title: Hemodynamic collapse following bilateral knee arthroplasty: a mysterious case.
abstract: Severe hemodynamic collapse after knee surgery from bilateral adrenal hemorrhages is rare. Even rarer is it occurring from adrenal hemorrhage as a complication of heparin induced thrombocytopenia. Due to lack of awareness of this rare complication and associated complex scenario in critically ill patients, diagnosis is often made post mortem. A diagnosis of bilateral adrenal hemorrhage should be considered in any patient presenting with non-specific symptoms of fever, abdominal pain, confusion and rapid hemodynamic collapse not responding to standard therapy. This is crucial especially in the setting of heparin induced thrombocytopenia as thrombosis and not hemorrhage is often the most feared complication of this syndrome.
authors.affiliation: Internal Medicine Resident PGY3, Creighton University, 601 N 30th Street, Omaha, NE 68131, USA. ramyathota1@gmail.com
authors.forename: Ramya
authors.initials: R
authors.lastname: Thota
authors.forename: Joann
authors.initials: J
authors.lastname: Porter
authors.forename: Apar K
authors.initials: AK
authors.lastname: Ganti
authors.forename: Eric
authors.initials: E
authors.lastname: Peters
mesh_terms: D000311:Adrenal Glands / Q000473:pathology* / Q000503:physiopathology; D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D006801:Humans; D008297:Male; D019106:Postoperative Hemorrhage / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D012769:Shock / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology