Anticoagulation During RRT in the ICU

Abstract

A 10-year-old boy presented to the Emergency Department with a history of fever and abdominal pain of 2 days’ duration. His parents reported that his condition worsened over the past few hours as he became lethargic and looked pale, and his abdomen was distended. On examination, he was lethargic and febrile (39.5 °C; 103 °F) with a heart rate of 140/min and blood pressure 90/50 mmHg, and his respirations were slow with minimal movement of the abdominal wall. His abdomen was distended, and there was guarding and tenderness on palpation. He received two 0.9% saline (20 mL/kg) fluid boluses, and he was taken to the operating room for evaluation of a presumed surgical abdomen. During surgery, he was found to have a perforated appendix and purulent peritoneal fluid. He was subsequently admitted to the PICU where he was on mechanical ventilation and received vasopressors (epinephrine and norepinephrine) for blood pressure support. He also received broad-spectrum antibiotics with coverage for anaerobic organisms. Over the next 24 h, he became 15% fluid overloaded as his urine output progressively decreased to anuria over 12 h. His serum chemistries revealed sodium 143 mEq/L, potassium 5.6 mEq/L, chloride 98 mEq/L, bicarbonate 17 mEq/L, urea nitrogen 48 mg/dL, creatinine 2.4 mg/dL, and calcium 8.9 mg/dL. Hematology labs revealed hemoglobin 8.6 g/dL and WBC count 22,000 with platelet count of 66,000/mm³. A nephrology consult was obtained for management of acute kidney injury (AKI).