Lessons learnt from managing a case of dengue hemorrhagic fever complicated with acute liver failure and acute kidney injury: a case report

Abstract

* Case report * Open Access * Open Peer Review Lessons learnt from managing a case of dengue hemorrhagic fever complicated with acute liver failure and acute kidney injury: a case report * Chamara Dalugama1Email author and * Indika Bandara Gawarammana1 Journal of Medical Case Reports2018 12:215 https://doi.org/10.1186/s13256-018-1766-0 © The Author(s). During the latter 24 hours of the critical phase of DF, she had severe metabolic acidosis with lactic acidosis: PH of 7.2, bicarbonate 8 mmol/L, and partial pressure of carbon dioxide 16 mmHg with a lactate level of 12 mmol/L, which was corrected medically with 8.4% sodium bicarbonate 200 ml in divided boluses. Table 1 Summary of the basic blood investigations of the patient during hospital stay Day 1 2 3 4 5 6 7 8 9 10 Hemoglobin (g/dL) 15.3 14.2 11 11.3 12.8 12 11.5 11.8 12 12.5 White cell count (106/microL) 3.22 5.5 7.5 7 6.6 4.6 5 5.4 7 7.5 Platelets (103/microL) 74 21 27 46 79 80 126 146 189 224 Sodium (mmol/L) 146 150 141 136 139 136 135 132 135 135 Potassium (mmol/L) 5.8 4.9 4.2 4.4 4 4.5 3.9 3.2 3.4 4.2 Creatinine (micromole/L) 277 345 432 241 172 160 280 308 150 97 Calcium (ionized) 1.95 1.7 PT/INR 1.43 1.93 1.98 1.65 1.08 1.1 ALT (U/L) 6542 8010 4678 3103 1607 932 260 104 100 88 AST (U/L) 30617 41546 24331 5612 1472 302 250 250 110 74 ALP (U/L) 245 156 140 Bilirubin (micromole/L) 48 75.5 68.2 21 GGT (U/L) N/A Albumin (g/L) 25 24 27 29 32 35 CRP (mg/L) 138 145 150 134 254 208 160 84 46 ALP alkaline phosphatase, ALT alanine transaminase, AST aspartate transaminase, CRP C-reactive protein, GGT gamma-glutamyltransferase, N/A not available, PT/INR prothrombin time-international normalized ratio Discussion DF is a common mosquito-borne viral disease among humans seen mainly in the Asia-Pacific region [1]. The AST released from damaged striated muscle, cardiac muscle, and erythrocytes could explain the levels of AST that are higher than those of ALT in patients with DF at an earlier stage [12, 13]. [...]a rise in AST might not be a true reflection of hepatic involvement.