P0706 / #858: TROMBOTIC MICROANGIOPATHY IN AN INFANT WITH SEPSIS AND FATAL OUTCOME: CASE REPORT

Abstract

Aims & Objectives: A 1 year-old- female previously healthy and with no history of recurrent infections or previous hospital admissions reported a total of 30 vomits over 3 days prior to presentation. She visited a local hospital in Xilotepec, state of Mexico and an arterial blood gas report: pH 7.10, pco2 9, po2 97, hco3 3, glucose 30 mg/dl. She was treated with IV fluids, glucose and bicarb and she was transferred to our hospital. Upon admission she was with poor neurologic response, HR 174 bpm, tachypneic (55 breaths per minute), with no palpable peripheral pulses, cool extremities, and dry oral mucosa, aggressive IV fluids was started. The analysis of arterial blood gas revealed: hco3 of 4.1 DB -22.2, CO2 14, Anion Gap 46, lactate 1.7. Bicarbonate correction, broad spectrum antibiotics and orotracheal intubation was performed. Toxic etiology was discarded and she was admitted to PICU. Methods: During PICU she required inotropic and vasopressor support, as well as bicarb infusion up to 100 mEqkg due to persistence of severe metabolic acidosis, she developed renal failure that was treated with diuretics. Results: At 24 hours of admission she presented in hands and legs with necrotic lesions which was managed with enoxaparin and pentoxifylline. Blood culture, serology for hepatitis B and hepatitis C were negative. Chest X ray and echocardiography was normal.Conclusions: She was extubated on day 8 and transferred to ward on day 21, she was readmitted 3 days before with refractory septic shock and the patient finally died 12 hours after readmission.