Case 2: Refractory Hypertension in a Neonate
| Autor: | Aimee Moore, T. Keefe Davis, Stephanie J. Attarian, Patrick Sloan, David T. Balzer |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
medicine.medical_specialty
Polyhydramnios Creatinine business.industry Umbilical artery medicine.disease Left ventricular hypertrophy Surgery chemistry.chemical_compound Blood pressure chemistry medicine.artery Internal medicine Pediatrics Perinatology and Child Health medicine Cardiology Renal artery Hyponatremia business Blood urea nitrogen |
| Zdroj: | NeoReviews. 16:e493-e496 |
| ISSN: | 1526-9906 |
| Popis: | A 5-day-old female infant born at 351/7 weeks is transferred to our neonatal intensive care unit (NICU) for evaluation and management of systemic hypertension. She is twin A of a monochorionic diamniotic pregnancy complicated by twin-to-twin transfusion syndrome in which she is the donor twin. On fetal ultrasonography performed before delivery, twin B has polyhydramnios and a pericardial effusion, and twin A has reversed end-diastolic umbilical artery blood flow. The twins are born by emergency caesarean delivery due to concern for fetal status. Her Apgar scores are 4 and 8 at 1 and 5 minutes, respectively. Her birth weight is 1,990 g. In the NICU, blood pressures are noted to be elevated with recordings consistently above 120/100 mm Hg by an oscillometric device. Echocardiography reveals left ventricular hypertrophy with mild tricuspid and mitral regurgitation. On arrival at our NICU, her weight is 1,830 g, and blood pressure is 124/97 mm Hg. Four quadrant blood pressures do not identify a gradient between the upper and lower extremities. Physical examination is unrevealing: cardiac auscultation reveals a regular rate and rhythm with no murmurs, symmetric and palpable femoral and brachial pulses, and no abdominal masses or renal artery bruits. Serum electrolytes are remarkable for mild hyponatremia (sodium, 130 mEq/L [130 mmol/L]; potassium, 6.3 mEq/L [6.3 mmol/L]; chloride, 101 mEq/L [101 mmol/L]; bicarbonate, 17 mEq/L [17 mmol/L]; blood urea nitrogen, 10 mg/dL [3.6 mmol/L]; and creatinine, 0.7 mg/dL [53 μmol/L]). Renin level is elevated at 270 ng/mL/h (expected for age, 1.4–7.8 ng/mL/h), and aldosterone level is also … |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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