J. S. is 23 years old. He was brought to the emergency department after an auto

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?

Explanation / Answer

1. The type of renal failure is acute renal failure. The cause of renal failure is pre renal cause - decreased blood supply to the kidneys as a result of blood loss due to accident.

2. If J.S. does not receive adequate treatment ,patient might go in shock with renal failure because of blood loss /volume loss. The best treatment to prevent this is IV fluid therapy with colloids , blood transfusion , use of anti coagulants like heparin and diuretics .

3. Renal function test , ABG ,CBC should be done to check the levels of creatinine , potassium,(for renal function) platelets ,Hb, PT, PTT(for hemodynamic monitoring)and ABG to evaluate both renal and hemodynamic balance.

4. If J.S. renal function continues to diminish the patient will end up in end stage renal disease and hemodialysis might be needed and patient will have difficulty in breathing, edema , hemodynamic instability, HTN, and there might be need for mechanical ventilation and support.

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