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Washington University Experience | VASCULAR | Cavernous Angioma | 3A0 Case 3 History
Case 3 History ---- The patient was a 69 year old woman with a past medical history significant for asthma, diabetes, hypertension, chronic kidney disease and long-standing history of back pain and spinal stenosis. On June 7 she had a L4-5 laminectomy performed successfully but on June 11 she had altered mental status, acute hypotension and acute respiratory difficulties as well as sinus bradycardia. She had minimal urine output with thick, foul-smelling urine. Her blood pressure was in 70s-80s. Due to the morbid obesity of the patient, IV access was lost. A new triple-lumen catheter was inserted in the right groin as well as an arterial line. The labs showed glucose of 43, NA 145, K 5.3, cortisol 26.4, WBC 10.1, RBC 3.30, Hb 9.4, plt 86K, lactic acid 164, BUN 59, creatinine 2.82, PT 22.5, PTT 44.0 and INR 2.04. With a suspicion for retroperitoneal hemorrhage, a CT scan of the abdomen was performed and was negative. Head CT scan was also performed and showed involutional change and small vessel disease. The patient eventually expired on June 2012 with the clinical diagnosis of sepsis. The premortem cultures showed gram negative bacilli in the blood and E.coli in urine.
