Question

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's 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 15ml/hr with a high urine osmolality and low urine sodium.  

Questions

1. What type of renal failure is P.W. likely developing? What data supports this conclusion?

2. Without adequate therapy, what may develop? Why? What is the best therapy for preventing this from occurring?

3. In addition to urine output, what laboratory date should be monitored to assess changes in P.W's renal function?

If P.W's renal function does not return to normal, but continues to be diminished, what are the subsequent stages of his renal disorder and what clinical problems do they present?

Answer 1

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.

1. Renal failure is P.W. likely developing Acute intrinsic kidney failure because P.W's vital signs and hematocrit suggest that he has had a blood loss of about 2500 ml.

The diagnosis is supported by the urine output is averaging 15ml/hr with a high urine osmolality and low urine sodium.  

2.

P.W now is in hypovolemic shock. Without adequate treatment, P.W may develop chronic intrinsic kidney failure.

The best treatment to prevent this problem is blood transfusion and fluid replacement therapy.

3.

In addition to urine output,

Serum urea, serum creatinine, sodium and potassium, and ABG (Arterial blood gas) data should be monitored to assess changes in P.W's renal function.