Question

J.G. is a 26-year-old male who was admitted to the emergency room complaining of “feeling sick” and nauseated during the past 2 days. The history revealed that he had cleaned the tiles on the wall of his girlfriend’s unvented bathroom with a cleaning solution containing carbon tetrachloride 2 days ago. During the cleaning process, the two of them drank several beers in the kitchen. Since that time he had not been feeling well. He also noted that he had only been able to urinate a small amount since that time. He stated that he does not take any drugs (legal or illegal) and his health has always been excellent. Physical examination findings were unremarkable except for lethargy and slight ankle edema. Vital signs were: TPR = 98° F, HR = 110 bpm, 20/min; BP = 140/70. An ECG revealed peaked T waves and a widening of the QRS. 50 cc of dark urine was obtained from bladder catheterization and was sent to the lab along with a blood specimen.

Blood	Urinalysis
Na+ = 132 mEq/L	Na+ = 48 mEq/L
Cl++ = 92 mEq/L	sp. gravity = 1.005
K+ = 7.2 mEq/L	Protein = 2+
HCO3 = 15 mEq/L	Microscopic examination
BUN = 200 mg/dl	5 WBC/hpf, 3 coarse
Creatinine = 18 mg/dl	granular casts/hpf,
pH = 7.15	many epithelial cells

1.         What do you think happened to J.G.?   What is your diagnosis?

What caused his condition (correlating your diagnosis with his background/condition).

What are the criteria used for the diagnosis?

What is the significance of exposure to CCl₄ and drinking alcohol have to do with J.G.’s problem if any?

2.         What type of fluid and electrolyte problem does J.G. have according to the data obtained? Is it dangerous and if so, how should it be treated?

3.         What is the usual clinical course (stages) of the diganosis?

What other treatment do you expect to administer to this patient?

What are possible complications and what is the general prognosis?

Please answer ALL questions. Typed. Thank you.

Answer 1

1st Answer:

• J.G is suffering from Acute Kidney Injury (Nephritis).
• Inhalation of Carbon tetrachloride toxicity has led to Kidney Injury.
• The criteria for diagnosis of Nephritis elevate BUN levels, creatinine levels and potassium levels
• Urine analysis show granular casts in urine, on examination it was observed that there is fluid retention in the extremities.
• Studies have shown that CCl4 along with Alcohol can cause Liver Fibrosis and Liver Lesions. In J.G's case the exposure of CCl4 and Alcohol

2nd Answer:

• J G has hyperkalemia. We should administer I.V Calcium Gluconate 4.5 mEq.
• I.V administration of sodium bicarbonate to alkalise the plasma and cause a temporary shift of potassium into the cells
• I.V administration of regular insulin and a hypertonic dextrose solution can cause a temporary shift of potassium into the cells
• Beta-2 agonists like albuterol are effective in decreasing potassium levels but remain a controversy.
• Loop diuretics like furosemide, increase excretion of water and potassium.
• Peritoneal dialysis and hemodialysis can be used.

3rd Answer:

Now the patient suffers from acute kidney injury if left untreated it can lead to chronic kidney disease and finally end stage renal failure.

Hemodialysis or Peretoneal Dialysis will be administered to patient to remove the excessive potassium and byproducts.

Hyperkalemia can lead to dysrhythmias and cardiac arrest. It can also effect the peripheral nervous system leading to muscle weakness, quadriplegia, paralysis of respiratory and speech muscles.

If treatment is given correctly the prognosis will be excellent.