Case-3: Patient History
P.W. is 23 years old. He was the victim of a hit-and-run auto-pedestrian accident and suffered multiple abrasions, a concussion, and a deep laceration of his left thigh. He was discovered approximately 2 hours after the incident and is now in the emergency department. P.W.âs vital signs and hematocrit suggest that he has had a blood loss of about 2500 ml. A urinary catheter is inserted to monitor urine output, and fluid resuscitation is initiated while his wounds are cleaned and sutured. The urine output is averaging 15 ml/hr, with a high urine osmolality and low urine sodium.
What type of renal failure is P.W. likely developing? (select all that apply)
| Intrarenal acute renal failure |
| Prerenal acute renal failure |
| Postrenal acute renal failure |
| Chronic renal failure Based on your answer for the previous question, what is the best therapy for preventing this from occurring? (select all that apply) | Adequate extracellular volume replacement with blood or isotonic fluids to ensure adequate circulating blood volume and perfusion pressure to the kidney is essential. | | Antibiotic therapy should be administered immediately. | | Restriction of fluid intake to prevent increase in circulating blood volume and perfusion pressure to the kidney is essential. | | Dialysis should be initiated immediately. | In addition to urine output, what laboratory data should be monitored to assess changes in P.W.âs renal function? (select all that apply) | Serum BUN, creatinine, and potassium should be monitored. A decrease indicates decreased renal function. | | Creatinine clearance can be measured to more accurately assess glomerular filtration rate. | | Serum BUN, creatinine, and potassium should be monitored. An increase indicates decreased renal function. | | Serum sodium may be useful in determining the correct IV fluid composition to administer. If P.W.âs renal function does not return to normal, but continues to be diminished, what renal disorder might develop? (select all that apply) | He may progress to acute tubular necrosis. | | He may develop renal calculi. | | He may develop pyelonephritis | | He may develop nephrotic syndrome | | |
