Redo AVR in ICU .
Uneventful surgery.
Post operative hypertension needing Sodium nitroprusside , GTN and Metoprolol.
High sugars( 350 to 400 mgm%)
Marked diuresis.
PCWP 12
Warm peripheries.
Persistent Base excess -15...despite correction of sugar.
Abdomen soft. no bowel sounds.
Possibilities:
Hypovolemia, ( unlikely - PCWP 12)
tissue hypoperfusion (possible)
Gut ischaemia (possible)
low cardiac output( unlikely, warm peripheries, hypertension, excellent urineOutput)
tamponade (unlikely as warm, good u.o., hypertensive)
BP control without vasodilators, colloid transfusion, IV insulin to control glucose slowly corrected the acidosis.
If this doesnt resolve the issue, Gi cause needs to be ruled out. Bedside diagnostic laparoscopy can be valuable aid.
