Use of initial distribution volume of glucose to determine fluid volume loading in pulmonary thromboembolism and right ventricular myocardial infarction

Abstract

We report a case of acute right ventricular myocardial infarction (right AMI) following pulmonary thromboembolism (PTE). Following percutaneous coronary intervention, the patient was treated in our intensive care unit (ICU) with intraortic balloon pumping, anticoagulants, and plasma expansion. Fluid overload may cause a further leftward shift of the interventricular septum in patients with PTE, resulting in decreased cardiac output (CO). The initial distribution volume of glucose (IDVG) has been reported to indicate central extracellular fluid volume. As both PTE and right AMI affect cardiac filling pressures, such as central venous pressure (CVP) and pulmonary artery wedge pressure (PAWP), we measured IDVG in order to evaluate the patient's cardiac preload, comparing it with the cardiac filling pressures. Fluid volume loading over 12 h yielded an obvious increase in IDVG. However, low arterial blood pressure and CO, associated with high CVP, remained unchanged and were accompanied by deteriorating pulmonary oxygenation. Accordingly, volume loading was discontinued and the rates of infusion of catecholamines were increased instead. At 12 h thereafter, IDVG became normal, and both CO and blood pressure became improved. However, the cardiac filling pressures remained increased. Although the patient died on the subsequent day, this case report could support the usefulness of IDVG as a fluid volume marker in critically ill patients, especially those with right AMI.