Hoping for some insights from emerging research. What are some newer/latest PO options for managing a patient’s hypotension?
My patient is a 60 year old female with Hx of DVT (on warfarin for 6 years) and RA for over 15 years and has been on several monoclonal antibodies mostly because her joint pain was not relieved. During this time she has b/l knees and hips replaced. All other joints are doing well.
She was hospitalized 5 months ago for Acute on chronic renal failure needing HD for the first time. Her kidney biopsy showed showed amyloidosis likely 2/2 to her RA. Since her initial hospitalization she has been in ICU for the third time. First two admissions were becasue she could not tolerate HD on regular in-patient floor, her MAPs would drop to 30s. Recently she had Cdiff, HI PNA and bacteremia, as well as aspiration PNA requiring antibiotics (vancomycin and zosyn), she is now off Bipap, however, still quite weak. Continues to stay on TF.
Overall, the main issue holding her in ICU is her hypotension. She has been on CRRT and not been able to come off levophed for over a month. Just like her previous ICU transfers she is not able to tolerate HD. Her MAPs drops in 30’s. Also, her hypotension is constant not just HD related or postural. She has been on midodrine 20 mg TID. Her echo is normal/ very low suspicion that she has cardiac amyloidosis. Her WBC count has been in 35, no fevers, normal procal and inflammatory markers. A wbc scan was done to look for this yesterday which shows her vessels are dilated. Since we are not suspecting any infection it could be amyloidosis related I guess…
Big question: what are my patient’s options for treating or managing her hypotension?
My patient is a 60 year old female with Hx of DVT (on warfarin for 6 years) and RA for over 15 years and has been on several monoclonal antibodies mostly because her joint pain was not relieved. During this time she has b/l knees and hips replaced. All other joints are doing well.
She was hospitalized 5 months ago for Acute on chronic renal failure needing HD for the first time. Her kidney biopsy showed showed amyloidosis likely 2/2 to her RA. Since her initial hospitalization she has been in ICU for the third time. First two admissions were becasue she could not tolerate HD on regular in-patient floor, her MAPs would drop to 30s. Recently she had Cdiff, HI PNA and bacteremia, as well as aspiration PNA requiring antibiotics (vancomycin and zosyn), she is now off Bipap, however, still quite weak. Continues to stay on TF.
Overall, the main issue holding her in ICU is her hypotension. She has been on CRRT and not been able to come off levophed for over a month. Just like her previous ICU transfers she is not able to tolerate HD. Her MAPs drops in 30’s. Also, her hypotension is constant not just HD related or postural. She has been on midodrine 20 mg TID. Her echo is normal/ very low suspicion that she has cardiac amyloidosis. Her WBC count has been in 35, no fevers, normal procal and inflammatory markers. A wbc scan was done to look for this yesterday which shows her vessels are dilated. Since we are not suspecting any infection it could be amyloidosis related I guess…
Big question: what are my patient’s options for treating or managing her hypotension?
