The use of conTinuous meThylene blue for The TreaTmenT of refracTory sepTic shock : a new sTandard ? (original) (raw)

2013

Abstract

fecal occult blood were negative. Urinalysis showed urinary tract infection (UTI). Despite treatment with multiple anticonvulsants, the jerky movements continued and she was ultimately intubated for airway protection and started on propofol. CT brain on admission was unremarkable. Blood ammonia concentrations were obtained because of persistent altered mental status and were found to be elevated at 299 umol/L( range 11-32). An EEG at bedside was normal. She was started on antibiotics to treat the urinary tract infection. She was also started on lactulose to help lower ammonia levels. However within the next 2-3 hours, she suddenly became hypertensive and tachycardic and subsequently hypotensive requiring vasopressors.Pupils were dilated and fixed to light. Urgent repeat CT Brain showed diffuse cerebral edema and uncal herniation. Ammonia levels sent at the time of acute decompensation were markedly elevated at 1257 umol/L. Hemodialysis was immediately started. Unfortunately she prog...

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