SHM Converge Scientific Abstract ePoster Gallery-Same Hospitalization, Different Shock: Exploring Infectious Sources in the Micu

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A 38-year-old woman with sickle cell disease, pulmonary hypertension with right heart failure, and adrenal insufficiency was admitted to the MICU with septic shock from MRSA bacteremia. Her ICU course was complicated by acute decompensated heart failure and hypoxic respiratory failure, which improved with diuresis and BiPAP, allowing transfer to the floor on antibiotics and continued diuresis.<br /><br />Several days later, she deteriorated with hypotension, altered mental status, acute kidney injury, acute liver injury, and DIC, prompting readmission to the MICU for undifferentiated shock. The team treated for both cardiogenic and septic shock. Because liver tests worsened, abdominal ultrasound was obtained and showed gallbladder hydrops with concern for possible cholecystitis; a HIDA scan was recommended. A prior ultrasound had already shown a smaller gallbladder with similar wall thickening. No further biliary workup or source-control intervention was pursued. Her shock progressed despite maximal support, and she died five days later after transition to comfort care.<br /><br />The case raises concern for a missed opportunity for source control, possibly from biliary sepsis. The authors note that diagnostic error may have occurred due to failure to act on imaging findings suggestive of cholecystitis and hydrops. They emphasize that source control is essential in septic shock and that additional imaging, surgery consultation, or percutaneous biliary drainage might have been indicated.<br /><br />However, they also acknowledge that the patient was already in multiorgan failure and may not have tolerated further procedures, making benefit uncertain. The case underscores the importance of standardized evaluation of shock with explicit documentation of possible infectious sources, even when other causes of shock are present.

Asset Subtitle

Russell Ledford

Meta Tag

Author List Chase Jeffrey J. Webber DO FACP, Russell Ledford

Category Clinical Vignettes

Concept Infection Source

Concept Sepsis

Concept Septic Shock

Concept Sepsis Source Control

Concept Shock

Distinguished Non-Finalist

Presenter Organization Vanderbilt University Medical Center

Presenting Author Russell Ledford

Track Adult

Keywords

sickle cell disease

MRSA bacteremia

septic shock

pulmonary hypertension

right heart failure

adrenal insufficiency

gallbladder hydrops

cholecystitis

source control

diagnostic error

Infection Source

Sepsis

Septic Shock

Sepsis Source Control

Shock