Question

Mr. W, a 26 year-old man, entered the emergency department with complaints of fever, severe abdominal pain, and nausea. He denied any health problems but disclosed a daily intake of four to six beers per day. An abdominal computed tomography (CT) scan performed on admission revealed pancreatic inflammation and intraabdominal ascites. He was admitted to the step-down unit for the management of acute pancreatitis. His treatment plan included intravenous antibiotics, pain control, and management of alcohol withdrawal. Within 48 hours of admission to the hospital, Mr. W. developed tachycardia (heart rate 120 beats per minute), hypotension (blood pressure 88/46 mm Hg), and tachypnea (respiratory rate 30 breaths per minute) and a temperature of 38.5° C. Arterial blood gases results were pH 7.20; partial pressure of arterial oxygen (PaO2) 78 mm Hg; partial pressure of arterial carbon dioxide (PaCO2) 28 mm Hg; and bicarbonate 18 mEq/L. He was intubated for acute respiratory distress syndrome (ARDS) and transferred to the critical care unit. Prone positioning and pressure control ventilation were initiated for the management of hypoxemia. Mr. W. required repeated fluid boluses and the titration of vasoactive infusions to achieve hemodynamic stability. A second CT scan of the abdomen revealed extensive edema and necrosis of the pancreas. Intraabdominal pressure was measured at 17 mm Hg. During the first 48 hours of admission to the critical care unit, urine output ranged from 10 to 20 mL per hour or greater than 0.5 mL/kg/hr. His serum potassium level was 6.3 mEq/L, and his creatinine level had risen to 3.8 mg/dL (admission creatinine level was 0.9 mg/dL). The renal medical service was consulted for management of acute kidney injury. Continuous venovenous hemofiltration was initiated and continued for 5 days. The patient was extubated on day 14 and transferred to the step-down unit on day 20.

4. Discuss the benefits of continuous venovenous hemofiltration (CVVH) in the management of Mr. W.’s acute kidney injury.

5. On hospital day 20, a third CT scan of the abdomen was requested by the treatment team. What precautions need to be considered to prevent or minimize further kidney injury?

Answer 1

4. Benefits of continous venovenous hemofiltration in the management of acute kidney injury

               * CVVH help to avoid the complications of acute kidney injury like hyperkalemia,arrythmias

                  and pulmonary edema.

              * It is necessary to regulate metabolic processes of the patient with acute kidney injury.

              * CVVH help to regulate the body temperature in normal level.

              * It helps to avoid abnormal intercerebral fluid shifts which occur due to poor functioning of

                kidney.

              * CVVH useful to remove excess fluid which accumulate in the body due to acute kidney

                 injury.

5.Precautions needed to prevent or minimize further kidney injury

              * Educate patient about maintain a healthy low sodium diet and if not awaire of plan a diet

                seek help of renal dietition.

             * Routine check up should be done identify changes in vital signs especially blood pressure.

             * Don't stop the medications which are used to control BP and DM without the instruction of

               a physician.

            * Check Hba1c and creatinine level as per doctors order.

           * Avoid bad habits like smoking and alcohol consumption which is injurious to normal functioning

             of kidney.

          * Regular exercise needed to maintain normal kidney function.