[HSF] progress on postCABG+ mitral repair thrombocytopenia

Wed Jul 8 22:12:27 EDT 2009

Prassana,

should we give amikacin+metro together?no Lactic acidosis on blood gases  at  that time.What else to ruule out mesenteric ischemia?.BTW she is very slowly recovering( started small amount off urine, platelet 90X1000,...

eerdinc

> From: prasannasimha at gmail.com
> Date: Mon, 6 Jul 2009 07:40:52 +0530
> Subject: Re: [HSF] progress on postCABG+ mitral repair thrombocytopenia
> To: OpenHeart-L at lists.hsforum.com
> CC: 
> 
> You can start Metranidazole and Amikacin if C difficle is suspected.Add a
> lactobacillus suspension or active yoghurt feeding orally or via a Ryles
> tube.Has mesenteric Ischemioa been ruled out ?
> Prasanna
> 
> 2009/7/5 erdinç naseri <enaseri at hotmail.com.tr>
> 
> >
> > Michael,
> >
> > Thanks for the tips. GGI is already involved but refused colonoscopy. Their
> > dx is either diverticulitis or angiodysplasia.No availability of stool
> > C.diff toxin detection.Her abd is silent. She was on EN untilll developed
> > melena 3-4 days ago. I restarted VM today ( had stoped when everything went
> > fine after 5-6 days of iv use)
> >
> > erdinc
> >
> > > From: msfirst at gmail.com
> > > To: OpenHeart-L at lists.hsforum.com
> > > Subject: Re: [HSF] progress on postCABG+ mitral repair thrombocytopenia
> > > Date: Sun, 5 Jul 2009 13:03:25 -0400
> > > CC:
> > >
> > > In general, I have a low index of suspicion in any patient that starts
> > > developing a very high white count even while on antibiotics.
> > > Although most people associate it with severe diarrhea - it can
> > > present with a variety of GI complaints (even an ileus). I would send
> > > a stool sample for the toxin - my concern is even more elevated due to
> > > the melena and the prolonged course of antibiotics - and treat
> > > emperically. Metronidazole, I think the dose is 500mg PO (NOT IV)
> > > Q6h. For severe cases, people use PO Vanco and sometimes rectal vanco
> > > infusions. The downside to treating is minimal. With the melena I
> > > would also want a colonscopy. Getting GI involved asap can we very
> > > helpful.
> > >
> > > severe cases can require colectomy.
> > >
> > > -michael
> > >
> > > On Jul 5, 2009, at 12:53 PM, erdinç naseri wrote:
> > >
> > > >
> > > > It can be due to any superinfection. Don't have much experience in
> > > > the dx ( symptomatology) of C difficile infectio. Can you share yours?
> > > >
> > > > erdinc
> > > >
> > > >> Date: Sun, 5 Jul 2009 10:35:38 -0400
> > > >> Subject: Re: [HSF] progress on postCABG+ mitral repair
> > > >> thrombocytopenia
> > > >> From: msfirst at gmail.com
> > > >> To: OpenHeart-L at lists.hsforum.com
> > > >> CC:
> > > >>
> > > >> can the new WBC count be from C. Diff?
> > > >>
> > > >> -michael
> > > >>
> > > >>
> > > >> 2009/7/5 erdinç naseri <enaseri at hotmail.com.tr>
> > > >>
> > > >>>
> > > >>> still intubated,anuric,severe hematokezia and then melena requiring
> > > >>> multiple tx from 3 days ago ,on coumadin and off lepirudin
> > > >>> ( fortunately
> > > >>> before our lepirudin stock was finished),platelets still 40
> > > >>> X1000 . A surge
> > > >>> in wbc from 12 to 28 X1000 in the last 24 hours ( on
> > > >>> meronem ) ,CRP 12,
> > > >>> sedim 5mm/hr!!!, chest X ray clear, no fever, no bacterial
> > > >>> isolation.
> > > >>> hemodynamics stable without inotropics / IABP. TTE: no LA
> > > >>> thrombus!!.
> > > >>>
> > > >>> erdinc
> > > >>> _______________________________________________
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> 
> 
> -- 
> Prasanna Simha M
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