A (b)(6) y.O boy with recurrent fsgs post-transplant.Has been receiving plasmapheresis up until today.Gfr well below 60 but a moot point in post-transplant; serum creatinine 2.9; serum protein 4.6; albumin 3.5; h&h 9.2, 28.6; 305 platelets.He was on ace-i (enalapril) and off for 72 hours according to his mother.He had a double lumen ij patent with good flows.Plasma volume tb treated 4,200 ml (90kg x 60ml).1.8 u heparin for bolus and 1.8 u heparin during treatment (25 u per kg).Two alarms early on for venous pressure which were quickly remedied with a flush.His mother states that one of the ports was not working well and the nurses doing the plasmapheresis only used one of the ports.Started at 60ml bfr and 20% pfr.Treatment started at 09:48 vss 125/76-84-16 skin warm, and dry color normal at 10:04, 16" into treatment, patient complained of chest pain and started thrashing in the bed; color pale lips cyanotic even though pulse ox 100%.The patient was lowered the head of the bed got o2 non rebreather mask; stopped the pumps had rn give 100 cc bolus normal saline (ns); code called and nurses gave solu medrol 125 and dr.Wanted 500 cc bolus ns given.Vs were 154/84-129-24.Patient within 5 minutes felt better.10:28 bp 128/78-72.Patient transferred to the er.Patient stable after 30 to 40".It was very first experience on him with liposorber switched from plasmaexchange (the last pex was (b)(6) 2020).Mfr# 3002808904-2019-00005.
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