Cardiogenic Shock After 5-FU Treatment
A 24-year-old female patient with recently diagnosed colorectal cancer underwent folinic acid, fluorouracil (5-FU), and oxaliplatin infusion and 24-36 hours later presented with nausea and vomiting. She was found to be tachycardic with a heart rate in the 120-130 range and blood pressure of 100/70. She was initially admitted to the oncology service with concerns for dehydration and plans for intravenous fluid resuscitation. She acutely decompensated shortly thereafter with hypotension requiring vasopressors, a wide complex tachycardia (Figure 1), acute kidney injury requiring continuous renal replacement therapy, and encephalopathy requiring intubation. A STAT echocardiogram revealed biventricular failure with left ventricular ejection fraction of 15% (Figure 2).
What is the best course of treatment for this patient?