UK hantavirus, renal failure, and pet rats

摘要

In November, 2012, a 28-year-old man, presented with a 4-day history of fever, shivers, sweating, and vomiting. He had type-2 diabetes, which was being treated with sitagliptin and metformin. On admission he had evidence of a systemic inflammatory response (temperature 39 . 3 deg C, pulse 160 bpm, respiratory rate 30 per min, white cell count 15.0x109 per L, with 12-3 neutrophils and 0 . 2 myelocytes), abnormalities of blood clotting (INR1-6, PTT 57 s, fibrinogen 0-99 g/L (normal range 1-5-4-5); platelets 19x10~9 per L), multi-organ failure (creatinine 167 umol/L, raised alanine aminotransferase 511 U/L and bilirubin 87 umol/L), progressive hypoxia, hyperglycaemia glucose 20-6 mmol/L), and lactic acidosis (PH 7-29, lactate 7 . 5 mmol/L). He was diagnosed with overwhelming sepsis and transferred to the intensive care unit. Initial treatment was with piperacillin-tazobactam, insulin, oxygen, and aggressive fluid replacement, including platelet infusions, fresh frozen plasma, and cryo-precipitate.