RT Book, Section
A1 Rachoin, Jean-Sebastien
A1 Weisberg, Lawrence S.
A2 Lee, Kiwon
SR Print(0)
ID 1101645409
T1 Acute Renal Failure
T2 The NeuroICU Book
YR 2012
FD 2012
PB McGraw-Hill Education
PP New York, NY
SN 9780071636353
LK neurology.mhmedical.com/content.aspx?aid=1101645409
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  daily  and  naproxen  400  mg  twice  a  day.  On  physical  examination,  he  has  a  low-grade  fever  of  38°C  (100.4°F),  his  initial  blood  pressure  is  130/66  mm  Hg,  and  his  heart  rate  is  88  bpm.  He  is  breathing  at  28  breaths/min,  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  a  computed  tomogram  (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  38.9°C  (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  serum  creatinine,  1.6  mg/dL  on  arrival,  increases  to  2.0  mg/dL  by  the  following  day,  and  the  blood  urea  nitrogen  (BUN)  has  risen  from  22  mg/dL  to  36  mg/dL.  Urine  output  has  been  about  20  mL/h  for  the  past  8  hours.