RT Book, Section
A1 Rachoin, Jean-Sebastien
A1 Weisberg, Lawrence S.
A2 Lee, Kiwon
SR Print(0)
ID 1143957581
T1 Acute Kidney Injury
T2 The NeuroICU Book, 2e
YR 2017
FD 2017
PB McGraw-Hill Education
PP New York, NY
SN 9780071841443
LK neurology.mhmedical.com/content.aspx?aid=1143957581
RD 2024/04/19
AB A  72-year-old-man,  recently  treated  for  resistant  Escherichia  coli  urosepsis,  is  sent  to  the  emergency  department  from  his  nursing  home  because  of  new  left-sided  hemiparesis.  He  has  a  past  history  of  chronic  kidney  disease  (CKD),  hypertension,  and  osteoarthritis.  Medications  include  lisinopril,  20  mg/d  and  naproxen,  400  mg  twice  a  day.  On  physical  examination,  he  has  a  low-grade  fever  (100.4°F),  his  initial  blood  pressure  is  130/66  mm  Hg,  and  his  heart  rate  is  88  beats  per  minute  (bpm).  His  respiratory  rate  is  28  breaths  per  minute,  and  his  hemoglobin  oxygen  saturation  by  pulse  oximetry  is  89%  on  supplemental  oxygen  by  nasal  cannula.  He  has  a  flaccid  left  hemiparesis  and  is  stuporous.He  undergoes  computed  tomography  (CT)  of  the  head,  which  shows  no  hemorrhage.  He  has  a  CT  angiogram  of  the  chest,  which  shows  no  evidence  of  pulmonary  embolism.  His  temperature  rises  quickly  to  102°F,  the  blood  pressure  falls  to  78/50  mm  Hg,  and  the  heart  rate  rises  to  120  bpm.  His  initial  white  blood  cell  count  is  29.9  with  44%  bands,  and  a  urine  analysis  shows  pyuria  and  bacteriuria.  Treatment  is  initiated  with  vancomycin,  gentamicin,  and  cefepime.  Intravenous  normal  saline  is  given  by  rapid  infusion,  according  to  the  sepsis  protocol.  The  patient  is  intubated  and  placed  on  mechanical  ventilation.  The  plasma  creatinine,  1.6  mg/dL  on  arrival,  increases  to  2.0  mg/dL  by  the  following  day,  and  the  blood  urea  nitrogen  (BUN)  rises  from  22  mg/dL  to  36  mg/dL.  Urine  output  has  been  about  20  mL/h  for  the  past  8  hours.The  patient’s  daughter,  a  registered  nurse,  is  in  the  room  when  you  make  rounds.  She  is  aware  of  her  father’s  history  of  CKD  and  wants  to  know  if  he  is  in  “kidney  failure.”  What  do  you  tell  her?