Summary:
The ongoing outbreak of Covid-19 presented with a wide variety of
clinical manifestations. Apart from the common respiratory
complications, acute renal impairment and bleeding complications
on full anticoagulation has been also observed in some patients.
Here we report a 67 year old male with COPD and CKD presented
with symptoms of covid-19 and found ground glass opacity on CT
scan and bibasilar opacity on chest X-ray, admitted to the hospital
and he was initially stable after supportive management, discharged
home on antibiotics but readmitted after 4 days with worsening
shortness of breath, hypoxia, tachycardia (A-fib with Rapid
Ventricular Response) and high ESR. He was started on High flow
nasal cannula (HFNC), diltiazem, adenosine and antibiotics
ultimately needed intubation. While he was on antibiotics,
hydroxychloroquine, DVT prophylaxis and statin he developed
septic shock two days after intubation. Next day he had to receive
Continuous Renal Replacement Therapy (CRRT).
He was placed on heparin infusion. With clinical
improvement the patient was extubated to HFNC, but after
one day of extubation he developed bradycardia, hypotension
and gradually became unresponsive. He was given
vasopressors and intubated again. CT scan showed
retroperitoneal hematoma 10 x7 x 12 cm. His heparin was
discontinued and was managed conservatively. With
supportive treatment his clinical condition improved
gradually and was extubated again. CRRT was switched
from CVVH (Continuous Veno -Venous Hemofiltration) to
HD and eventually he was discharged home.
Clinicians should remain watchful at all stages of critical
care management of COVID 19 because timely intervention
and drug adjustment is lifesaving.
Keywords: COVID-19, Acute kidney injury (AKI),
Retroperitoneal bleeding, Continuous renal replacement
therapy (RRT).
(J Bangladesh Coll Phys Surg 2020; 38: 136-140)
DOI: https://doi.org/10.3329/jbcps.v38i0.47341