1. Identify the goals of therapy for treatment of acute renal failure in CM.
2. Classify CM’s acute renal failure as prerenal, intrarenal, or postrenal and justify your answer.

Patient and Setting: CM is a 45-year-old man, on an inpatient surgical unit

Chief Complaint: Sudden onset of nausea/vomiting, some difficulty breathing, change in status

History of Present Illness: CM is in hospital, day 2 post-ORIF fractured femur with significant haemorrhage 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 current 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 0.34 Creatinine 189 BUN 23

Blood Gas: pH 7.3; pCO2 40; HCO3 18; pO2 97

Urine Output: 300 mL/24 hr