J.M. is a 37-year-old woman transferred to a large medical center from a small rural hospital for further evaluation of lower abdominal pain, nausea, vomiting, and progressive deterioration of urinary output.
-Long history of ETOH Abuse with a drinking binge two days ago
-Arthritis with heavy use of ibuprofen
-HTN for three years, treated with hydrochlorothiazide and a calcium channel blocker
-Borderline NIDDM for three years, does not want to take medications and has been trying
to lose weight and “watch her sugar intake.”
B/P: 160/110 K: 6.3 mEq/L Urinary output: <15ml/hr Na: 149 mEq/L Lethargic Hgb A1C: 9.2%
Creatinine: 9.6 mg/dL BUN: 121 mg/dL
CRITICAL THINKING QUESTIONS…
1. Address how the various factors in her past medical history could have contributed to her present renal problem.
2. Is her acute renal failure likely to be prerenal, intrarenal, postrenal, or a combination? Why?
3. Discuss each of the laboratory values and how they reflect the pathophysiology that occurs in renal failure. What is the significance of her Hgb A1C level?
4. What are the specific priorities of treatment for J.M.?
5. Explain the types of dialysis available, their indications, and their advantages/ disadvantages. What type of dialysis will most likely be used for J.M?
6. After two weeks of intensive support and dialysis, J.M’s urinary output returns. Explain the diuretic phase of recovery in Acute Renal Failure, and what complications can occur.
7. Do you think she needs intervention for her diabetes? What guidelines did you consult? How would you start in treating a patient with newly diagnosed Type 2 diabetes? Which medication(s) might you want to start first? What patient education issues would you emphasize in the initial period?