Question

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.

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 is the best treatment option to prevent this from occurring?

3) What other laboratory data beside urine output should 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

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, and there is continuous oozing in the bandaged site.

His 24-hour urine volume is 350 ml with a high urine osmolality and low urine sodium.

1. J.S is developing acute renal failure due to hypovolemic shock. Severe Hypovolemia causes hypotension in the body which leads to a decrease in blood supply to the kidney and developed in Renal failure.

2. If J.S does not receive proper treatment then it may be developed to

a. Acid-base imbalance (Severe metabolic acidosis)

b. Severe Hyponatremia

c. Severe Hyperkalemia

d. Chronic Kidney injury

It's because of acids build up in the body due to decreased urine output. The best treatment here is rehydration therapy, IV fluids, and Blood transfusion. If the kidney is not responding after the fluid volume is maintained then you can go for diuretics.

3. We should evaluate

Blood urea, Blood creatinine, serum sodium, serum potassium, BUN and Uric acid.

We can also evaluate ABG (arterial blood gas) to know Acid-base imbalance.

4. If J. S.’s renal function continues to be diminished without any improvement then he may develop permanent kidney damage and chronic kidney disease.

Then there will be the only option left, that is Dialysis.