J. S. is 23 years old. He was brought to the emergency department after an auto
ID: 128162 • 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?
Cite specific areas from your readings and research to support your ideas.
Explanation / Answer
1.Low urine sodium is a stage which detects whether a person is having insufficient or more amount of water.This low sodium levels is called hyponatremia and high urine osmolality means concentrated urine.In such cases J.S may develop renal failures like prerenal azotemia or acute kidney tubular necrosis.This type of renal failures might develop as the urine is not filtered properly and generally 24 hour urine should be between 800-2000ml per day for which J.s urine volume is just 350 ml which clearly indicates either he is not having enough water or he has some renal problem.THis can become more problematic so it should be treated to prevent from any renal diseases.Medications ,intravenous fluids,changing the eating habits,drinking plenty of water etc can be done to prevent it from occuring.
2.The other laboratory data beside urine input to evaluate his renal function are serum-creatinine test,blood urine nitrogen test,estimated GFR are of utmost important to know the actual problem.
3.Either chronic renal diseases or end stage renal disease might be the subsequent stages.Chronic renal disease is the condition where the kidneys are permanently damaged and results in diabetes and high BP.End stage renal disease is the condition where the kidney functions are almost totally absent with GFR less than 5% than normal.In this stage dialysis or kidney transplantation is the only source to live life.
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