09 Jun A 45-year old man presented to the hospital with alcohol withdrawal.
Question
A 45-year old man presented to the hospital with alcohol withdrawal. After drinking a pint of brandy daily for the past 5-6 years, he decided to stop drinking 4 days ago. He experienced tremors and then visual and auditory hallucinations. On arrival at the hospital, he was diaphoretic and tachycardiac, with a pulse rate of 102. His chemistry results are shown below:
Na+ 130 mmol/L LOW
K+ 3.7 mmol/L NORMAL
Cl- 90 mmol/L LOW
CO2 20 mmol/L LOW
BUN 81 mg/dL HIGH
Creatinine 4.0 mg/dL HIGH
Magnesium 1.4 mg/dL
Alcohol Negative
Total Protein 7.1 g/dL
Normal
Albumin 3.7 g/dL
Medical history included arthritis, hypertension, depression, and alcoholism. He had been taking an anti-inflammatory medication for arthritis and an antidepressant. Overnight, he became agitated and required increasing doses of a benzodiazepine, together with physical restraints for behavior control. The next morning, he was transferred to the ICU where he was evaluated for acute renal failure. The patient was rehydrated and his arthritis and antidepressant medication were withheld. Lab test results are listed below:
Na+ 139 mmol/L NORMAL
K+ 3.5 mmol/L NORMAL
Cl- 107 mmol/L NORMAL
CO2 23 mmol/L NORMAL
BUN 16 mg/dL NORMAL
Creatinine 1.4 mg/dL SLIGHTLTY HIGH
Questions:
1. Is the patient still in acute renal failure? Explain your answer.
Yes, the patient is still in acute renal failure. He is classified to be in Stage 3 according to the Glomerular filtration rate. His GFR is 55. All of his lab results are normal besides his creatinine levels, which are slightly high. They should be between .6-1.2 mg/dl for male patients.
2. What was the cause of his acute renal failure?
3. Why has the patient’s electrolyte status improved?
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