A young primigavida had an unsupervised home delivery, had some bleeding at home and presented with what looked like anemic heart failure. Packed cell volume however came out to be 42% and 46% on two different occasions. she was discharged home when she appeared to have stablised only to reurn a week later with orthopnoea, pulmonary oedema and a very low blood pressure of 90/?mmHg. Within the resources available, the managing team placed her on a diuretic for the pulmonary oedema. But they also commenced her intravenous fluids for the hypotension in addition to dobutamine for inotropic effect.
Achieving the right balance in concurrent use of diuretics and intravenous therapy in thesame patient is very challenging especially in resource constrained settings.
We would be glad to have peoples' experiences or suggestions/recommendations in the management of such a case.
Any idea what her "normal baseline" was? This very low blood pressure might not be far from "her norm"
Thank you for your interest.
Actually her condition deteriorated and the blood pressure dropped further to 70/?mmHg. Her normal baseline is however not known because she did not receive antenatal care for the index pregancy and she had no idea about her blood pressure at presentation.
Ideal would be positive pressure ventilation, that is often not possible in low resource setting. So, oxygen, morphine and PRBC are mainstay of therapy here. Now regarding fluid balance, keep her on minimum fluid level- 75 ml/hour and low dose diuretics- like 20 mg furosemide 12 hourly.
actually this is so difficult to give any diuretics patient at home since the pecient is hypotension , the first treatments is the resuscitation of the patient fluid then reassessing of the cases then follow the client at the health facility and giving of the flrocimid drug for edema
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