SESSION TITLE: Wednesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Intra-abdominal pressure (IAP) is the pressure within the abdominal cavity. Elevated IAP can lead to Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). This is caused by a wide variety of causes including ascites. This entity can cause low abdominal perfusion pressures (AAP) and result in end organ damage. We present a case of AKI caused by tense ascites, which resolved after drainage CASE PRESENTATION: A 52-year-old man was transferred to our ICU for the management of hyponatremia and AKI. He presented initially with confusion, weakness, and fall. He has a history of systolic heart failure and alcohol abuse. On presentation, he was significantly volume overloaded with ascites, pitting lower extremity edema and significant electrolyte abnormalities including severe hyponatremia, hypokalemia and an AKI with creatinine of 1.35mg/dL (baseline = 0.6). Urine electrolytes were consistent with pre-renal AKI and his echo showed a normal LV function, RV and RA dilation with no signs of pulmonary hypertension. He was initially treated with hypertonic saline infusion. He was found to have liver cirrhosis on abdominal ultrasound. Given his tense abdomen, a paracentesis was performed in conjunction with IAP monitoring via an arterial line monitoring system. After zeroing the pressure at the insertion of the paracentesis catheter, an initial IAP of 22 mmHg was obtained. IAPs were documented at end expiration following each liter of ascites fluid removed (figure 1). A total of 8.75L were removed and a final IAP of 6mmHg was recorded. Mean arterial pressure prior to paracentesis was 73mmHg and AAP was 51mmHg. Over the following 24 hours, patient’s urinary output increased dramatically to over 4L without diuretics and his creatinine normalized (figure 2). Over the course of the hospital stay, the patient’s electrolyte abnormalities, volume overload, weakness and confusion resolved and he was discharged without complication DISCUSSION: We demonstrate a case of a patient who developed AKI and electrolyte derangements from tense ascites causing IAH that resolved after fluid removal. We illustrate that there may be a linear decrease in IAP with ascites volume removal. The most likely cause the the dramatic increase in UOP following the paracentesis is restoration of renal blood flow with normalization of IAP. CONCLUSIONS: IAH and ACS can be dramatic consequences of elevated IAP and clinicians should be aware of more subtle presentations of organ damage that are due to IAH Reference #1: Papavramidis, Theodossis S et al. “Abdominal compliance, linearity between abdominal pressure and ascitic fluid volume” Journal of emergencies, trauma, and shock vol. 4,2 (2011): 194-7. Reference #2: Caldwell CB, Ricotta JJ. Changes in visceral blood flow with elevated intraabdominal pressure.J Surg Res. 1987;43(1):14. Reference #3: Caldwell CB, Ricotta JJ.Changes in visceral blood flow with elevated intraabdominal pressure. J Surg Res. 1987 Jul;43(1):14-20. DISCLOSURES: No relevant relationships by Amit Chopra, source=Web Response No relevant relationships by Kurt Hu, source=Web Response No relevant relationships by Ali Wazir, source=Web Response No relevant relationships by Robert Wilcott, source=Web Response
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