Bringing Back A Hearty Smile
An untiring team effort strengthens a weak heart
A 6 month old baby boy was brought to BLK OPD with severe respiratory
distress and signs of heart failure with altered sensorium. He was
immediately shifted to PICU. He had severe metabolic acidosis with
lactate of 7.9, and was immediately intubated and ventilated. ECHO
showed dilated cardiomyopathy with severe LV dysfunction (EF 15%).
Lab investigation showed hypocalcemia, raised CPK-MB, troponin I.
The child was immediately supported with inotropes and after 24 hours
of admission, his clinical condition improved slightly. However, in the
next few hours, his urine output started declining and he became anuric
with metabolic acidosis and worsening lactates. His blood pressure
dropped to a range of 40/20 mm Hg. Renal and liver parameters were
markedly deranged. Peritoneal dialysis was started immediately and
inotropes upgraded. The child remained critically ill and sustained on
low blood pressure for few hours. Precise balance between preload and
afterload status was maintained. In the next 24 hours, his blood gases
showed improvement and blood pressure started stablising. Gradually
in the next 3 to 4 days, renal and liver functions normalised. Inotropes
were tapered at a very slow pace and oral medications for heart
failure were added. On day eight of admission, he was extubated onto
HHHFNC, which was subsequently weaned off.
The hard work of the team comprising professionals from PICU and
Nephrology unit finally paid off and smiles returned on the face of
the baby boy and his parents. He returned back to his normal clinical
status. His pre-discharge ECHO showed EF of 35% and he is doing fine
post discharge as well.