Case report: transcaval impella placement in a patient with acute lv dysfunction from ethylene glycol toxicity

Prashanth Singanallur MD, Nilesh Goswami MD, Govind Pandompatam MD, Muhammad Kashif Qaseem MD
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Abstract

Introduction: Ethylene glycol is a toxic alcohol commonly found in antifreeze, or other household and industrial agents. Patients usually survive ethylene glycol toxicity when promptly treated but delay in care can cause significant morbidity and mortality. Significant metabolic acidosis can lead to multisystem organ dysfunction including Left ventricular dysfunction which can pose a unique challenge. Case report: The patient is a young female who presented with acute encephalopathy, intraventricular hemorrhage (IVH), severe metabolic acidosis, and severe left ventricular dysfunction following acute ethylene glycol toxicity. A diagnosis was quickly made due to presence of calcium oxalate crystals in the urine. The patient received timely interventions with Fomepizole and kidney replacement therapy (KRT), which failed to reverse her severe shock. The patient required mechanical circulatory support (MCS) in the form of Transcaval peripheral ventricular assist device (pVAD). Conclusion: This case showed the use of the transcaval approach to place an pVAD in a young patient suffering from ethylene glycol toxicity and severe left ventricular dysfunction. Although it remains an uncommon approach, it can be used when more traditional access points have failed, and the patient requires MCS.
病例报告:经颅穿刺置管治疗一例乙二醇中毒引起的急性左室功能障碍
乙二醇是一种有毒的酒精,常见于防冻剂或其他家用和工业试剂中。如果及时治疗,患者通常能在乙二醇中毒中存活,但延误护理可导致显著的发病率和死亡率。严重的代谢性酸中毒可导致多系统器官功能障碍,包括左心室功能障碍,这是一个独特的挑战。病例报告:患者是一名年轻女性,急性脑病,脑室内出血(IVH),严重代谢性酸中毒,急性乙二醇中毒后严重左心室功能障碍。由于尿液中存在草酸钙晶体,很快就做出了诊断。患者及时接受了福美唑和肾脏替代疗法(KRT)的干预,但未能扭转她的严重休克。患者需要机械循环支持(MCS)形式的经颅外周心室辅助装置(pVAD)。结论:本病例显示了使用经颅入路放置pVAD的年轻患者乙二醇中毒和严重的左心室功能障碍。虽然它仍然是一种不常见的方法,但当更传统的接入点失败并且患者需要MCS时,可以使用它。
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