title: Polymyxin B-immobilized fiber hemoperfusion with low priming volume in an elderly septic shock patient with marked endotoxemia.
abstract: An 84-year-old woman with septic shock caused by pyelonephritis is described herein. She was admitted for severe back pain and high fever. Her white blood cell (WBC) count and C-reactive protein (CRP) and endotoxin levels were elevated at 38,000/microl, 40.0 mg/dl, and 8,400 pg/ml, respectively. Her blood pressure was 80/34 mm Hg. Urinalysis revealed occult blood with innumerable WBCs. Plain abdominal radiography showed calcium stones in both kidneys. Septic shock with endotoxemia was diagnosed, and the patient was treated with antibiotics, gamma-globulin, and dopamine. However, her plasma endotoxin level remained high for 3 days. We performed direct hemoperfusion twice using a polymyxin B-immobilized fiber (PMX-F) column with a low priming volume. After PMX-F treatment, the patient's temperature decreased to 36.8 degrees C; her WBC count and CRP level decreased to 9,200/microl and 3.8 mg/dl, respectively. Her plasma endotoxin level decreased to 840 pg/ml after the first treatment and to 188 pg/ml after the second treatment. The next day, her blood endotoxin level further decreased to 32 pg/ml. Her blood pressure increased to 92/60 mm Hg after the first treatment and to 118/76 mm Hg after the second treatment. The patient was discharged on day 26 after admission. Our experience in this case suggests that PMX-F treatment with a low priming volume may be beneficial in elderly patients with septic shock and marked endotoxemia.
authors.affiliation: Department of Medicine, Shinmatsudo Central General Hospital, Chiba, Japan.
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Nakamura
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kawagoe
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Ueda
authors.forename: Hikaru
authors.initials: H
authors.lastname: Koide
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D001831:Body Temperature / Q000187:drug effects; D002097:C-Reactive Protein / Q000032:analysis / Q000187:drug effects; D004298:Dopamine / Q000627:therapeutic use; D019446:Endotoxemia / Q000150:complications / Q000628:therapy*; D004731:Endotoxins / Q000097:blood; D005260:Female; D006464:Hemoperfusion / Q000379:methods*; D006801:Humans; D007669:Kidney Calculi / Q000000981:diagnostic imaging; D007958:Leukocyte Count; D011112:Polymyxin B / Q000627:therapeutic use*; D012772:Shock, Septic / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D016482:Urinalysis; D005719:gamma-Globulins / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D004731:Endotoxins; D005719:gamma-Globulins; D002097:C-Reactive Protein; D011112:Polymyxin B; D004298:Dopamine