McPheeters Rick A, Purcell Thomas B, Snyder Donald L, Peterson Ronald T
Department of Emergency Medicine, Kern Medical Center, Bakersfield, CA.
Cal J Emerg Med. 2003 Apr;4(2):36-8.
We present a case report of a 10-year-old male with nephrotic syndrome who presented with a complaint of shortness of breath. The patient had been recently hospitalized for an exacerbation of nephrotic syndrome and had received steroid and diuretic therapy. Initial vital signs showed tachycardia and mild tachypnea. After being observed for more than four hours without deterioration he was discharged home for close follow up. The patient returned 4 hours later with worsening symptoms and went into cardiac arrest in the ED. Autopsy revealed bilateral large pulmonary emboli. Pulmonary embolism is a known complication of nephrotic syndrome. Hyperviscosity occurs due to a variety of mechanisms. Nearly all reported incidents are associated with the use of steroids and diuretics. It is essential to maintain a heightened suspicion of pulmonary embolism (PE) when children with nephrotic syndrome present with pulmonary complaints, particularly when they have been treated with steroids and diuretics.
