Dr. Gaurav Agrawal
Associate Consultant
Paediatric Cardiology
BLK Heart Centre
BLK Super Speciality
Hospital, New Delhi

THE CASE

A 6 month old baby boy was brought to BLK OPD with severe respiratory distress and signs of heart failure with altered sensorium. He was immediately shifted to PICU. He had severe metabolic acidosis with lactate of 7.9, and was immediately intubated and ventilated. ECHO showed dilated cardiomyopathy with severe LV dysfunction (EF 15%). Lab investigation showed hypocalcemia, raised CPK-MB, troponin I.

THE PROCEDURE

The child was immediately supported with inotropes and after 24 hours of admission, his clinical condition improved slightly. However, in the next few hours, his urine output started declining and he became anuric with metabolic acidosis and worsening lactates. His blood pressure dropped to a range of 40/20 mm Hg. Renal and liver parameters were markedly deranged. Peritoneal dialysis was started immediately and inotropes upgraded. The child remained critically ill and sustained on low blood pressure for few hours. Precise balance between preload and afterload status was maintained. In the next 24 hours, his blood gases showed improvement and blood pressure started stablising. Gradually in the next 3 to 4 days, renal and liver functions normalised. Inotropes were tapered at a very slow pace and oral medications for heart failure were added. On day eight of admission, he was extubated onto HHHFNC, which was subsequently weaned off.

THE RESULT

The hard work of the team comprising professionals from PICU and Nephrology unit finally paid off and smiles returned on the face of the baby boy and his parents. He returned back to his normal clinical status. His pre-discharge ECHO showed EF of 35% and he is doing fine post discharge as well.