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Case report of high-dose hydroxocobalamin in the treatment of vasoplegic syndrome during liver transplantation
- Source :
- American Journal of Transplantation. 18:1552-1555
- Publication Year :
- 2018
- Publisher :
- Elsevier BV, 2018.
-
Abstract
- A 66-year-old man with cryptogenic cirrhosis secondary to nonalcoholic steatohepatitis presented for orthotopic liver transplantation. Following organ reperfusion, the patient developed vasoplegic syndrome, with arterial blood pressures of approximately 60-70/30-40 mm Hg (mean arterial pressure [MAP] 90 minutes. He required high-dose norepinephrine and vasopressin infusions, as well as i.v. bolus doses of norepinephrine and vasopressin to reach a goal MAP> 60 mm Hg. There was minimal response to a 2 mg/kg i.v. bolus of methylene blue. Following the administration of 5 g of i.v.hydroxocobalamin, the patient had a profound improvement in arterial blood pressure, with subsequent discontinuation of the vasopressin infusion and rapid reduction of norepinephrine infusion from 20 to 2 μg/min. While there have been several reports of the efficacy of hydroxocobalamin for vasoplegia after cardiopulmonary bypass, there have been only limited cases of hydroxocobalamin used in liver transplantation, and none with high-dose administration. We present a case of vasoplegic syndrome during liver transplantation that was refractory to high-dose vasopressors and methylene blue but responsive to high-dose i.v. hydroxocobalamin.
- Subjects :
- Male
Mean arterial pressure
medicine.medical_treatment
030204 cardiovascular system & hematology
Liver transplantation
Article
03 medical and health sciences
0302 clinical medicine
Bolus (medicine)
Hydroxocobalamin
Vasoplegia
medicine
Humans
Immunology and Allergy
Pharmacology (medical)
030212 general & internal medicine
Vasoplegic syndrome
Aged
Transplantation
business.industry
medicine.disease
Liver Transplantation
Blood pressure
Anesthesia
Arterial blood
business
medicine.drug
Subjects
Details
- ISSN :
- 16006135
- Volume :
- 18
- Database :
- OpenAIRE
- Journal :
- American Journal of Transplantation
- Accession number :
- edsair.doi.dedup.....9f20a4204ad841e8a40f875c1cd05b10
- Full Text :
- https://doi.org/10.1111/ajt.14736