HSC 4555 Spring 2015

Unit 4 Case Study

A 45-year old man presented to the hospital with alcohol withdrawal. After drinking a pint of brandy daily for the past 5-6 years, he decided to stop drinking 4 days ago. he experienced tremors and then visual and auditory hallucinations. On arrival at the hospital, he was diaphoretic and tachycardiac, with a pulse rate of 102. His chemistry results are shown below: Na+ | 130 mmol/L | K+ | 3.7 mmol/L | Cl- | 90 mmol/L | CO2 | 20 mmol/L | BUN | 81 mg/dL | Creatinine | 4.0 mg/dL | Magnesium | 1.4 mg/dL | Alcohol | Negative | Total Protein | 7.1 g/dL | Albumin | 3.7 g/dL |
Medical history included arthritis, hypertension, depression, and alcoholism. He had been taking an anti-inflammatory medication for arthritis and an antidepressant. Overnight, he became agitated and required increasing doses of a benzodiazepine, together with physical restraints for behavior control. The next morning, he was transferred to the ICU where he was evaluated for acute renal failure. The patient was rehydrated and his arthritis and antidepressant medication were withheld. Lab test results are listed below: Na+ | 139 mmol/L | K+ | 3.5 mmol/L | Cl- | 107 mmol/L | CO2 | 23 mmol/L | BUN | 16 mg/dL | Creatinine | 1.4 mg/dL |

Discussion Questions: 1.) Is the patient still in acute renal failure? Explain your answer. * Yes, the patient is still in acute renal failure. Acute renal failure, also called acute kidney failure, is when the kidneys suddenly become unable to filter waste products from your blood. When the kidneys lose their filtering ability dangerous levels of wastes can accumulate and the body’s chemical makeup may get out of balance. * It is clear that he is still in acute renal failure because his BUN (blood urea nitrogen) and creatinine chemistry results were nearly four times the normal amount. His BUN was 81 mg/dl when the norm averages at approximately 10-20 mg/dl. Additionally, his creatinine level was 4.0 mg/dl when the normal level averages between 0.7-1.5mg/dl. * Both the BUN and creatinine levels rose four times the normal level because they are measured together. Acute changes in glomerular filtration rate are reflected in a higher BUN-to-creatinine ratio, usually higher than 20:1; which is present in the patient.

2.) What was the cause of his acute renal failure? * Renal failure can be caused by impaired blood flow to the kidneys. One of the many conditions that can lead to this is severe dehydration. * The patient’s symptoms of tremors and hallucinations after suddenly quitting drinking 4 days prior to going to the hospital, and having a history of alcoholism, are a sign of alcohol withdrawal. * Excessive drinking, such as a pint of brandy daily, excites the nervous system. Over time your body becomes dependent on alcohol and your central nervous system can no longer easily adapt to the lack of it. Among the signs a doctor would look for is dehydration. Alcohol is a diuretic, meaning you urinate more. The headache associated with a hangover the next day is your body indicating that it is dehydrated. Therefore, dehydration occurred as a result of the patients excessive drinking, thus in the long run causing acute renal failure.

3.) Why has the patient's electrolyte status improved? * Electrolytes play a key role in keeping water balanced both inside and outside of cells so that muscles and organs can continue to function properly. * The patient’s electrolyte status improved because he was rehydrated. * After being rehydrated the patient’s lab results were back to normal.

Citation

"Acute Kidney Failure." Causes. Mayo Foundation for Medical Education and Research, 6 July 2012. Web. 23 Apr. 2015. .

Copstead, Lee Ellen, and Jacquelyn Banasik. Pathophysiology. 5th ed. St. Louis, Mo.: Saunders Elsevier, 2010. 199-201. Print.

Patel, Vishal. "Electrolytes & Hydration." Nuun Blog. 10 Jan. 2014. Web. 23 Apr. 2015. .