Kyle Huff

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My husband Kyle had received a transplanted kidney 19 years ago from his father. In March of this year he started to have fevers, and didn’t feel well, but no other symptoms. Being a transplant patient and having gone through it multiple times, he could tell in late March he was dehydrated and likely needed IV fluids. (Sepsis and Impaired Immune System)

He went to our local ER and they checked a rainbow of labs and only found that his lactic acid that was elevated at 2.6, so they gave him a liter of IV fluid and rechecked. His lactic acid improved to 2.2 so they sent him home after the bolus. Since he did not have an elevated white blood count, they felt antibiotics were not necessary. Five days later he was still having fevers and developed a severe right sided headache that was unrelieved by pain medication. He went back to the ER where they did a head CT and found a sinus infection. He still had no elevated white blood count so he was started on oral antibiotics and sent home. Even though I asked, they didn’t feel rechecking his lactic acid was necessary.

A week later when he completed the round of antibiotics his fever returned, but this time it was higher at 102-103. This time we went to his kidney doctor to avoid the ER and exposure to other illnesses. His labs still looked ok, but he was admitted for IV antibiotics. During that visit he was tachycardic and experienced 2 episodes of hypotension that required fluid bolus. Infectious Disease specialists were consulted to see if they could find a source of infection since there were still no labs that supported an infection. Again, I relayed that his his lactic acid had been elevated a couple of weeks ago and since he was tachycardic, febrile, and hypotensive shouldn’t they check again and was told that his white count was fine so it was not necessary.

After a week of IV antibiotics we were sent home on a course of oral doxycycline. The day after he finished this course his temperature spiked to 104, the nephrologist called in yet another oral antibiotic for him and advised him to try to wait for his hospital follow up. After the new antibiotic he developed nausea and vomiting and severe right pelvic pain. He was again admitted to the hospital with infectious disease on board. I told the admitting doctor, I’m concerned that he’s septic, he’s tachycardic, tachypnic, febrile, and just not acting right. I was still assured that they didn’t think it was that bad since there was no source of infection, they thought he may have a DVT causing an inflammatory response.

This admission they decided to hold IV antibiotics in case they were masking the infection. On the 4th day in the hospital I found my husband delirious, with a respiratory rate of 48, heart rate of 145, febrile, and was told that his creatinine had bumped overnight and glucose had dropped and he now required oxygen. The physician on call told me, he felt my husband was fluid overloaded, had laid around too much, and taken too much pain medication and he was going to discontinue IV fluids and pain meds and order a PT consult. I finally told him I felt like they were missing something big. I told him I was sure he was septic and they had waited too long. He again assured me that there was no indication for sepsis. As I was calling to report that I felt the doctors were letting my husband die he came back in and said “On second thought, maybe I’ll order an ABG.” To which I responded “Please include a lactic acid.”

When the ABG resulted a few minutes later my husband’s lactic acid was 10. He was taken to the ICU where his pressures continued to drop and levophed was started and his oxygen demand continued to increase. He became more delirious and his lactic acid continued to trend up. And still he had no elevated white count. The doctors were stumped. We were sent to Duke since he was a transplant patient to see if the transplant doctors had any ideas. We had been in the MICU at Duke for a few hours before he needed to be intubated and another pressor was added. Overnight and the next day he continued to decline, they had added a 3rd pressor and a study drug to try to keep his MAP >65, his kidney was taking a hit so we started CRRT, and his lactic acid continued to climb. His white count finally began to be elevated this last day and when it did it was 75,000. He finally stopped having fevers but then he began to be hypothermic and needed a warming blanket.

That evening the doctors approached us to say that since they still had no idea what was causing this response in my husband they wanted to start chemotherapy for PTLD just in case, but that it may make things worse and if so did I want him resuscitated since at this point he was requiring near maximum ventilator support, 3 pressors, bicarb, and a study drug to keep him going. I decided to make my husband a DNR and start chemo without any differential diagnosis because I didn’t know what else to do. Before starting chemo they added a 4th pressor. About an hour after beginning the chemo his oxygen levels continued to deteriorate and he required the maximum ventilator support to maintain a saturation of 90%. It became clear after another hour that I was losing my husband as his sats were in the low 80s on the ventilator. Knowing that if by some miracle we were able to get him back, his quality of life at this point would be something my husband did not want, I decided to withdraw care and allow him to pass as peacefully as possible.

We still don’t know if there was an infection driving his inflammatory response or if it were PTLD (post-transplant lymphoproliferative Disorder) but either way, I feel like if nurses and physicians had been listened to me when I was concerned for sepsis we could have intervened sooner. I’ll never know if it would have turned out differently, but what if it had?

Source: Deanna Huff (Kyle's wife)

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