Question

Case Scenario: A 23-year-old patient was the victim of a hit and run auto pedestrian accident and suffered multiple abrasions, a concussion, and a deep laceration of his left thigh. He was discovered approximately two hours after the incident and is now in the ER. His vital signs and hematocrit suggest that he has had a blood loss about 2500 mL. A urinary catheter is inserted to monitor urine output, and fluid resuscitation is initiated while his wounds are clean and sutured. The urine output is averaging 15 mL per hour, with a high urine osmolality and low urine sodium.

Question: without adequate therapy, what complication may develop? Why? What is the best therapy for preventing this complication? you will need to defend your answer using specific facts, data, and other information drawn from the textbook and at least one other supplemental source.

Answer 1

✓blood loss = 2500 ml caused due to multiple abrasions and deep laceration of thigh.

✓urinary output of patient = 15ml/ hr  

Patient has oliguria (defined as urinary output less than 500cc per day).

✓ low urinary sodium indicates hypovolemia.

COMPLICATIONS -

A) ACUTE RENAL FAILURE - hypovolemia leads to decreased renal blood flow. This causes ischaemic changes to renal parenchyma. If this continues , renal parenchyma gets severely injured.

B) ACUTE TUBULAR NECROSIS - if ischaemia in renal parenchyma continues for a long time , cell death occurs.

C) INFECTION - if the wound is not cleaned properly, microbial growth at site of trauma may cause infection. Since laceration is deep , the infection may even reach internal organs.

D) MULTIORGAN FAILURE - hypovolemia ,if continued, will lead to low oxygen perfusion throughout the body , which will result in shutdown of multiple organ systems.

E) SHOCK - hypovolemic shock is highly probable in this patient due to severity of blood loss.

F) COAGULOPATHIES - caused due to hemorrhage induced shock. One third of all trauma patients are bound to suffer with coagulopathies.

PREVENTION -

✓ firstly , stop further blood loss.

✓ do blood transfusion if required.

✓ fluid resuscitation and electrolyte balance.

✓ in case of volume overload, furosemide is prescribed.

✓ acidosis managed with sodium bicarbonate.

✓ dialysis is done depending on glomerular filtration rate.

✓ antibiotic therapy to prevent infection.

FOR SUPPLEMENTAL SOURCE REFER article on acute kidney injury by Konstantinos makris and loukia spanou.