SESSION TITLE: Medical Student/Resident Critical Care Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: COVID-19 infection has varied presentations and complications inclusive of pneumonia(PNA),gastroenteritis(GE) and Acute kidney injury(AKI) Prompt identification with aggressive therapy is needed to reduce morbidity and mortality We present a case of COVID-19 infection with septic shock and severe AKI,successfully treated CASE PRESENTATION: A 65-year-old female presented with 7-days of vomiting,diarrhea,fever,dry cough,fatigue & confusion Multiple household members had recently tested positive for SARS CoV-19 She had a history of localized breast cancer on tamoxifen,HTN and CKD3a Baseline creatinine(Cr) 3 months prior was 1 2 On exam,BP was 86/48mm/hg, T 95F,RR 27 breaths/min She had dry mucous membranes, coarse breath sounds & rales bilaterally on auscultation,confusion & flapping wrist tremor Significant labs were a Cr of 21 5,BUN 162, CO2 9,D-dimer &gt;20,CRP 55 & random urine protein on 19 (&lt;12mg/dl) ABG on 3L nasal cannula showed PH 7 21, PO2 104, PCO2 30 CXR noted right upper lobe infiltrate CT head and EEG were unremarkable SARS-CoV-2 PCR was positive She was transferred to ICU for management of septic shock from COVID-19 PNA & GE with severe AKI Despite aggressive IV fluids,she remained hypotensive requiring phenylephrine for pressor support She received IV D5 ½ NS with bicarbonate, doxycycline,ceftriaxone & vancomycin Dialysis was considered but her renal function rapidly improved: within 24 hours she was weaned off phenylephrine & Cr decreased to 12 She was started on full dose Enoxaparin in light of elevated D-dimer, worsening bilateral infiltrates on CXR and PO2 falling to 68 on 6L NC with monitoring of anti-factor XA levels in light of AKI Within 5 days she had complete return of baseline mentation, improved ventilation & resolution of asterixis On discharge at day 10 her Cr was 1 0, with BUN 17,D-dimer 8 5 & CRP 24 She was discharged on Apixaban 5mg bid DISCUSSION: The Covid-19 global pandemic has resulted in numerous deaths and disability Prompt identification and aggressive treatment of the critically ill is paramount in the attempt to prevent multi-organ failure and death AKI occurs in as much as 23% of Covid 19 patients and confers increased mortality especially when associated with septic shock In our patient,with severe AKI,uremia with encephalopathy she had marked improvement and resolution with supportive therapy Her renal recovery with this degree of impairment is unusual as the majority of patients with similar characteristics have poor outcomes This recovery may be attributed to aggressive fluid resuscitation,correction of metabolic acidosis and possible early initiation of anticoagulation CONCLUSIONS: It is well known that AKI in critically ill Covid-19 patients is associated with high mortality This case reminds us that renal and overall clinical recovery is still possible in these patients More research is needed to identify predictors of prompt recovery Reference #1: Batlle, D , Soler, M , Sparks, M , Hiremath, S , South, A , Welling, P ,… Kidney Working Group (2020, May 04) Acute Kidney Injury in COVID-19: Emerging Evidence of a Distinct Pathophysiology Retrieved June 01, 2020, from https://jasn asnjournals org/content/early/2020/05/04/ASN 2020040419 Reference #2: Cheng, Y , Luo, R , Wang, K , Zhang, M , Wang, Z , Dong, L , Li, J , Yao, Y , Ge, S , & Xu, G (2020) Kidney disease is associated with in-hospital death of patients with COVID-19 Kidney international, 97(5), 829–838 https://doi org/10 1016/j kint 2020 03 005 DISCLOSURES: No relevant relationships by Deborah Fein, source=Web Response No relevant relationships by Latoya Gayle, source=Web Response No relevant relationships by Maha Imran, source=Web Response No relevant relationships by Gene Otuonye, source=Web Response No relevant relationships by Rani Sittol, source=Web Response No relevant relationships by Karlene Williams, source=Web Response
Severe Acute Kidney Injury in Covid-19: Not Irrecoverable