Reactions 1704, p205 - 2 Jun 2018 Acute kidney injury and hypervolemic hyponatraemia: case report A 58-year-old woman developed acute kidney injury and hypervolemic hyponatraemia following administration of iohexol [Omnipaque 350] as a contrast medium [dosage, route and durations of treatments to reaction onsets not stated]. The woman experienced intermittent palpitation and chest discomfort with sensation of compression during exercise. Treadmill exercise test was positive for ischaemic change. She had a history of diabetes mellitus type 2, hypertension and stage 3 chronic kidney disease. She was scheduled for complex percutaneous coronary intervention for multiple vessel coronary artery disease. Before the procedure, she received sodium chloride [normal saline] solution for hydration to prevent contrast-induced nephropathy. She then underwent percutaneous coronary intervention for total revascularisation. One drug eluting stent (DES) was placed near the ostial left anterior descending artery after predilatation. However, proximal left circumflex artery (LCA) delay flow due to plague shifting after stenting occurred. Therefore, another DES was placed at the ostial LCA for plague shifting. Another short DES was deployed to the first obtuse marginal branch, and another two DESs were deployed to the proximal and mid-right coronary artery after adequate predilatation. After stenting and adequate post-dilatation with high-pressure balloons, thrombolysis in myocardial infarction flow three was achieved. Iohexol 280mL as a contrast medium was used due to multiple vessel approach, plaque shifting at ostial LCA and subtotal lesion at right coronary artery. She received hydration with sodium chloride. Subsequently, her serum creatinine level increased and urine output gradually decreased. She experienced transient bradycardia and symptomatic dizziness for several times and transvenous temporary pacemaker was inserted. AKI with oliguria was observed. Due to no urinary tract infection and no other nephrontoxic drug used in this patient, contrast-induced nephropathy was favoured. Therefore, hydration with sodium chloride was continued, and her body weight increased by 3kg. She received high dose of furosemide, but urine output remained <1000 mL/d. Increase in serum creatinine and decrease in serum sodium were also noted. Orthopnoea and impending respiratory failure was observed. Chest radiography revealed pulmonary congestion. High brain-type natriuretic peptide was observed. The woman was treated with tolvaptan due to hyponatraemia and oliguria. One day later, urine output increased to 1000 to 1500mL every 8 hours. Her symptoms abated and serum sodium significantly returned within normal range. Six days later, serum creatinine level returned to 2.05 mg/dL. Twelve days later, her serum creatinine level was 1.38 mg/dL. Her symptoms gradually improved and she was discharged 20 days later. During 1 year follow-up period, she presented with adequate urine output. Author comment: "We reported an interesting case about tolvaptan use for contrast-induced AKI and associated hypervolemic hyponatremia, which prevented the patient from hemodialysis." Lee WC, et al. Tolvaptan rescue contrast-induced acute kidney injury: A case report. Medicine 97: e0570, No. 17, Apr 2018. Available from: URL: http:// doi.org/10.1097/MD.0000000000010570 - China 803322777 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704
Reactions Weekly – Springer Journals
Published: Jun 2, 2018
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