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Quiz Page January 2006
AJKD
QUIZ PAGE JANUARY 2006
A 17-year-old man with Down syndrome underwent mitral valve replacement surgery for severe mitral insufficiency. Refractory hypotension requiring the use of an aortic contrapulsation balloon pump developed postoperatively. He had a progressive decline in urine output, and serum creatinine level increased from 1.2 to 7.0 mg/dL (106 to 619 mol/L). Other laboratory values were as follows: potassium, 7.0 mEq/L (7.0 mmol/L); total carbon dioxide, 14.5 mEq/L (15 mmol/L); uric acid, 17.2 mg/dL (1,023 mol/L); calcium, 6.8 mg/dL (1.7 mmol/L); and phosphorus, 8.1 mg/dL (2.62 mmol/L). He underwent hemodialysis, but his serum potassium level rebounded from 5.8 mEq/L (5.8 mmol/L) immediately postdialysis to 7.0 mEq/L (7.0 mmol/L) 2 hours later. Therefore, treatment with continuous venovenous hemodiafiltration was started. Three hours later, contents of the ultrafiltrate were noted to be pink.
Figure 47A.
Ultrafiltrate from continuous venovenous hemodiafiltration. Why is the ultrafiltrate pink?
What is your diagnosis? For the answer, go to www.ajkd.org Case provided by Javier Ocaña, MD, Rocio Echarri, MD, and Fernando Liaño, MD, Department of Nephrology, Hospital Ramon y Cajal, Madrid, Spain.
If you have an interesting case you would like to submit for consideration, please go to http://ajkd.edmgr.com to do so. Originally published online as doi:10.1053/j.ajkd.2005.05.038 on December 5, 2005. © 2005 by the National Kidney Foundation, Inc. doi:10.1053/j.ajkd.2005.05.038
xxxii
American Journal of Kidney Diseases, Vol 47, No 1 (January), 2006: p xxxii
QUIZ PAGE JANUARY 2006
A 17-year-old man with Down syndrome underwent mitral valve replacement surgery for severe mitral insufficiency. Refractory hypotension requiring the use of an aortic contrapulsation balloon pump developed postoperatively. He had a progressive decline in urine output, and serum creatinine level increased from 1.2 to 7.0 mg/dL (106 to 619 mol/L). Other laboratory values were as follows: potassium, 7.0 mEq/L (7.0 mmol/L); total carbon dioxide, 14.5 mEq/L (15 mmol/L); uric acid, 17.2 mg/dL (1,023 mol/L); calcium, 6.8 mg/dL (1.7 mmol/L); and phosphorus, 8.1 mg/dL (2.62 mmol/L). He underwent hemodialysis, but his serum potassium level rebounded from 5.8 mEq/L (5.8 mmol/L) immediately postdialysis to 7.0 mEq/L (7.0 mmol/L) 2 hours later. Therefore, treatment with continuous venovenous hemodiafiltration was started. Three hours later, contents of the ultrafiltrate were noted to be pink.
Figure 47A.
Ultrafiltrate from continuous venovenous hemodiafiltration. Why is the ultrafiltrate pink?
What is your diagnosis? For the answer, go to www.ajkd.org Case provided by Javier Ocaña, MD, Rocio Echarri, MD, and Fernando Liaño, MD, Department of Nephrology, Hospital Ramon y Cajal, Madrid, Spain.
If you have an interesting case you would like to submit for consideration, please go to http://ajkd.edmgr.com to do so. Originally published online as doi:10.1053/j.ajkd.2005.05.038 on December 5, 2005. © 2005 by the National Kidney Foundation, Inc. doi:10.1053/j.ajkd.2005.05.038
xxxii
American Journal of Kidney Diseases, Vol 47, No 1 (January), 2006: p xxxii