A Delayed Diagnosis of Hemorrhagic Shock in a Patient with Alcoholic Cirrhosis and Ascites on Bedside Ultrasound
Undifferentiated shock is a common and challenging problem in critical care. We present a case of hemorrhagic shock due to splenic and hepatic lacerations diagnosed by bedside paracentesis, initially misclassified as septic shock due to suspected spontaneous bacterial peritonitis (SBP). Case. A 47-y...
Saved in:
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2019-01-01
|
| Series: | Case Reports in Critical Care |
| Online Access: | http://dx.doi.org/10.1155/2019/5895801 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832551542959374336 |
|---|---|
| author | Madeline Bach Julian Choi Rory A. Smith Sarkis Arabian |
| author_facet | Madeline Bach Julian Choi Rory A. Smith Sarkis Arabian |
| author_sort | Madeline Bach |
| collection | DOAJ |
| description | Undifferentiated shock is a common and challenging problem in critical care. We present a case of hemorrhagic shock due to splenic and hepatic lacerations diagnosed by bedside paracentesis, initially misclassified as septic shock due to suspected spontaneous bacterial peritonitis (SBP). Case. A 47-year old man with a history of reported alcoholic cirrhosis and ongoing heavy alcohol use was brought to the emergency room after a syncopal event. He was found to be anemic (hemoglobin 9.9 g/dl) and hypotensive with a blood pressure of 64/34. Despite crystalloid infusion he remained hypotensive and required vasopressor support with norepinephrine. Bedside ultrasound revealed moderate ascites and as there was no evidence of active bleeding, his shock was attributed to sepsis due to SBP. A bedside paracentesis was performed which revealed gross blood. A repeat hemoglobin returned at 4.4 g/dl. Massive transfusion protocol was initiated and interventional radiology was emergently consulted due to concerns for intraabdominal hemorrhage; general surgery deemed the patient too unstable for surgical intervention. Angiogram revealed a splenic laceration and possible hepatic laceration, both embolized successfully. Internal medicine practitioners should keep the differential of hemorrhagic shock due to intraabdominal organ injury in mind for patients with undifferentiated shock. |
| format | Article |
| id | doaj-art-76c43063c9f8465491148d92635cc50d |
| institution | Kabale University |
| issn | 2090-6420 2090-6439 |
| language | English |
| publishDate | 2019-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Critical Care |
| spelling | doaj-art-76c43063c9f8465491148d92635cc50d2025-02-03T06:01:09ZengWileyCase Reports in Critical Care2090-64202090-64392019-01-01201910.1155/2019/58958015895801A Delayed Diagnosis of Hemorrhagic Shock in a Patient with Alcoholic Cirrhosis and Ascites on Bedside UltrasoundMadeline Bach0Julian Choi1Rory A. Smith2Sarkis Arabian3Department of Internal Medicine, Arrowhead Regional Medical Center, Colton, CA, USADepartment of Internal Medicine, Arrowhead Regional Medical Center, Colton, CA, USADepartment of Internal Medicine, Arrowhead Regional Medical Center, Colton, CA, USADepartment of Internal Medicine, Arrowhead Regional Medical Center, Colton, CA, USAUndifferentiated shock is a common and challenging problem in critical care. We present a case of hemorrhagic shock due to splenic and hepatic lacerations diagnosed by bedside paracentesis, initially misclassified as septic shock due to suspected spontaneous bacterial peritonitis (SBP). Case. A 47-year old man with a history of reported alcoholic cirrhosis and ongoing heavy alcohol use was brought to the emergency room after a syncopal event. He was found to be anemic (hemoglobin 9.9 g/dl) and hypotensive with a blood pressure of 64/34. Despite crystalloid infusion he remained hypotensive and required vasopressor support with norepinephrine. Bedside ultrasound revealed moderate ascites and as there was no evidence of active bleeding, his shock was attributed to sepsis due to SBP. A bedside paracentesis was performed which revealed gross blood. A repeat hemoglobin returned at 4.4 g/dl. Massive transfusion protocol was initiated and interventional radiology was emergently consulted due to concerns for intraabdominal hemorrhage; general surgery deemed the patient too unstable for surgical intervention. Angiogram revealed a splenic laceration and possible hepatic laceration, both embolized successfully. Internal medicine practitioners should keep the differential of hemorrhagic shock due to intraabdominal organ injury in mind for patients with undifferentiated shock.http://dx.doi.org/10.1155/2019/5895801 |
| spellingShingle | Madeline Bach Julian Choi Rory A. Smith Sarkis Arabian A Delayed Diagnosis of Hemorrhagic Shock in a Patient with Alcoholic Cirrhosis and Ascites on Bedside Ultrasound Case Reports in Critical Care |
| title | A Delayed Diagnosis of Hemorrhagic Shock in a Patient with Alcoholic Cirrhosis and Ascites on Bedside Ultrasound |
| title_full | A Delayed Diagnosis of Hemorrhagic Shock in a Patient with Alcoholic Cirrhosis and Ascites on Bedside Ultrasound |
| title_fullStr | A Delayed Diagnosis of Hemorrhagic Shock in a Patient with Alcoholic Cirrhosis and Ascites on Bedside Ultrasound |
| title_full_unstemmed | A Delayed Diagnosis of Hemorrhagic Shock in a Patient with Alcoholic Cirrhosis and Ascites on Bedside Ultrasound |
| title_short | A Delayed Diagnosis of Hemorrhagic Shock in a Patient with Alcoholic Cirrhosis and Ascites on Bedside Ultrasound |
| title_sort | delayed diagnosis of hemorrhagic shock in a patient with alcoholic cirrhosis and ascites on bedside ultrasound |
| url | http://dx.doi.org/10.1155/2019/5895801 |
| work_keys_str_mv | AT madelinebach adelayeddiagnosisofhemorrhagicshockinapatientwithalcoholiccirrhosisandascitesonbedsideultrasound AT julianchoi adelayeddiagnosisofhemorrhagicshockinapatientwithalcoholiccirrhosisandascitesonbedsideultrasound AT roryasmith adelayeddiagnosisofhemorrhagicshockinapatientwithalcoholiccirrhosisandascitesonbedsideultrasound AT sarkisarabian adelayeddiagnosisofhemorrhagicshockinapatientwithalcoholiccirrhosisandascitesonbedsideultrasound AT madelinebach delayeddiagnosisofhemorrhagicshockinapatientwithalcoholiccirrhosisandascitesonbedsideultrasound AT julianchoi delayeddiagnosisofhemorrhagicshockinapatientwithalcoholiccirrhosisandascitesonbedsideultrasound AT roryasmith delayeddiagnosisofhemorrhagicshockinapatientwithalcoholiccirrhosisandascitesonbedsideultrasound AT sarkisarabian delayeddiagnosisofhemorrhagicshockinapatientwithalcoholiccirrhosisandascitesonbedsideultrasound |