Download ICU Clinical Scenarios

1.
A 46-year-old male with rheumatoid arthritis was admitted to the ICU on May 3, 2022, with
severe methotrexate toxicity, presenting with pancytopenia and mucositis. Given the high level of
methotrexate in his blood (1.2 µmol/L), he was started on high-flux hemodialysis to hasten
methotrexate clearance. His condition improved over a period of two weeks, and he was shifted out of
the ICU on May 17, 2022.
2.
On May 10, 2022, a 40-year-old woman was admitted to the ICU with a diagnosis of thrombotic
thrombocytopenic purpura (TTP). She presented with severe anemia (Hb: 6 g/dL), thrombocytopenia
(platelets: 20,000/µL), and acute kidney injury (serum creatinine: 2.5 mg/dL). Urgent plasma exchange
was initiated, which led to a gradual improvement in her platelet count and renal function. She was
transferred to a regular unit on May 22, 2022.
3.
A 65-year-old male with chronic liver disease was admitted to the ICU on May 21, 2022, with
hepatorenal syndrome type 1. His creatinine level was 3.0 mg/dL, and he was initiated on terlipressin (2
mg every 4 hours) and albumin (20g daily). His condition did not improve, and he was started on
continuous renal replacement therapy (CRRT). After a week, he underwent a liver transplant. His renal
function gradually improved, and he was discharged from the ICU on June 10, 2022.
4.
On May 28, 2022, a 50-year-old man was admitted to the ICU with wheat pill poisoning
(superwarfarin). He presented with severe coagulopathy (INR >10) and active gastrointestinal bleeding.
He was given a massive transfusion protocol with fresh frozen plasma and packed red cells, along with
vitamin K (10 mg IV daily). Despite initial control of bleeding, he succumbed to his injuries on June 2,
2022, due to a massive intracranial bleed.
5.
A 32-year-old female was admitted to the ICU on June 6, 2022, with hemolytic uremic syndrome
(HUS) secondary to E. coli O157:H7 infection. She presented with severe anemia, thrombocytopenia,
and acute kidney injury necessitating hemodialysis. Despite aggressive management, she passed away
on June 18, 2022.
6.
On June 15, 2022, a 38-year-old woman was admitted to the ICU with thrombotic
microangiopathy (TMA) secondary to systemic lupus erythematosus. She was started on plasma
exchange and high-dose corticosteroids. Her condition improved gradually, and she was transferred to
the general ward on June 25, 2022.
7.
A 60-year-old male was admitted to the ICU on June 20, 2022, with disseminated intravascular
coagulation (DIC) secondary to sepsis from a Klebsiella pneumoniae lung infection. Despite treatment
with broad-spectrum antibiotics and supportive care, he died on June 30, 2022.
8.
On June 22, 2022, a 40-year-old man with a history of cirrhosis was admitted to the ICU with
severe pneumonia and ARDS secondary to methicillin-resistant Staphylococcus aureus (MRSA). Despite
aggressive treatment with vancomycin and mechanical ventilation, he passed away on June 28, 2022.
9.
A 70-year-old male was admitted to the ICU on June 27, 2022, with severe community-acquired
pneumonia requiring mechanical ventilation. He was started on piperacillin/tazobactam (4.5g IV every 6
hours) and azithromycin (500mg IV daily). His condition gradually improved, and he was successfully
extubated and transferred out of the ICU on July 10, 2022.
10.
On June 5, 2022, a 43-year-old man was admitted to the ICU after ingesting an unknown
quantity of rat poison (containing anticoagulant). His PT and INR were significantly elevated, and he was
treated with fresh frozen plasma and high-dose Vitamin K. Despite the treatment, he developed severe
intracranial hemorrhage and died on June 10, 2022.
11.
A 66-year-old woman with history of colon cancer was admitted to the ICU on May 12, 2022,
with severe sepsis secondary to a Clostridium difficile infection. Despite aggressive treatment with
vancomycin (125mg orally every 6 hours), her condition worsened, and she developed DIC. She passed
away on May 19, 2022.
12.
A 35-year-old male was admitted to the ICU on May 15, 2022, following an overdose of opioids.
He was initially intubated and mechanically ventilated, and naloxone was administered. His condition
improved significantly, and he was extubated and transferred out of ICU on May 20, 2022.
13.
On May 20, 2022, a 50-year-old woman was admitted to the ICU with cardiogenic shock
following an acute myocardial infarction. She was started on an intravenous infusion of dobutamine (5
mcg/kg/min). Despite initial improvement, she suffered a cardiac arrest on May 23, 2022, and could not
be resuscitated.
14.
A 42-year-old male was admitted to the ICU on June 15, 2022, with severe acute respiratory
distress syndrome (ARDS) secondary to influenza A infection. Despite treatment with oseltamivir and
maximum ventilatory support, he died on June 22, 2022.
15.
A 48-year-old woman was admitted to the ICU on May 28, 2022, with organophosphate
poisoning. Despite rapid initiation of atropine and pralidoxime, she developed intermediate syndrome
requiring prolonged ventilatory support. Her condition gradually improved, and she was weaned off the
ventilator and transferred out of the ICU on June 5, 2022.
16.
On June 7, 2022, a 30-year-old male with no significant past medical history was admitted to the
ICU following an accident with traumatic brain injury. Despite neurosurgical intervention and optimal
ICU care, he succumbed to his injuries on June 15, 2022.
17.
A 60-year-old male was admitted to the ICU on May 18, 2022, with septic shock secondary to
peritonitis. Despite optimal fluid resuscitation, broad-spectrum antibiotics, and vasopressor support
with norepinephrine (up to 0.2 mcg/kg/min), he passed away on May 25, 2022.
18.
On June 11, 2022, a 57-year-old woman was admitted to the ICU with acute severe asthma
exacerbation leading to respiratory failure. Despite maximum bronchodilators and systemic
corticosteroids, she needed ventilatory support. Her condition gradually improved, and she was
successfully extubated on June 18, 2022, and shifted out of ICU on June 21, 2022.
19.
A 62-year-old female with a history of end-stage renal disease was admitted to the ICU on June
2, 2022, with hyperkalemia (7.8 mEq/L). She was started on hemodialysis. Her condition improved, and
she was transferred to the renal unit on June 5, 2022.
20.
A 33-year-old male was admitted to the ICU on May 29, 2022, after a near-drowning incident.
He developed ARDS and required mechanical ventilation. Despite aggressive care, he succumbed to his
injuries on June 4, 2022.
4.
On May 28, 2022, a 50-year-old man was admitted to the ICU with suspected wheat pill
(aluminium phosphide) poisoning, which had led to the production of toxic phosphine gas upon
ingestion. He presented with severe metabolic acidosis (pH: 7.1, HCO3: 10 mEq/L), hypotension, and
tachycardia. Supportive management was initiated with fluid resuscitation, vasopressors
(norepinephrine 0.1 µg/kg/min), and sodium bicarbonate infusion to correct the acidosis. Despite initial
stabilization, he developed refractory shock and multi-organ dysfunction syndrome (MODS), and he
succumbed to his illness on June 2, 2022.
On June 15, 2022, a 38-year-old woman with a known history of systemic lupus erythematosus (SLE) was
admitted to the ICU. She had been in a flare for the past month and was on high-dose prednisone. She
presented with fatigue, pallor, and dark urine. Her lab results showed severe anemia (Hb: 6.8 g/dL),
thrombocytopenia (platelets: 25,000 per µL), and elevated lactate dehydrogenase (LDH: 800 U/L),
indicative of hemolysis. In addition, she had a high serum creatinine level of 2.6 mg/dL, which was
significantly increased compared to her baseline, indicating acute kidney injury.
A peripheral smear revealed schistocytes, and her haptoglobin was low, confirming microangiopathic
hemolytic anemia. A direct Coombs test was negative, making an autoimmune hemolytic anemia less
likely. Her ADAMTS13 activity was normal, ruling out thrombotic thrombocytopenic purpura (TTP).
Taken together, these findings were suggestive of thrombotic microangiopathy (TMA) secondary to a
lupus flare.
She was initiated on plasmapheresis along with pulse doses of methylprednisolone (1g daily for 3 days)
followed by a tapering dose of prednisone. Her anti-double-stranded DNA antibodies and complement
levels were closely monitored to track the activity of her lupus.
On June 15, 2022, a 38-year-old woman with systemic lupus erythematosus (SLE) was admitted to the
ICU presenting with severe anemia (Hb: 6.8 g/dL), thrombocytopenia (platelets: 25,000 per µL), elevated
lactate dehydrogenase (LDH: 800 U/L), and acute kidney injury (serum creatinine: 2.6 mg/dL). These
findings, along with a peripheral smear revealing schistocytes and low haptoglobin, suggested
thrombotic microangiopathy (TMA). The patient was promptly initiated on plasmapheresis and pulse
doses of methylprednisolone to control the lupus flare. She also received hemodialysis for her kidney
injury. Over 10 days, her hematological and renal parameters improved, with a decrease in LDH and an
increase in platelet count and hemoglobin. The patient was stable enough to be transferred to the
rheumatology ward on June 25, 2022.