Premium Essay

Acute Tubular Necrosis Case Study

Submitted By
Words 231
Pages 1
In Louis’s diagnosis of nephrotoxic acute tubular necrosis, could be related to his treatment for his urinary tract infection with the aminoglycoside gentamicin, also his advanced age along with his preexisting UTI.
Acute tubular necrosis (ATN) is the death of tubular cells, which may result in the tubular cells are not being supplied with enough oxygen or when they have been exposed to a toxic drug or molecule. Injury of tubular cells is most noicaable in the straight portion of the proximal tubules and in the thick ascending limb of the loop of Henle, as it dips into the relatively hypoxic medulla. The decrement in the glomerular filtration rate (GFR) that develop from ischemic injury is a result not only of reduced filtration due to hypoperfusion

Similar Documents

Free Essay

Vision 2021

...Available online at www.sciencedirect.com Environmental Toxicology and Pharmacology 25 (2008) 334–341 Carbofuran in water: Subchronic toxicity to rats Dragica V. Brki´ a , Slavoljub Lj. Vitorovi´ b , Slavica M. Gaˇi´ a , Neˇko K. Neˇkovi´ a,∗ c c sc s s c a Institute of Pesticides and Environmental Protection, Banatska 31-b, P.O. Box 163, 11080 Belgrade, Serbia b Faculty of Agriculture, University of Belgrade, Belgrade, Serbia Received 31 July 2007; received in revised form 26 October 2007; accepted 4 November 2007 Available online 17 November 2007 Abstract Carbofuran toxicity on rats was studied during subchronic exposure. Female and male rats were administered carbofuran in drinking water in concentrations of 25, 100 and 400 ppm for a period of 90 days. Clinical symptoms, water consumption, body weight gain, organ weight, pathological and histopathological changes in the liver and kidneys were observed and biochemical and haematological examinations were carried out. The results obtained show that carbofuran administered to rats caused a significant decrease in water consumption as well as in brain, serum and erythrocyte cholinesterase activities. Statistically significant increases in relation to the control were found in the serum enzyme activities. The haematological data showed that carbofuran had no significant effect on Hb concentration and total RBC, but total WBC showed a significant statistical decrease. The histopathological changes in...

Words: 4984 - Pages: 20

Free Essay

Pestel Analysis of Pharmaceutical Industry

...INTRODUCTION Acetaminophen (paracetamol, N-acetyl-p-aminophenol, 4-hydroxyacetani­ lide) is a non-prescription antipyretic analgesic that was first introduced into clinical medicine towards the end of the last century (1). It attracted little interest until it was found to be the major metabolite of both acetani­ lide and phenacetin (2, 3) and in recent years it has become an increasingly popular substitute for aspirin. Acetaminophen seemed to be remarkably safe when taken in recommended doses and formal toxicity studies were never carried out. In 1964 Eder (4) first reported liver damage in cats given 25-50 mglKg of acetaminophen daily for 26 weeks, and two years later Boyd & Bereczky described extensive hepatic necrosis in acute toxicity studies in rats (5). At the same time liver damage was first reported in man following acetaminophen overdosage (6, 7). The use of acetaminophen for self-poisoning has since increased dramatically in many countries and acute hepatic necrosis, sometimes fatal, has attracted much attention as the major complication (8-16). CLINICAL MANIFESTATIONS AND COMPLICATIONS OF ACETAMINOPHEN POISONING Apart from nausea and vomiting there are no specific early signs of severe intoxication and consciousness is not impaired. However, 12 to 36 hours after ingestion biochemical...

Words: 7818 - Pages: 32

Premium Essay

Renal Transplant Biopsy

...Functional Parameters Are IndependentPredictors of Renal Function at 3 Months | 202(111 biopsied) | | A donor preimplantation biopsy with sufficient material forevaluation was available in 111 cases. Mean global glomerularsclerosis was 1.2% _ 3.5% and in seven cases globalglomerular sclerosis was greater than 10%. Mean donorchronic damage score was 0 in 77 cases; 1 in 15 cases; 2 in13 cases; and _3 in five cases(LOW PERCENTAGE OF GLOMEROSCLEROSIS) | | Histopathologic Evaluation of Pretransplant Biopsy as a Factor InfluencingGraft Function After Kidney Transplantation: A 1-Year Observation | 92 | We observed a significant correlation between immediate graft function (IGF)and lack of ATN in the pre-0 biopsy. We observed no correlation between renal functionand arterial hyalinization and fibrosis, inflammatory infiltration, tubular atrophy. In thepostoperative period, we observed a significant correlation between IGF and lack ofinterstitial fibrosis with significantly lower levels of creatinine, urea, and potassium andhigher urine output early after transplantation. IGF and better function of the right kidneywas correlated with shorter time to reach a creatinine level of 2 mg%. In the postoperativeperiods, we also observed a difference between renal function depending on gender. Thepresence of acute tubular necrosis, arterial fibrosis, lack of inflammatory infiltration in thepre-0 biopsy correlated with worse late renal function. Among explantation biopsies 65.5%showed signs of CAN, and 37.93%, histologic...

Words: 2991 - Pages: 12

Free Essay

Nurse

...may also promote electrolyte and water secretion into the colon. It increases the amount of water and fat absorbed by the feces, softening the stool and making it easier to pass.Inhibits the reabsorption of sodium and chloride from the loop of Henle and distal renal tubule. Increases renal excretion of water, sodium, chloride, magnesium, potassium, and calcium. | Contraindicated with allergy to acetaminophen. Use cautiously with impaired hepatic function, chronic alcoholism, pregnancy, lactation. Adverse effects CNS: Headache CV: Chest pain, dyspnea, myocardial damage when doses of 5–8 g/day are ingested daily for several weeks or when doses of 4 g/day are ingested for 1 yr GI: Hepatic toxicity and failure, jaundice GU: Acute kidney failure, renal tubular necrosis Contraindications Hypersensitivity; severe chronic heart failure, bronchial asthma or related bronchospastic conditions; severe hepatic impairment. Adverse effects Bradycardia, AV...

Words: 2080 - Pages: 9

Premium Essay

Pneumonia Case Study Solution

...Abstract Pneumonia Introduction: I will not be looking too deep into this severe case of Community Acquired Pneumonia. My objectives in this case study will basically be to determine whether hospital admission for intravenous antibiotics are necessary. This will be done by using clinical scores and other in-hospital diagnostic criteria to determine prognosis and severity. The relevance to this case study with be treatment regime and a ventilator strategy you may not have heard of. Case study: 67 year old female of colored ethnicity from wellington, transferred from Paarl hospital intubated, ventilated will host of problems including Chronic Obstructive Pulmonary Disease grade ii , Community Acquired Pneumonia (CAP) , Gastro Intestinal Tract bleed which occurred just before transferring from Paarl, also history of smoking, one packet year, and ethanol (ETOH) abuser. Conclusion: Diagnostic criteria, is clinical presentation and chest x-ray. The simplest of all clinical scoring system is CURB-65 using 5 prognostic variables to determine the severity of Pneumonia, instead of 20. Much easier and practical can be applied at patient bedside. Inverse ratio ventilation to aid and improve filling of non-compliant...

Words: 1624 - Pages: 7

Free Essay

Wgu - Biochemistry

...Article ID 487480, 6 pages doi:10.1155/2012/487480 Review Article Acute Liver Failure Caused by Amanita phalloides Poisoning Luca Santi,1 Caterina Maggioli,1 Marianna Mastroroberto,2 Manuel Tufoni,1 Lucia Napoli,1 and Paolo Caraceni1 1 U.O. Semeiotica Medica, Department of Clinical Medicine, Alma Mater Studiorum University of Bologna, Via Albertoni 15, 40138 Bologna, Italy 2 S.S.D. Liver Transplant, Department of Clinical Medicine, Alma Mater Studiorum University of Bologna, Via Albertoni 15, 40138 Bologna, Italy Correspondence should be addressed to Paolo Caraceni, paolo.caraceni@unibo.it Received 4 May 2012; Accepted 11 May 2012 Academic Editor: Bruno Nardo Copyright © 2012 Luca Santi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Mushroom poisoning is a relatively rare cause of acute liver failure (ALF). The present paper analyzes the pathogenesis, clinical features, prognostic indicators, and therapeutic strategies of ALF secondary to ingestion of Amanita phalloides, which represents the most common and deadly cause of mushroom poisoning. Liver damage from Amanita phalloides is related to the amanitins, powerful toxins that inhibit RNA polymerase II resulting in a deficient protein synthesis and cell necrosis. After an asymptomatic lag phase, the clinical picture is characterized...

Words: 4886 - Pages: 20

Free Essay

Laboratory Medicine Pathology Final

...Name: Student Number: UNIVERSITY OF TORONTO Faculty of Arts and Sciences APRIL 2011 EXAMINATIONS LMP301H1S DURATION: 2 HOURS Examination Aids: Non-programmable calculators are allowed Version A SECTION I – MULTIPLE CHOICE (88 marks) The 44 questions are of equal value (2 marks). Select the most correct answer for each question. 1. Which of the following statements is TRUE regarding lipid biomarkers? i. ii. iii. iv. A. B. C. D. E. Total Cholesterol to HDL-C ratio is more sensitive for heart disease than cholesterol alone Elevated triglycerides are a defining criterion in metabolic syndrome Increase in lipoprotein(a) reflects accumulation of the small-dense form of LDL particles Measurement of Apo-A1 levels is useful in patients with metabolic syndrome at high risk i and ii i and iii iii and iv iv only All of the above (i, ii, iii and iv) 2. Which of the following statements is FALSE regarding regulation of body water? A. B. C. D. E. Receptors in the hypothalamus respond to increased osmolality and stimulate thirst As the effective circulating volume increases, aldosterone secretion is suppressed Congestive heart failure may arise from volume overload of the circulatory system Anti-diuretic hormone stimulates the Na+/K+ transporter to retain sodium and water Angiotensin II stimulates vasoconstriction and sodium resorption in the kidney Page 1 of 15 Name: Student Number: 3. Given the following test results: sodium potassium chloride bicarbonate glucose...

Words: 3089 - Pages: 13

Free Essay

Benziodiazepine Drugs

...Benziodiazepine Drugs: Comparison of Diazepam, Clonazepam, & Lorazepam Table of Content Page 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Introduction Page 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Diazepam: History & Mechanism of Action Page 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Diazepam: Pharmacokinetics Page 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Diazepam: Comparison of Pharmacokinetics Page 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Diazepam: Comparison of Pharmacokinetics Page 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Diazepam: Comparison of Pharmacokinetics Page 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Diazepam: Adverse Effect Page 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Diazepam: Overdose Page 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Diazepam: Contradiction Page 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Clonazepam: Information & Mechanism of Action Page 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Clonazepam: Pharmacokinetics Page 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Clonazepam: Comparison of Pharmacokinetics Page 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Clonazepam: Comparison of Pharmacokinetics Page 16 . . . . . . . . . . . . . . . . . ...

Words: 6612 - Pages: 27

Premium Essay

Renals

... eMedicine article/238798 MeSH D007676 Chronic kidney disease (CKD), also known as chronic renal disease (CRD), is a progressive loss in renal function over a period of months or years. The symptoms of worsening kidney function are non-specific, and might include feeling generally unwell and experiencing a reduced appetite. Often, chronic kidney disease is diagnosed as a result of screening of people known to be at risk of kidney problems, such as those with high blood pressure or diabetes and those with a blood relative with chronic kidney disease. Chronic kidney disease may also be identified when it leads to one of its recognized complications, such as cardiovascular disease, anemia or pericarditis.[1] It is differentiated from acute kidney disease in that the reduction in kidney function must be present for over 3 months. Chronic kidney disease is identified by a blood test for creatinine. Higher levels of creatinine indicate a lower glomerular filtration rate and as a result a decreased capability of the kidneys to excrete waste products. Creatinine levels may be normal in the early stages of CKD, and the condition is discovered if urinalysis (testing of a urine sample) shows that the kidney is allowing the loss of protein or red blood cells into the urine. To fully investigate the underlying cause of kidney damage, various forms of medical imaging, blood tests and often renal biopsy (removing a small...

Words: 5130 - Pages: 21

Premium Essay

Renal Nursing

...COMPLICATIONS OF KIDNEY TRANSPLANT | 17 - 18 | 8 | NURSING PROCESS | 18 - 21 | 9 | HEALTH EDUCATION FOR PATIENT | 22 | 10 | CONCLUSION | 23 | 11 | REFERENCES | 24 | INTRODUCTION URINARY SYSTEM The urinary system consists of the kidneys, ureters, urinary blabber and urethra. The kidneys produce the urine and account for the other functions attributed to the urinary system. The ureters convey the urine away from the kidneys to the urinary bladder, which is a temporary reservoir for the urine. The urethra is a tubular structure that carries the urine from the urinary bladder to outside of the body. WHAT DO NORMAL KIDNEYS DO? * Remove extra water. * Remove waste products. * Balance chemicals in the body. * Help control blood pressure. * Help make red blood cell. * Help build strong bones. When the kidneys no longer able to perform normal functions and starts to deteriorate, renal failure will occur, this condition may be acute or chronic. Then the following problems will occur: * Retention of waste and toxic products and excess water. * Nausea * Vomiting * Loss of appetite * Tiredness * Swelling...

Words: 4203 - Pages: 17

Free Essay

Outline for Shock

...Diminished bowel sounds * Restlessness progressing to confsion * Hyperglycemia * Increased specific gravity and decreased creatinine clearance. | Progressive | * Progressive tissue hypoperfusion * Anaerobic metabolism wih lactic acidosis * Failure of sodium potassium pump * Cellular edema | * Dysrhythmias * Decreased BP with narrowed pulse pressure * Tachypnea * Cold, clammy skin * Anuria * Absent bowel sounds * Lethargy progressing to coma * Hyperglycemia * Increase BUN, CREATININE, AND POTASSIUM * Respiratory and metabolic acidosis. | Refractory | * Severe tissue hypoxia with ischemia and necrosis * Worsening acidosis * SIRS * MODS | * Lifethreatening dysrhythmias * Severe hypotension despite vasopressors * Respiratory and metabolic acidosis * Acute respiratory failure * Acute respiratory...

Words: 12469 - Pages: 50

Free Essay

Hypercalcemia

...Overview Hypercalcemia is the most common life-threatening metabolic disorder associated with neoplastic diseases, occurring in an estimated 10% to 20% of all adults with cancer. It also occurs in children with cancer, but with much less frequency (approximately 0.5%–1%).[1-3] Solid tumors (such as lung or breast cancer tumors) as well as certain hematologic malignancies (particularly multiple myeloma) are most frequently associated with hypercalcemia.[4] Although early diagnosis followed by hydration and treatment with agents that decrease serum calcium concentrations (hypocalcemic drugs) can produce symptomatic improvements within a few days, diagnosis may be complicated because symptoms may be insidious at onset and can be confused with those of many malignant and nonmalignant diseases. However, diagnosis and timely interventions not only are lifesaving in the short term but also may enhance the patient’s compliance with primary and supportive treatments and may improve quality of life.[5] When a patient has a refractory, widely disseminated malignancy for which specific therapy is no longer being pursued, the patient may want to consider withholding therapy for hypercalcemia. For patients or families who have expressed their wishes regarding end-of-life issues, this may represent a preferred timing and/or mode of death (as compared with a more prolonged death from advancing metastatic disease). This option is best considered long before the onset of severe hypercalcemia or...

Words: 10714 - Pages: 43

Free Essay

Abc and 123

...reperfusion. (Endoh, 1996: 110-15) It is therefore essential to restore cellular energy levels between retrieval and reimplantation for NHBD livers. Previous studies have shown that perfusion prior to harvesting of the NHBD liver can restore cellular energy levels before cold storage. Total body reperfusion with cardiopulmonary bypass (CPB) using autologous blood after 30 min without ventilation was shown to revive total adenosine 5' -triphosphate (ATP) content in porcine livers and kidneys", Conditioning the liver with 30 min of normothermic isolated perfusion in vivo, using whole blood, has been shown to increase mitochondrial ATP content after 10 min of circulatory arrest in the porcine model7. CPB for only 10 min after 30 min of arrest, at 37°C, provided functional recovery of the heart, liver and kidney in the canine models. In the porcine transplant model, CPB for systemic perfusion with cold, oxygenated Eurocollins solution restored tissue energy charge after 10 min ofarrest9. These livers were then cold-stored for 5 h and transplanted with a survival rate of 100 per cent in the perfused group, while there were no recipient survivors in the control group (no perfusion). The largest study utilizing preharvest perfusion to salvage NHBD livers in the transplant model comes from Barcelona (Tabet, 1997: 3482-3). In this study, pigs were assigned progressive circulatory...

Words: 3584 - Pages: 15

Premium Essay

Doctor

...III - Vascular Access Vascular Access Chapter 6 - Establishing Venous Access Chapter 7 - The Indwelling Vascular Catheter Section IV - Hemodynamic Monitoring Hemodynamic Monitoring Chapter 8 - Arterial Blood Pressure Chapter 9 - The Pulmonary Artery Catheter Chapter 10 - Central Venous Pressure and Wedge Pressure Chapter 11 - Tissue Oxygenation Section V - Disorders of Circulatory Flow Disorders of Circulatory Flow Chapter 12 - Hemorrhage and Hypovolemia Chapter 13 - Colloid and Crystalloid Resuscitation Chapter 14 - Acute Heart Failure Syndromes Chapter 15 - Cardiac Arrest Chapter 16 - Hemodynamic Drug Infusions Section VI - Critical Care Cardiology Critical Care Cardiology Chapter 17 - Early Management of Acute Coronary Syndromes Chapter 18 - Tachyarrhythmias Section VII - Acute Respiratory Failure Acute Respiratory Failure Chapter 19 - Hypoxemia and Hypercapnia Chapter 20 - Oximetry and Capnography Chapter 21 - Oxygen Inhalation Therapy Chapter 22 - Acute Respiratory Distress Syndrome Chapter 23 - Severe Airflow Obstruction Section VIII - Mechanical Ventilation Mechanical Ventilation Chapter 24 - Principles of Mechanical Ventilation Chapter 25 - Modes of Assisted Ventilation Chapter 26 - The Ventilator-Dependent Patient Chapter 27 -...

Words: 91543 - Pages: 367

Premium Essay

Ncp Nursing Care Plan

...NUR160 Ca Name: Jodi Wiak | Section: 160 | Instructor: Ms. Higgins | Dates of care: 4/1/14 | Week: 1st clinical | Name: Jodi Wiak | Section: 160 | Instructor: Ms. Higgins | Dates of care: 4/1/14 | Week: 1st clinical | General Survey | Age: 85 | Sex: F | Ethnicity: Caucasion | # of days since admission: 7d | Allergies: Latex PCN | Code Status: FULL CODE | Diet: TPN | Rationale: Small bowel obstruction and resection benefit TPN over tube feedings is that all the nutrition is delivered at a cellular level making it immediately available for the body to utilize rather than making the body breakdown and absorb nutrients in the GI tract. It makes it easier on the digestive tract by giving the GI a chance to rest and heal without causing more harm. The patient also has to expend energy to breakdown foods/nutrition through the GI tract. Getting it TPN conserves the much needed energy the patient needs to heal their tissues and gain strength. | Activity: bedridden w/slight mobility with a walker | Rationale: Post surgical abdominal surgery, pt age, weakness, and recent foot surgery limiting her mobility. | Behavior/Affect: My pt was anxious when I first arrived due to her elevated B/P, N&V, and pain intolerance. By the end of shift my patient was very calm and communicative. | Isolation: | Yes | No | Culture: ⦵ | Source: ⦵ | Type of Isolation: ⦰ ⦵ | Height: 5’ 7.5” | Weight: 133 | BMI: 20.5 (BSA 1.71) | General Survey | Age: 85 | Sex:...

Words: 14960 - Pages: 60