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Update (12/09): Status of patients from the JCO Criticality
RADSAFERS,
Science and Technology Agency web page is beginning to posting Mr. A's condition
promptly daily.
I have revised Mr. A's (12/08) update with input from Dr. Funahashi. Dr.
Funahashi explains that once severe lactic acidosis with decompensated metabolic
acidosis becomes established, especially in conjunction with multi-organ
failure, septic shock is likely to be irreversible despite therapy.
Tosh Ushino
ICN Dosimetry
tushino@icnpharm.com
==========================================================================
RBC = Red Blood Cell WBC = White Blood Cell BP = Blood Pressure
Temp = Temperature Pulse = Pulse Rate Resp = Respiration rate
CRP = C-reactive protein
Mr. A: 9.06 Sv
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12/03/99 17:00
BP: 165/70 mm Hg (w/ blood pressure controlling medication), Pulse: 120/min.,
Resp: 24/min., Temp: 37.4 C
Continuing with sedative and ventilation. WBC count in small blood vessels is
5,400/mm^3. On continuous hemodialysis due to the state of hypouresis. Despite
the transfusion, the rate of RBC increase is low. Hemophagocytic syndrome (HS)
was diagnosed, and plasma was exchanged today. The cause of HS is suspected to
be viral infection and fat dysbolism (sp?) due to inadequate liver function,
etc. Currently investigating the cause. (HS is condition in which RBC, etc., are
engulfed by macrophage.) There is slight improvement trend in liver function.
Radiation damage to intestine and skin continues. Continuing problem with large
volume of fluid seeping out from the areas of injuries due to radiation burn.
Because of this, the patient requires massive amount of fluid and blood products
transfusion daily.
Treatment Direction: Continue massive volume of transfusion and continue with
hemodialysis. Continue ventilation management, infection prevention, nutrition
management, continued transfusion management, and detailed total body
management.
Others: With medication, blood pressure, pulse and other vital signs remain
relatively stable, but the condition continue to require vigilance.
12/04/99 17:00
BP: 121/62 mm Hg (w/ blood pressure controlling medication), Pulse: 127/min.,
Resp: 30/min., Temp: 38.6 C
Continuing with sedative and ventilation. WBC count in small blood vessels is
5,200/mm^3. On continuous hemodialysis due to the state of hypouresis. Plasma
was exchanged again today to counter hemophagocytic syndrome (HS). The cause of
HS is suspected to be viral infection and fat dysbolism due to inadequate liver
function, etc. There is slight improvement trend in liver function. Radiation
damage to intestine and skin continues. Continuing problem with large volume of
fluid seeping out from the areas of injuries due to radiation burn. Bleeding
from digestive tract continues, the patient requires massive amount of fluid and
blood products transfusion daily.
Treatment Direction: Continue massive volume of transfusion and continue with
hemodialysis. Continue ventilation management, infection prevention, nutrition
management, continued transfusion management, and detailed total body
management.
Others: With medication, blood pressure, pulse and other vital signs remain
relatively stable, but the condition continue to require vigilance.
12/05/99 17:00
BP: 150/73 mm Hg (w/ blood pressure controlling medication), Pulse: 112/min.,
Resp: 30/min., Temp: 36.5 C
Continuing with sedative and ventilation. WBC count in small blood vessels is
4,200/mm^3. On continuous hemodialysis due to the state of hypouresis. Plasma
was exchanged again today to counter hemophagocytic syndrome (HS). There is
slight improvement trend in liver function. Radiation damage to intestine and
skin continues. Continuing problem with large volume of fluid seeping out from
the areas of injuries due to radiation burn. Due to bleeding from digestive
tract and hemophagocytic syndrome, the patient is on continuous transfusion.
Treatment Direction: Continue massive volume of transfusion and continue with
hemodialysis. Continue ventilation management, infection prevention, nutrition
management, continued transfusion management, and detailed total body
management.
Others: With medication, blood pressure, pulse and other vital signs remain
relatively stable, but the condition continue to require vigilance.
12/06/99 17:00
BP: 142/63 mm Hg (w/ blood pressure controlling medication), Pulse: 114/min.,
Resp: 30/min., Temp: 38.6 C
Continuing with sedative and ventilation. WBC count in small blood vessels is
3,300/mm^3. On continuous hemodialysis due to the state of hypouresis. Plasma
was exchanged again today to counter hemophagocytic syndrome (HS). There is
slight improvement trend in liver function. Radiation damage to intestine and
skin continues. Continuing problem with large volume of fluid seeping out from
the areas of injuries due to radiation burn. The patient is on continuous
transfusion due to bleeding from upper digestive tract and hemophagocytic
syndrome.
Treatment Direction: Continue massive volume of transfusion and continue with
hemodialysis. Continue ventilation management, infection prevention, nutrition
management, continued transfusion management, and detailed total body
management.
Others: With medication, blood pressure, pulse and other vital signs remain
relatively stable, but the condition continue to require vigilance.
12/07/99 17:00
The patient's circulatory function has become unstable and blood pressure is
fluctuating. Sepsis is suspected to be the cause.
BP: 167/68 mm Hg (w/ blood pressure controlling medication), Pulse: 137/min.,
Resp: 30/min., Temp: 38.6 C
Continuing with sedative and ventilation. WBC count in small blood vessels is
2,200/mm^3. On continuous hemodialysis due to the state of hypouresis. Plasma
was not exchanged today due to unstable circulatory function. Radiation damage
to intestine and skin continues. Continuing problem with large volume of fluid
seeping out from the areas of injuries due to radiation burn. The patient is on
continuous transfusion due to bleeding from upper digestive tract and
hemophagocytic syndrome.
Treatment Direction: Continue massive volume of transfusion and continue with
hemodialysis. Continue ventilation management, infection prevention, nutrition
management, continued transfusion management, and detailed total body
management.
Others: With medication, blood pressure, pulse and other vital signs have
recovered, but the condition has become critical, requiring even more vigilance.
12/08/99 17:00
BP: 141/43 mm Hg (w/ blood pressure controlling medication), Pulse: 123/min.,
Resp: 30/min., Temp: 37.0 C
The patient is in state of lactic acidosis. The blood pressure has become even
more unstable than yesterday, and from the characteristics of circulatory
condition, progression of septic shock is suspected. Continuing with sedative
and ventilation. WBC count in small blood vessels is 1,100/mm^3. On continuous
hemodialysis due to the state of hypouresis. Radiation damage to intestine and
skin continues. Continuing problem with large volume of fluid seeping out from
the areas of injuries due to radiation burn. The patient is on continuous
transfusion due to bleeding from upper digestive tract and hemophagocytic
syndrome.
Treatment Direction: Continue massive volume of transfusion and continue with
hemodialysis. Continue ventilation management, infection prevention, nutrition
management, continued transfusion management, and detailed total body
management.
Others: With medication, blood pressure, pulse and other vital signs are
maintained, but the condition has become critical, requiring more vigilance.
12/09/99 17:00
BP: 116/47 mm Hg (w/ blood pressure controlling medication), Pulse: 131/min.,
Resp: 30/min., Temp: 37.4 C
However, the systolic blood pressure fluctuates widely between 110 mm Hg and 190
mm Hg. Lactic acidosis has progressed and blood is now acidic. Septic shock
resulting from change in circulatory condition is suspected. Continuing with
sedative and ventilation. WBC count in small blood vessels is 1,100/mm^3. On
continuous hemodialysis due to the state of hypouresis. Radiation damage to
intestine and skin continues. Continuing problem with large volume of fluid
seeping out from the areas of injuries due to radiation burn. The patient is on
continuous transfusion due to bleeding from digestive tract and hemophagocytic
syndrome.
Treatment Direction: Continue with hemodialysis. Continue ventilation
management, infection prevention, nutrition management, continued transfusion
management, and detailed total body management.
Others: With medication, blood pressure, pulse and other vital signs are
maintained, but the condition has become critical, requiring more vigilance.
Mr. B 4.96 Sv
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12/03/99
Conscious, lucid, with good spirits, and no major change to examination result.
RBC transfusion given because of anemia.
BP: 144/62 Pulse: 100/min, Temp (peak): 37.7 C WBC count:
11,980/mm^3 Hemoglobin: 7.9 g/dl
Platelet: 49,000/mm^3
12/06/99
Conscious, lucid, in good spirits as usual. There was a bowel movement. No major
change to examination result. Continuing fever and inflammation. Examination
reveals epidermis recovering but tend to bleed easily.
BP: 132/70 Pulse: 120/min, Temp (peak): 39.0 C WBC count:
8,930/mm^3
12/08/99
Conscious, lucid, in good spirits as usual. There was a bowel movement today. No
major change to examination result. Continuing fever in 39 deg C range.
BP: 138/80 Temp (peak): 39.2 C WBC count: 8,930/mm^3
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Toshihide "Tosh" Ushino, CHP Tel: (800) 548-5100 x2413
Product Development Manager Fax: (714) 668-3149
Dosimetry Div., ICN Biomedicals, Inc. Email: tushino@icnpharm.com
3300 Hyland Ave., Costa Mesa, CA USA 92626 tushino@hotmail.com
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