Question

Mr. K. G. is a thin 60-year-old man admitted to the hospital for cardiac catheterization for recurrent angina. Past medical history includes hypertension, tympe 2 diabetes mellitus, and a previous myocardial infarction 2 years ago. Current medications are metformin (Glucophage), glipizide (Glucotrol), enteric-coated aspirin (Ecotrin), and lisinopril (Zestril). Laboratory tests on admission revealed the following: normal electrolyte levels; blood urea nitrogen (BUN), 40 mg/dL; and serum creatinine, 2.0 mg/dL and total cholesterol of 275 mg/dl.. A complete blood cell count and urinalysis were unremarkable. Mr. K. G. receives intravenous fluids at a rate (20 mL/hr.) on the morning of the procedure. He successfully undergoes the catheterization and returns to the telemetry unit. The day after the procedure, Mr. K. G.’s urine output decreases to less than 10 mL/hr. Mr. K. G. is given a fluid bolus of ¬normal saline without any increase in urine output. Furosemide is administered intravenously, with a slight increase in urine output to 15 mL/hr for several hours. Laboratory studies reveal the following: potassium, 5.9 mEq/L; BUN, 70 mg/dL; serum creatinine, 7.1 mg/dL, and carbon dioxide total content, 16 mEq/L. The next day Mr. K. G. has 2+ edema and basilar crackles, and he complains of feeling short of breath. A preliminary diagnosis of Acute Kidney Injury is made.  

1.What is the laboratory test to assess Diabetes Mellitus?

2. Identify 5 cardiovascular risk factors that this client has?

3. What are the normal value ranges of each laboratory test?

4. What is normal urinary output per hour? Infant, child, adult, elderly.

5. What are possible factors predisposing Mr. K. G. for acute renal failure?

6. What laboratory studies would be useful to assist in the diagnosis of acute renal failure? Describe expected results for a patient with acute tubular necrosis.

7.What medical interventions do you anticipate for Mr. K. G.?

8. What interventions could have been taken before Mr. K. G.’s cardiac catheterization to possibly ¬prevent his acute renal failure?

9. Discuss the advantages and disadvantages of using diuretic therapy in patients with acute renal failure

Answer 1

1.The laboratory test to assess diabetes mellitus are

• Blood investigation: Fasting blood glucose and post prandial blood glucose levels
• Glycosylated hemoglobin can be helpful to read blood glucose for a average of 3 months
• Urine test can reveral presence of blood sugar and ketone levels.

2..The cardiovascular risk factors the patient has are

• Hypertension
• Type 2 diabetes mellitus
• Previous myocardial infarction
• Elevated blood cholesterol levels
• Age
• Male gender are usually at very high risk for cardiovascular issues

3.The normal value ranges are

• BUN: 7 to 20 mg/dL
• Potassium:3.5 to 5.5 mmol/L
• Sr.creatinine: 0.5-1.2 mg/dL
• Urine output:GFR >30ml/hr

4.The normal urine output per hour are

• Infant:2ml/kg/hr
• Child:1.5ml/kg/hr
• Adult:30ml/hr
• Elderly:1ml/kg/hr