ARDS

[aspiringmd1015]

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there was a Q i came across about ARDS, and with the PCWP being normal, thus indicating its not a LV failure/HF issue, and it said that the urine output of the patient is normal, as they gave the patient IV fluids, indicating volume overload wasnt an issue. If i volume overloaded a patient, and the patient developed pulmonary edema, the PCWP would be elevated correct? as there would be an increase in LVEDP/EDV?

 

[zhopv10]

Yes assuming there was output failure in the left heart (or HF-PEF) you would see increased PCWP and LVEDP/EDV could be increased. However keep in mind with ARDS the potential for Cor pulmonale with pulmonary HTN, peripheral edema and right heart failure. In which case volume overload could also be occurring but in in the right heart.


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[aspiringmd1015]

side note, whats the enzyme name that conjugates bile acids with glycine and taurine? its not udpGT right?

 

[aspiringmd1015]

and ketoconazole inhibiting 17,20 desomolase, is that the first step in steroidogensis in the adrenals and such? or are they talking about the 17,20 lyase step that works in the reticularis.

 

[dorster]

Yes assuming there was output failure in the left heart (or HF-PEF) you would see increased PCWP and LVEDP/EDV could be increased. However keep in mind with ARDS the potential for Cor pulmonale with pulmonary HTN, peripheral edema and right heart failure. In which case volume overload could also be occurring but in in the right heart.


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When you say that ARDS can lead to cor pulmonale wouldn't that be a very late stage complication because ARDS would first have to lead to pulmonary fibrosis which then would lead to the pulmonary hypertension and right heart failure? because I wasn't ever aware that right heart failure was a direct complication of ARDS... unless I missed that haha

 

[zhopv10]

So acute Cor pulmonale is seen in ARDS patients within 3 days of dx (can't remember how often, 30% or something? Idk). So it's possible (looks like inflammatory cytokines, vasoconstrictors etc can play a role). But ya I mean it's not really thought of as a super common common complication I don't think I just more brought it up more just for the thought experiment of it so good call pointing that out. I suppose at some level I misspoke as well as I was mainly just highlighting the idea that a volume overload with pulm edema could occur without increasing the PCWP and elevating the LVEDP/EDV in the case of Cor pulmonale, not necessarily focusing on how it specifically applies to ARDS (even though it ostensibly could). Hopefully that clears it up somewhat.


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[dorster]

So acute Cor pulmonale is seen in ARDS patients within 3 days of dx (can't remember how often, 30% or something? Idk). So it's possible (looks like inflammatory cytokines, vasoconstrictors etc can play a role). But ya I mean it's not really thought of as a super common common complication I don't think I just more brought it up more just for the thought experiment of it so good call pointing that out. I suppose at some level I misspoke as well as I was mainly just highlighting the idea that a volume overload with pulm edema could occur without increasing the PCWP and elevating the LVEDP/EDV in the case of Cor pulmonale, not necessarily focusing on how it specifically applies to ARDS (even though it ostensibly could). Hopefully that clears it up somewhat.


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Thanks! that makes sense