J. S. is 23 years old. He was brought to the emergency department after an auto
ID: 3518299 • Letter: J
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.
What type of renal failure is J. S. developing? Why is this type of renal failure developing?
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?
What other laboratory data beside urine output should be collected to evaluate J. S.'s renal function?
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
J.S. develops renal failure due to acute loss of blood . Due to loss of blood, blood to kidney suddenly drops down as a result renal cells suffer from hypoxia. Thus it can be regarded as acute prerenal renal failure. If J.S. is not treated at the earliest then the kidneys may shut down completely leading to renal failure. This would cause accumulation of body waste and toxins in the body until dialysis is done. The best treatment option to prevent this from happening is to monitor tthe blood levels of the patient and pput the patient on dialysis so as to reduce the load on kidneys and give it sufficient time to recover. Other tests that can give status on the renal functioning are Blood urea nitrogen and creatinine. Acute renal failure can give way to chronic renal failure. Such a situation can have adverse effect on liver due to accumulation of toxins in body.
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