Dear All

Hope all okay - am just reflecting on a  case on our ward of a previously fit 
35 year old guy, discharged from ICU after severe sepsis from arm cellulitis 
and Group A Strep in blood.  He's had a good week of Benpen and Clindamycin, 
but left with bilateral moderate pleural effusions and a RR of 24, in the 
context of albumin 24.  Questions:

i) how common is sepsis induced myocardial dysfunction, or is that all more 
likely to be iatrogenic fluid overload?  Thought it was a bit odd that lung 
fields clear on examination and no parenchymal changes of pulmonary oedema on 
CXR

ii) If he'd had acute lung injury during the acute process, could that have 
resolved into pleural effusions?  Am assuming that this wouldn't respond to 
frusemide quite as well as the top two would do.  He wasn't ventilated by the 
way.
Many thanks

Tom Morris
ID/GIM Str

Sent from my iPhone
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