Tuesday, October 5, 2010

TOPIC DISCUSSION: An uncommon consult:-OHSS!

Here is a case: someone with elevated serum creatinine, hyponatermia, marked edema and hypoalbuminemia --> 6 weeks into pregancy induce by in vitro fertilization.

We will pause here to recognize British researcher Robert Edwards who was just awarded the 2010 Nobel Prize in Medicine...

Ovarian Hyperstimulation Syndrome(OHSS) typically presents as volume overload and elevated serum creatinine early in the course of IVF. Hormonal therapy (appropriately) stimulates the ovaries, but occasionaly "hyper"-stimulated ovaries enlarge, become cycstic and large fluid shifts can occur in a capillary-leak like syndrome. It is believed that Vascular Endothelial Growth Factor plays a role by increasing sensitivity to nitric oxide and promoting neoangiogenesis.

Cases range from mild to life-threatening and are graded in severity from 1-3. Mild cases are treated with observation and discontinuation of hormonal therapy, whereas severe cases can have marked electrolyte disorders (hyponatremia, hyperkalemia), severe ascites, pericarial/pleural effusions and thromboembolic phenomenon from hemoconcentration.

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