The patient becomes increasingly hypoxic over the next 48 hours. Ascitic fluid is drained and shows high levels of white blood cells and E. coli. Blood results indicate severe coagulopathy (DIC).
This clinical progression suggests a rapidly evolving multi-system disorder with potential septic complications. Management should focus on:
- Aggressive respiratory support, potentially including mechanical ventilation
- Broad-spectrum antibiotic therapy targeting E. coli and other potential pathogens
- Correction of coagulopathy with blood products and potentially recombinant factors
- Continued renal replacement therapy
- Consideration of liver support therapies (e.g., plasma exchange, MARS)
- Close monitoring and support of other organ systems
- Multidisciplinary approach involving critical care, obstetrics, hepatology, Microbiology and infectious disease specialists
The presence of E. coli in the ascitic fluid indicates a potential source of sepsis, which may be complicating the underlying AFLP. The development of DIC further emphasizes the severity of the condition and the need for aggressive supportive care.
