Friday February 3, 2006
Systemic capillary leak syndrome
Capillary leak syndrome was described first time about 45 years ago. Being an intensivist, it is an important entity to know as episode is often preceded by shock syndromes, low-flow states, infection, ischemia-reperfusion injuries, toxemias, or poisoning and fallout is usually Multiple system organ failure (MSOF). Cause and pathophysiology is still not clear but most cases have been found associated with monoclonal gammopathy, generally an IgG class. Capillary leak syndrome as name says is due to capillary hyperpermeability with massive extravasation of plasma macromolecules and acute phase usually lasts for 1-4 days. Clinical features are abdominal pain, generalized edema, hypotension with possible cardiopulmonary collapse. Acute renal failure is due to hypovolemia and rhabdomyolysis. 6 Now here is the tricky part. Acute phase is followed by recruitment of the initially extravasated fluid causing intravascular overload marked by polyuria and/or pulmonary edema. Edema is usually proportional to earlier fluid resuscitation !. Treatment with Terbullatine and Theophylline has been suggested. 3
References: Click to get article/abstract: (appears in popup window and second popup overwrites first popup)
1. An unusual evolution of the systemic capillary leak syndrome -Nephrol Dial Transplant (2002) 17: 492-494
2. Capillary leak syndrome - orpha.net
3. Treatment of the Systemic Capillary Leak Syndrome with Terbutaline and Theophylline: A Case Series - annals 1 June 1999 Volume 130 Issue 11 Pages 905-909 -full pdf article available with free registration.
4. Systemic Capillary Leak Syndrome - Internal Medicine 41: 953?956, 2002, The Japanese Society of Internal Medicine
5. Lethal capillary leak syndrome after a single administration of interferon beta-1b - Neurology 1999;53:220
6.Idiopathic capillary leak syndrome complicated by massive rhabdomyolysis - Chest, Vol 104, 123-126
7. Lethal systemic capillary leak syndrome associated with severe ventilator-induced lung injury: An experimental study.- Critical Care Medicine. 31(3):885-892, March 2003.