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 of about 2500 ml. A urinary catheter is inserted to monitor urine output, and fluid resuscitation is initiated while his wounds are cleaned and sutured. The urine output is averaging 15 ml/hr, with a high urine osmolality and low urine sodium.Without adequate therapy, what complication may develop? Why? What is the best therapy for preventing this complication?
Answer: The low urine output is the result of the reduced supply of the blood to the kidney. This could happen due to blood loss, the loss of the urine output causes body gets in to the state of shock. This causes decreased blood flow to the other organs specially to the kidney.
In the case where adequate therapy is not provided, the renal hypoxic cell will influence the cell to convert in to the acute tubular necrosis. Due time huge amount of blood loss hemorrhage takes place. This will also leads to hypotention.
One of the best therapy that can prevent the ATN is to prevent the blood loss and preventing the site of the hemorrhage. It is important to provide blood transfusion as well as IV fluids. This will increase the perfusion. It is important to discountinue the ACE inhibitors, NSAIDs etc.
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