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A previously healthy 32-year-old woman is hospitalized for community-acquired pneumonia and suspected empyema. Her temperature is 38.9 °C (102.0 °F) and her blood pressure is 115/72 mm Hg. Laboratory studies show an elevated leukocyte count, decreased platelet count, blood urea nitrogen of 30 mg/dL (10.71 mmol/L), and serum creatinine of 2.4 mg/dL (212.21 μmol/L). The pleural space is drained via thoracotomy tube. Hypotension develops and does not resolve with fluid administration; vasopressor support is started. She now has anuric acute renal failure. Leukocyte count remains elevated, blood urea nitrogen is 110 mg/dL (39.28 mmol/L), serum potassium is 5.9 meq/L (5.9 mmol/L) (despite sodium polystyrene sulfonate), and serum bicarbonate is 15 meq/L (15 mmol/L). Arterial blood pH is 7.24.
Which of the following is the best approach to management for this patient?
A Alternate-day hemodialysis
B Daily hemodialysis
C Intravenous furosemide
D Intravenous bicarbonate infusion
E Fenoldopam infusion
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Hello pacemaker...
A Alternate-day hemodialysis
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Hello rammar !
Correct Answer = B)
Key Point
Daily hemodialysis has been shown to significantly reduce in-hospital deaths in patients with acute renal failure in surgical and medical intensive care units.
Daily hemodialysis is indicated in this patient. Patients with acute renal failure in surgical and medical intensive care units were randomized to management with daily hemodialysis vs. every other day hemodialysis. In this study, hospital mortality was only 28% in those who received daily hemodialysis compared with 46% in those treated every other day (P = 0.01). In addition, resolution of acute renal failure occurred in 9 ± 2 days in the patients given daily hemodialysis. Although commonly used in management of oliguria to help to œconvert to nonoliguric renal failure, furosemide has not been shown to alter clinical outcomes in patients with anuric renal failure. Bicarbonate infusions can eventually worsen intracerebral acid-base status by conversion via carbonic anhydrase, and acidosis does not cause its neurotoxicity or cardiotoxicity until it is very severe. Fenoldopam is approved for hypertensive urgency but not for anuric acute renal failure. It is possible, but not yet proven, that continuous renal replacement therapy (CRRT) such as continuous venovenous hemodialysis or continuous arteriovenous hemodialysis might be superior to daily hemodialysis; a pivotal, multi-center clinical trial is under way and incomplete.
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anyone has idea what might be underline reason/pathology for renal failure in this case.
thanks
