 102/54 on norepinephrine and vasopressin, RR 20 breaths/min on mechanical ventilation, O2 saturation 96% with FiO2 60%

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Case 44 Index
Case 44 Introduction
Case 44 Physical Exam
Case 44 Diagnostic Testing