Hsiang-Chi Huang
Dalin Tzu Chi Hospital, Chiayi
Taiwan
Abstract Title:
Integrative TCM Management Of Difficult Ventilator Weaning And Acute Kidney Injury With Electrolyte Imbalance In An Elderly Patient After Whipple Operation：A Case Report
Biography:
Dr. Hsiang-Chi Huang is a second-year resident in the Department of Traditional Chinese Medicine at Dalin Tzu Chi Hospital, where she is currently undergoing her post-graduate general medical training (PGY). She earned her Doctor of Medicine (M.D.) degree from Tzu Chi University, following a Bachelor of Pharmacy from China Medical University. Her clinical specialty focus on Traditional Chinese Internal Medicine.
Research Interests:
The gut-kidney axis represents an intricate bidirectional communication pathway between the gastrointestinal tract and kidneys, mediated through microbial metabolites, inflammatory mediators, and immune signals. Cumulative evidence suggests that Traditional Chinese Medicine(TCM) may exert beneficial effects on kidney diseases management by modulating gut microbiota dysbiosis. Clinical reports integrating TCM based on the gut-kidney axis framework for postoperative ventilator weaning remain scarce. Herein, we report a case utilizing TCM spleen-strengthening therapy to treat difficult ventilator weaning complicated by AKI and electrolyte imbalances following a Whipple procedure in an elderly patient.
Case Presentation: A 74-year-old male with multiple comorbidities underwent a Whipple procedure for a gastrointestinal stromal tumor on March 20, 2026. Postoperatively, he developed severe dyspnea requiring re-intubation, as well as AKI necessitating hemodialysis. Due to prolonged mechanical ventilation and difficult weaning, he was transferred to the respiratory care center on April 14.
The TCM consultation was initiated on April 24, 2026. The patient exhibited renal impairment (creatinine 4.8 mg/dL) and hypoalbuminemia (2.3 g/dL). During respiratory training, he frequently experienced severe dyspnea, abdominal distension, impaired digestion, and electrolyte imbalances (phosphorus 8.2 mg/dL, potassium 3.3 mmol/L). Integrating the gut-kidney axis and "tonifying earth to generate metal" concepts, a spleen-invigorating core formula was administered alongside heat-clearing, detoxifying, and phlegm-resolving herbs. Following a tracheostomy on May 12, the patient was successfully weaned from the ventilator on May 25 and transferred to a general ward. On May 25, the patient's serum phosphorus was 3.2 mg/dL and serum albumin was 3.2 g/dL. By May 29, renal function had recovered and electrolyte imbalances had resolved, with serum creatinine and potassium levels normalizing to 1.1 mg/dL and 3.8 mmol/L, respectively.
Conclusion: TCM-based integrative therapy may serve as a complementary strategy to improve gastrointestinal function, correct electrolyte disturbances, facilitate ventilator weaning, and promote renal recovery in critically ill postoperative patients.
