Hypofibrinogenemia in Patient with Extended Exposure to Argatroban Therapy

A 42 year old female with past medical history of asthma and recent admission for Alprazolam overdose presented to our hospital with dyspnea and generalized weakness.. She was noted by paramedics to be hypoxic, hypotensive and bradycardic, and she was intubated in the field prior to arrival.. Medication prior to admission, Albuterol HFA. Patient had no known drug allergies. On presentation to the emergency department, patient appeared critically ill, hypotensive to 74/50 , hypoxic with oxygen saturation of 60%, heart rate of 137 BPM, respiratory rate 15/min, temp 99 F, and unresponsive to verbal stimuli. Endotrachial tube placement was confirmed using laryngoscope. Whilein ED, patient went into Pulseless Electrical activity state and CPR was started immediately. She was given one round of Epinephrine with return of spontaneous circulation after 3 minutes.Bedside transthoracic echo suggestive of right heart strain, patient was given Tenecteplase given high risk of Pulmonary embolism. She was then transferred to the Intensive care unit and was started on pressure support.. Initial Chest CT angiogram showed no signs of pulmonary embolism. Pertinent laboratory values at admission were, serum Creatinine 1.28 mg/dl , WBC 14 K/mcl, HGB 12/4 g/dl, Platelet count 186 K/mcl, PT 12.4 sec, INR 1.1, APTT 29.9 sec, Arterial blood gas with PH 7.039, PCO2 70.9 mmhg, PO2 35.9 mmhg, HCO3 18.2 mmol/l and Lactate 11.0 mmol/l. Hepatic function panel showing Albumin 3.7 gm/dl, Total protein 7.2 gm...
Source: Blood - Category: Hematology Authors: Tags: 322. Disorders of Coagulation or Fibrinolysis Source Type: research