after several years of use, the AVF has blocked up & a new one has to be created on the other forearm. meanwhile, MZ has dialysis via a temporary catheter inserted in his neck. he was scheduled to have a new AVF done on saturday, a day after the previous dialysis.
his chest xray in the morning was essentially normal.
(ok, the heart is a little large but this is expected as MZ also has hypertension)
as he was being prepared on the operating table at noon, he started coughing violently & complained of a little breathlessness. it was decided that another chest xray be done before proceeding with the AVF creation. lo & behold, there were new changes in this xray:
white patches had appeared on both lung fields & the heart outline had becomed blurred. it meant that his lungs had become congested with fluids, as a result of his deteriorating condition. he needed another dialysis before the procedure can take place.
it's a good thing the chest xray was repeated, because had the surgery taken place, MZ may have come off worse. the lives of patients with ESRF are already hanging by a thin thread. as medics, we should provide them every opportunity to alleviate their suffering.
note: MZ had uncontrolled diabetes & hypertension for many years, resulting in the severe kidney damage.
2 comments:
Why did he have sudden fluid overload? Unless he drank like a fish after his latest dialysis, need to rule out a cardiac event impairing cardiac output.
hi hua jern,
thks for asking.
no, patients with ESRF don't drink like a fish. as the previous dialysis was done at another centre, i could not be sure if it was effective. although i mentioned that the 1st xray was essentially normal, if you look closer, there were already some changes over the right lower zone. this suggested that MZ already has some degree of pre-existing cardiac/renal deterioration.
as he didn't have an intravenous drip & there were no other sign/symptoms of infection, absolute fluid overload & pneumonia were not considered. cardiac enzymes & troponin-T were not elevated, so an acute cardiac event was also not likely.
the physicians will have their hands full here. the important lesson to be learned is that, in our haste to improve the lives of our patients, we must 1st do not further harm.
he subsequently underwent dialysis thru the CVC & will be listed for the vascular surgeon the following week.
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