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[Diabetic coma with deep hypothermia. Successful resuscitation with hemofiltration]
K Hekmat1, M Abel, R Zimmermann
1Klinik und Poliklinik für Herzchirurgie, Universität zu Köln.
Der Anaesthesist
|November 1, 1994
Summary
Venovenous hemofiltration effectively rewarmed a severely hypothermic patient with diabetic ketoacidosis. This minimally invasive technique offers a viable option for rewarming critically ill patients with preserved circulation.
Area of Science:
- Critical Care Medicine
- Nephrology
- Endocrinology
Background:
- Diabetic ketoacidosis (DKA) can lead to severe hypothermia and thermoregulation loss.
- Hypothermia in DKA presents significant challenges in patient management and rewarming.
Observation:
- A 41-year-old female with DKA presented with profound hypothermia (23.7°C rectal temperature), bradycardia, and unmeasurable blood pressure.
- Despite initial interventions, the patient remained hypothermic (27.3°C) upon transfer for advanced care.
Findings:
- Venovenous hemofiltration was initiated for gradual rewarming, achieving a blood flow rate of 200 ml/min with heated infusion solutions.
- The patient's core temperature increased to 35.5°C within 8 hours; sinus rhythm was restored at 29.5°C without antiarrhythmics.
- Successful treatment of associated adult respiratory distress syndrome (ARDS) led to discharge without permanent organ damage.
Implications:
- Venovenous hemofiltration is a potentially effective and less invasive method for rewarming deeply hypothermic patients with stable circulation.
- This technique may be a valuable alternative to cardiopulmonary bypass for managing severe hypothermia in specific clinical scenarios.