Question

Please refer to Chapter 28 and then answer the questions that follow the case study: 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? Cite specific areas from your readings and research to support your ideas.

Answer 1

The patient is developing  Acute Renal Failure(ARF) or Acute Kidney Failure.

It develops mainly because of severe blood loss due to the accident.A loss of major quantity of blood results in decreased blood flow to the kidney can be termed as prerenal cause.This will increase the workload of the kidney due to lack of blood.This results in stagnation of electrolytes or wastes in to the body as the filtration process is affected. This will increase the sodium in body and low level of sofium in urine and the concentration of urine is high.

If he does not receive adequate treatment this will lead to increased work pressure on the heart (high blood pressure ) and lungs (dysnoea),coagulation disorder prolonging The bleeding and clotting time,confusion and coma at the last stage

The best treatment option is to restore the kidney function by meet the fluid deficiency or volume deficiency by intravenous transfusion of blood (as per order and necessity ) and fluids.To stop the bleeding with medication (Tranexamic acid injection intravenously )

The other test like Sr.creatinine ,Sr.Electrolye, CBC,Urine analysis, ECG to assess whether it has affect the cardiac function, USG to determine any injury of the kidney, glomerular filtration rate .If the above things fail to identify the cause a biopsy is suggested

The patient may end up in irreversible kidney damage if the renal function continue to be on the diminished level.