Can't breathe or pee

[DartmouthDave]

Hello,

Rock Shoes. Yes, hyperuricemia is the reason why this lady was on the Allopurinol. Chbare added to this with Tumor Lysis Syndrome (TLS). Which was this lady actual Dx once she arrived in the hospital.

Her multi-vitamins were a standard over the counter brand. She has a wasted appearance and has been losing weight. Her EKG shows Sinus Tachycardia with numerous multifocal PVC and runs of ploymorphic VT. The hyperkalemia was managed but there is an other issue lurking here.

Current Situation

The patient is on the cot connected to the monitor. Access is obtained via PICC or EJ (crew preference). Treatment as outlined about plus she is given Ativan 1mg SL and she has settled some. Current VS are:

GCS 14/15 Drowsy, eyes open to voice

BP 170/98

HR 100 (EKG as noted above)

SpO2 88-89 (+10/+5)

Rate 30's loboured

The wheels start rolling to the ED.

Any other considerations?

Here is a general Wikipedia article on TLS. I have an Up To Date article I will try to add later.

TLS

Cheers...

[Aussieaid]

Just something to consider with the Torsades (polymorphic VT) she is probably hypomagnesemic along with the hypocalcemia. Ideally you would want some lab values but I think if she is being symptomatic with the episodes it would be reasonable to treat with a magnesium bolus. (It may also have secondary benefits of lowering the BP and helping the CHF from the fluid overload by some vasodilation), If they treat the hypocalcemia she would need some magnesium anyway.

Just a thought.

[DartmouthDave]

Just something to consider with the Torsades (polymorphic VT) she is probably hypomagnesemic along with the hypocalcemia. Ideally you would want some lab values but I think if she is being symptomatic with the episodes it would be reasonable to treat with a magnesium bolus. (It may also have secondary benefits of lowering the BP and helping the CHF from the fluid overload by some vasodilation), If they treat the hypocalcemia she would need some magnesium anyway.

Just a thought.

Hello,

She was given Mg. It worked quite nicely on fixing the runs of polymorphic VT. Once in the hospital she was admitted to the ICU. The Bi-PAP was changed to PAV (Proportional Assisted Ventilation). This is overly simple description, but one set the 'assistance' the patient gets. So, 50% reduced 50% of the work of breathing and so on.

This was a new bit of equipment in the RT department. I have been meaning to hit Up To Date and a few other references to read up on this. Alas, I have been slacking in this area.

Cheers