Interesting case recently I'll summarize for members:
64 year-old female on coumadin for history of CVA secondary to intracranial vascular disease, presented with acute cholecystitis. Begun on antibiotics, converted to heparin, heparin held 4 hours preop, underwent lap chole converted to open due to adhesions obscuring anatomy. Heparin restarted 12 hours postop, coumadin resumed. Clear liquids POD#3, some diarrhea POD#5, C.diff titer negative, felt well, eating solids POD#6, discharged home.
Returned 24 hours later with mental status changes--confusion, hypotension (SBP 95-105), low-grade temp (100.5). Some crampy abominal pain but no tenderness. WBC 10,000, AST, ALT, GGT normal. Total Bilirubin normal. Sodium 128, Potassium 5.6. Creatinine normal. Blood gas normal. EKG normal.
Blood cultures taken, broad spectrum antibiotics begun. CT Head--normal. Abd plain films--normal.
Over next 24 hours mental status deteriorated--confusion, lethargy, coma. Low-grade fever continued.