SFGH 8.14 pearls: C. diff, volume exam and HSP!

  • The overwhelming majority of patients (>97%, but varies by study) of patients with C. diff colitis will have watery diarrhea.
  • 25-30% of Henoch-schonlein purpura (HSP, also knows as IgA vasculitis) diagnoses occur in adults, though peak age of onset is 4-6 years old (though these numbers are primarily from European and Korean studies)
  • Adults diagnosed with HSP have significantly worse renal outcomes compared with children, which rates of nephrotic syndrome, hypertension and CKD.
    • About a third of adults with HSP have renal insufficiency within 4 months of diagnosis, and 95% have hematuria and proteinuria
    • 10-30% will have ESRD after 15 years
  • This may vary by type of ICU, but only about 50% of all hemodynamically unstable patients are fluid responsive
    • Pulse pressure variation in mechanically ventilated patients without arrhythmia had a sensitivity of 88% and specificity of 89% for fluid responsiveness in the article below.
    • Data is mixed, but most studies recently show that CVP does not predict fluid responsiveness (though you should still follow your ICU attending preferences if you want to survive residency…)

Evernote link: https://www.evernote.com/shard/s300/sh/9559ffce-0fe7-4dde-b877-7c964850902a/ba3d4ee725d753ad72e11d5bc8209768

Kelly CP, Pothoulakis C, LaMont JT. Clostridium difficile colitis. NEJM 1994;330:257-262.

Kang Y, Park JS, Ha YJ, et al. Differences in clinical manifestations and outcomes between adult and child patients with Henoch-Schönlein purpura. J Korean Med Sci 2014; 29:198.

Yang X, Du B. Does pulse pressure variation predict fluid responsiveness if crticall ill patients? A systematic review and meta-analysis. Crit Care. 2014 Nov 27;18(6):650.

Osman D, et al. Cardiac filling pressures are not appropriate to predict hemodynamic response to volume challenge. Crit Care Med 2007; 35(1):64-68.

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