- Joined
- Nov 6, 2015
- Messages
- 3,071
- Reaction score
- 6,258
So I had a case recently which has me a little puzzled.
EMS brings in a dude from local homeless shelter in respiratory distress - has a history of COPD + CHF, they’ve got him on cpap and his vitals are OK, low grade fever, but clearly sick. Mentating fine, no abdominal complaints.
Did the usual stuff in the ED, abx, steroids, careful IVF because of the CHF...labs (including liver stuff) only remarkable for metabolic acidosis and a white count. Notably did not get a lipase. Admitted to ICU, where he promptly decompensates, peri-intubation arrest, ROSC, ends up on 3 pressors, AKI —> renal necrosis, and then finally fulminant liver failure over the course of 72 hours. They never found a source infection.
Somewhere in there someone gets a lipase that came back >4000, and liver ultrasound also happened to see some large gallstones, but no evidence of an obstructing stone or CBD dilation.
Dude dies about 5 days after admission.
ICU attending puts in their final note, that they believe the patient had gallstone pancreatitis causing ARDS missed by the EP because we didn’t get lipase in the ED. I’m biased but feel like the bumped lipase was probably more from multi organ failure/persistent hypotension/pressors.
So my question is...are y’all consistently checking lipases on sick non-abdominal complaints?
EMS brings in a dude from local homeless shelter in respiratory distress - has a history of COPD + CHF, they’ve got him on cpap and his vitals are OK, low grade fever, but clearly sick. Mentating fine, no abdominal complaints.
Did the usual stuff in the ED, abx, steroids, careful IVF because of the CHF...labs (including liver stuff) only remarkable for metabolic acidosis and a white count. Notably did not get a lipase. Admitted to ICU, where he promptly decompensates, peri-intubation arrest, ROSC, ends up on 3 pressors, AKI —> renal necrosis, and then finally fulminant liver failure over the course of 72 hours. They never found a source infection.
Somewhere in there someone gets a lipase that came back >4000, and liver ultrasound also happened to see some large gallstones, but no evidence of an obstructing stone or CBD dilation.
Dude dies about 5 days after admission.
ICU attending puts in their final note, that they believe the patient had gallstone pancreatitis causing ARDS missed by the EP because we didn’t get lipase in the ED. I’m biased but feel like the bumped lipase was probably more from multi organ failure/persistent hypotension/pressors.
So my question is...are y’all consistently checking lipases on sick non-abdominal complaints?