QW04-September 2024

Clinical Case Scenario 1

A 60-year-old male patient with a history of diabetes mellitus and chronic kidney disease is admitted to the ICU with acute kidney injury (AKI). He also has a recent history of severe diarrhea. His arterial blood gas analysis is as follows:

pH:7.25,

HCO₃: 17 mEq/L,

Na: 142 mEq/L

K: 3.3 mmoL/L

Cl: 112 mEq/L

Albumin: 3.0 mg/dL

Random blood sugar: 5 mmoL/L

Lactate: 2.3 mmoL/L

Which of the following is the most likely cause of his metabolic disorder?

Clinical Case Scenario 2

A 45-year-old male presents to the emergency department with confusion and oliguria for one day. He has a history of discoloration of his eyes for the last five days. Laboratory tests reveal:

AST 320 U/L, ALT 410 U/L, GGT 229 U/L, INR > 1.5, Serum creatinine of 300 µmol/L.

Positive ANA (1:320), Positive Smooth Muscle Antibody (1:40), Elevated IgG levels.

Abdominal Ultrasound: Enlarged liver with mild hepatic inflammation, no evidence of cirrhosis or Budd-Chiari syndrome.

Other Tests: Negative viral hepatitis panel, normal ceruloplasmin, elevated ferritin. His GCS deteriorated from 13 to 7, for which the trachea was intubated and the patient was transferred to ICU. Inj Methylprednisolone 125 mg IV OD was started. Despite initial supportive measures, his condition continues to deteriorate. Which of the following extracorporeal therapies is most appropriate to manage this patient’s condition?