Question

Please refer to Chapter 28 and then answer the questions that follow the case study:

J. S. is 23 years old. He was brought to the emergency department after an auto accident. He suffered a concussion and a deep laceration of his right thigh. He lost about 4 units of blood prior to effective control of bleeding and closure of the wound. Fluid resuscitation is initiated, and a urinary catheter is inserted post operation to monitor his urine output. However, he continues to have significant oozing from his sutured wound.

His 24-hour urine volume is 350 ml with a high urine osmolality and low urine sodium. A coagulation screen results indicate the following: platelet count 250,000, bleeding time and a PTT time are both extended.

Answer all prompts:

1. What type of renal failure is J.S. developing? Why is this type of renal failure developing?
2. If J.S. does not receive adequate treatment, what further condition may he develop? Why? What would be the best treatment option for preventing that from occurring?
3. What other laboratory data beside urine output could be collected to evaluate J.S.'s renal function?
4. If J.S.’s renal function continues to be diminished without any improvement, what could be the subsequent stages of his renal disorder?

Answer 1

1. Acute renal failure (ARF)

2. ARF is developing because J.S is in shock because of trauma. It leads low blood pressure because of severe blood loss. Because of low BP, there is decrease blood flow in kidneys and kidneys can't receive proper oxygen or filter blood as efficiently as before.

3. If J.S doesn't receive adequate treatment these conditions may develop - fluid retention which cause swelling in legs, feet and ankles. Nausea, vomiting, drowsy feeling, numbness in hands and feet, confusion, shortness of breathing, seizures. All these conditions develops because wastes can't removed from the body.

4. Best treatments are fluid resuscitation, medication for infection. Because treating the cause of ARF takes time, body will be unable to remove the waste from the blood stream. In order to remove the toxins from the blood stream there is need of Dialysis. Sometimes there is high level of potassium in blood so medication needed to control potassium levels. He must be kept on kidney diet which is low in protein, salt and potassium. Fluid restrictions is also needed.

5. Creatinine test, blood urea nitrogen, electrolytes.

6. If renal function continues to be diminished without improvement there may be permanent kidney damage or end stage renal disease . It causes loss of kidney functions which further leads to death.