PATH 3505 – ACUTE CARE CASE STUDY
Patient and Setting: CM is a 45-year-old man, on an inpatient surgical unit
Chief Complaint: Sudden onset of nausea/vomiting, some difficulty
eathing, change in status
History of Present Illness: CM is in hospital, day 2 post-ORIF fractured femur with significant haemo
hage and other soft tissue injuries, sustained in an MVA. CM reports that his feet are swelling, (+) fatigue, (+) nausea and vomiting, and (+) SOB. He has also noticed a decrease in urine output , although he reports he has not been eating or drinking much.
Medical History: Hypertension (× 5 yrs), MVA
Surgical History: N/A (other than cu
ent hospitalization)
Family History: Mother: DM; Father: died at age 50 due to MI
Social History: Ethanol intake: Nil; tobacco: once/month
Medications:
Lisinopril 40 mg PO BID for 5 years
ASA 81 mg po daily
Rosuvastatin 20mg po daily
Amlodipine 10 mg PO QD for 2 years
Ibuprofen 800 mg PO TID for back pain
Centrum One 1 tab PO QD
Allergies: Morphine (tongue swelling, itching, rash, SOB)
Physical Examination:
GEN: Well-developed, nourished man
VS: BP 190/100, HR 83, RR 26, T 37.3°C, Wt 80 kg, Ht 182 cm
HEENT: WNL
CHEST: Small crackles, rales, and wheezing
ABD: WNL
EXT: Bilateral LE swollen with fluid, 3+ pitting edema
NEURO: A & O × 2 (place, time)
Results of Pertinent Laboratory Tests, Serum Drug Concentrations, and
Diagnostic Tests:
Na 132 K 5.9
Hgb 88 Hct XXXXXXXXXXCreatinine 189 BUN 23
Blood Gas: pH 7.3; pCO2 40; HCO3 18; pO2 97
Urine Output: 300 mL/24 h
CASE QUESTIONS
1. List signs and symptoms of acute renal failure. Which of these are present in CM?
2. How does renal failure cause metabolic acidosis? What values in CMs blood gases indicate metabolic acidosis?
3. List the physical assessment and laboratory findings in CM consistent with
Fluid overload. Why is he presenting with these findings?
4. What type of anemia is CM manifesting? What is the etiology and associated symptoms?
5. Identify the goals of therapy for treatment of acute renal failure in CM.
6. Classify CM’s acute renal failure as prerenal, intrarenal, or postrenal and justify
your answer.
7. What type of shock is CM at risk of? What are the mechanisms, signs and symptoms?
8. Identify 1 agent in CM’s medication profile with the potential to cause acute
enal failure and describe the mechanism for kidney damage.