Reactions 1680, p187 - 2 Dec 2017 Acute pancreatitis, acute renal injury and hemodynamicmanifestations: case report A 75-year-old man developed acute pancreatitis, acute renal injury and hemodynamicmanifestations following iohexol injection. The man presented with acute coronary syndrome and underwent an angioplasty with a drug eluting stent implanted in the severe LAD lesion. The contract agent used during the procedure was iohexol [dosage not stated]. Three days later, he came back with a history of severe nausea and dyspnoea. He was drowsy. His serum creatinine was 8.8 mg/dL and serum potassium was 8.1 mmol/L. He was severely acidotic and his condition rapidly deteriorated. Therefore, the man was put on ventilator, and underwent immediate haemodialysis. He was diagnosed with contrast induced, or cholesterol embolicacute renal injury with metabolic acidosis and shock. Mesenteric ischemia was also suspected. He was treated with meropenem along with dopamine and noradrenaline. On day one of admission, his serum amylase level was 1023 U/L, which rose to 1575 U/L on the following day. His serum lipase was more than 3000 units/L on the first day and remained high over the next many days. These clinical findings raised the possibility of acute pancreatitis as the primary problem, with renal and hemodynamic manifestations being secondary to the pancreatitis. A CT scan revealed peripancreatic fat stranding, medical renal disease and fatty liver with mild ascites. It was determined that the problem being related to use of injection of contrast agent. With the standard treatment of hydration, inotopic support and correction of fluid and electrolyte balance, he recovered over the following few days and ten days later, he was discharged. Author comment: "As in this case, patients in previous reports have also presented within a few days of [contrast media] exposure and responded to usual care with appropriate antibiotics, hydration and maintenance of hemodynamics". "Contrast injection during CTscan was avoided due to the present problem being related to use of contrast." Dalal JJ, et al. Contrast induced acute pancreatitis following coronary intervention. IHJ Cardiovascular Case Reports (CVCR) 1: 109-110, No. 2, May-Sep 2017. Available from: URL: http://doi.org/10.1016/j.ihjccr.2017.06.002 - India 803283970 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680
Reactions Weekly – Springer Journals
Published: Dec 2, 2017
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