Abstract: PO0300
Transition of Portal Vein Doppler Waveform with Improving Venous Congestion: A Case Study
Session Information
- AKI: Trainee Case Reports
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Chatterjee, Totini S., Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Koratala, Abhilash, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
Introduction
The diagnostic accuracy of physical examination, weight, laboratory parameters such as BNP is limited for the assessment of fluid status. Point-of-Care Ultrasonography (POCUS) is emerging as a valuable bedside tool for evaluation of hemodynamics at the bedside. Herein, we present a case which illustrates the practical utility of portal vein Doppler.
Case Description
A 78-year-old woman with a history of heart failure (HF) with reduced EF (<20%) and pulmonary hypertension was brought to the hospital for altered mental status. She was found to have acute kidney injury (AKI) with a serum creatinine of 2.2 mg/dL (baseline ~1.1) and urinalysis was suggestive of UTI. Urine sodium and chloride were <20 mmol/L. Antibiotic therapy was started; AKI was presumed to be secondary to volume depletion as her diuretic regimen was recently intensified. There was no significant weight gain. Admitting physician noted mild pedal edema and no jugular venous distension. NT-pro-BNP level was 8118 pg/mL (last available value 10,537). 1 liter of isotonic fluid was administered, and diuretics were held. Her metal status eventually improved; nephrology consulted for AKI. POCUS-assisted physical examination demonstrated severely impaired left ventricular systolic function, a D-shaped left ventricle suggestive of pressure and volume overload and a plethoric inferior vena cava (IVC) suggestive of elevated right atrial pressure. Portal vein Doppler waveform was pulsatile with intermittent flow reversal consistent with severe venous congestion. Based on these findings, diuretic therapy was restarted. Serum creatinine improved to 1 mg/dL at discharge. While IVC continued to be dilated, portal vein waveform showed consistent improvement during the course of decongestive therapy [Fig.1].
Discussion
While IVC POCUS is relatively easy to perform, it maybe chronically dilated in patients with pulmonary hypertension. Portal vein Doppler offers an additional datapoint to assess the severity of venous congestion and monitor the efficacy of decongestive therapy.