I'm an RN and I have this patient who had pancreatitis due to gallstones. She had explo-lap /cholecystectomy a month ago and was intubated prior to surgery because of her acidosis. She was extubated 6 days post-op but got re-intubated 2 days after and has been trached already but still unable to be weaned off the vent. She has an ongoing problem with ileus, started her with tube-feeding with resultant diarrhea or high amount of residual in her ngt. She's 70 y/o with hx of same 8 yrs. ago treated with ERCP and has been dx with DM afterwards and sl. hypertension left untreated since pt. is afraid to go to doctors. This last 3 days, she has worsening metabolic acidosis, was brought back to OR today for exploration due to increasing abdominal distention but no dead bowels were found, only inflammation and some redness in the bowels and pancreas. Still have high wbc,no bands. Of course, now she's got stool + vre. Can you please explain the ongoing metabolic acidosis and the ileus after all this time(1 month after original surg.) and treatment suggestions?
The metabolic acidosis in your patient may represent 1) hypoperfusion of tissues due to sepsis related to pancreatic inflammation, 2) hypoperfusion due to pancreatic necrosis, or 3) ketoacidosis due to the diabetes. Failure to wean the patient from the ventilator suggests a component of repiratory insufficiency and possibly a respiratory acidosis.
This information is provided for educational purposes on;y.
The Content on this Site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease; or a recommendation for a specific test, doctor, care provider, procedure, treatment plan, product, or course of action. MedHelp is not a medical or healthcare provider and your use of this Site does not create a doctor / patient relationship. We disclaim all responsibility for the professional qualifications and licensing of, and services provided by, any physician or other health providers posting on or otherwise referred to on this Site and/or any Third Party Site. Never disregard the medical advice of your physician or health professional, or delay in seeking such advice, because of something you read on this Site. We offer this Site AS IS and without any warranties. By using this Site you agree to the following Terms and Conditions. If you think you may have a medical emergency, call your physician or 911 immediately.