Hypotension,%20renal%20failure%20and%20pulmonary%20complication%20in%20leptospirosis

1
Hypotension, renal failure and pulmonary
complication in leptospirosis

• Kannika Niwattayakul, M.D., Orawan Khow, M.S.,
• And Visith Sitprija, M.D., Ph.D.
• Department of Medicine, Loei Hospital, Loei
• Queen Saovabha Memorial Institute, Bangkok,
  Thailand

2
Number of patients (deaths) of leptospirosis in
Thailand
10,084
365
266
169
113
102
8
2 - -
7
4
19
2544
1990 1991 1992 1993 1994 1995 1996
1997 1998 1999 2000 2001
3
Leptospirosis ??????????
4
????????????????????????? Leptospirosis
Diagnosis ??????????????????????????????????????
????????
CBC, platelet count , U/A
VS, BP, Pulse, temp, RR.

• Rx OPD case
• ???????
• BP gt 90/60
• plt. gt100,000
• ????? lt 24 ?????/????
• ??? Doxy 1x 2
• amoxy 2x 3
• ???? penV 1x 4
• Fu ??? 1 ??? 3-4 ?????

• Admit
• BPlt90/60
• plt.countlt100,000
• ?????????? 3 ?????????????????????
• clinical suspected??Fu???
• ??? ??????????? Cr
• ??? ???????? ?????????
• ??? ?????????????????????
• ??? CXR abnormal
• ??? ?????????? ?? arrythmia
• ??? Encephalopathy

• Specific treatment
• PGS 2 mu V ??? 6 hr
• Ceftriaxone 2 gm V ??? BP lt 90/60
• Supportive treatment
• Lung hemorrhage
• Shock
• Acute renal failure
• Hyperbilirubinemia
• Thrombocytopenia

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Hypotension, renal failure and pulmonary
complication in leptospirosis (?.?.42-?.?.43)

• ???????????? 148 ???
• ??? 107 ???
• ???? 41 ???
• ???? 8 - 76 ?? (?????? 36 ??)
• ??????????? 1 - 14 ??? (?????? 4 ???)

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????????
Specific PGS 2 mu IV ??? 6 ??.X 7 ???
Add Ceftriaxone 2 gm IV OD (????? clinical
sepsis) Supportive Hypotension
Thrombocytopenia c bleeding Acute renal
failure Respiratory failure
Hyperbilirubinemia
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Clinical manifestation in leptospirosis
8
Clinical manifestation in leptospirosis
9
Clinical manifestation in leptospirosis
10
Clinical manifestation in leptospirosis
11
Hypotension
12
Impaired renal funtion Creatinine gt1.5 mg/dl
( 85 patient )
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Renal and pulmonary complication in Hypotensive
and normotensive patients
HT hypotension NT normotension
14
Out come
Hemodilysis 7 ??? Peritoneal
dialysis 2 ??? PDHD 1 ??? Blood
Exchange 9 ??? ??? Tube on respirator 18 ???
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Out come
Complete recovery 143 ??? Dead 5 ??? (
mortality 3.4 ) Pulmonary Hge 3
??? ARDS c Sepsis 1 ??? Pneumonia c
Sepsis 1 ???