Systemic Lupus Erythematosus

By Alex Yartsev - Dec 24, 2015

Question 9 from the first paper of 2005 asked the candidates to list the clinical features and manifestations of SLE. Specific focus was on the influence of these various manifestations on the course of ICU stay, and how you might go about managing them.

Manifestations of Systemic Lupus Erythematosus
and their influences on ICU management
Topic Area	Manifestations	Influence on ICU management
Airway	Cricoarytenoiditis	Need for intubation Difficult intubation Risk of post-extubation stridor
Respiratory	Pulmonary fibrosis	Impaired gas exchange Restrictive ventilatory defect
	Pleuritis	Need to test pleural fluid for ANA
	Pulmonary hypertension	Hypoxia Hypothension in response to high PEEP Right heart failure
Circulatory	Myocarditis	Need for inotropes, IABP or ECMO Potential need for RV biopsy for diagnosis
	Constrictive pericarditis	Obstructive cardiac failure Danger of colchicine therapy Need for cardiothoracic surgical release
	Increased risk of coronary artery disease	MI is higher on the list of differentials for hemodynamic instability, even in young females
Neurological	Cerebral vasculitis	A differential diagnosis of seizures and decreased level of consciousness Impaired blood brain barrier
Endocrine	Cushing syndrome due to chronic steroid use	Hyperglycaemia Hyponatremia Fluid overload
Renal	Lupus nephritis	Pre-existing renail impairment Susceptibility to nephrotoxins is increased
Gastrointestinal	Gastrointestinal tract vasculitis (and/or ulceration)	Vigilant monitoring for GI haemorrhage Malabsorption of feeds may occur
Hepatic	Hepatic vein thrombosis due to APLS	A differential for ascites and hepatic failure in SLE patients Anticoagulation will be required
Haematological	Anaemia of chronic disease	Impaired haemopoietic response to haemorrhage Increased transfusion requirements
Haematological	Haemolytic anaemia	MAHA needs to be considered in the anaemic SLE patient Vasulitic and haemolytic screening needs to be performed
	Antiphospholipid syndrome	Risk of bleeding is increased Risk of thrombosis is increased Risks of anticoagulation need to be balanced with benefits
Infectious	Immunossuppression, and the risk of sepsis	Need to consider opportunistic organisms in the selection of antibiotic cover

References

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