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Clinical manifestations of gastroenteritis and possible renal injury

Mr. J.R. is a 73-year-old man, who was admitted to the hospital with clinical manifestations of gastroenteritis and possible renal injury. The patient’s chief complaints are fever, nausea with vomiting and diarrhea for 48 hours, weakness, dizziness, and a bothersome metallic taste in the mouth. The patient is pale and sweaty. He had been well until two days ago, when he began to experience severe nausea several hours after eating two burritos for supper. The burritos had been ordered from a local fast-food restaurant. The nausea persisted and he vomited twice with some relief. As the evening progressed, he continued to feel “very bad” and took some Pepto-Bismol to help settle his stomach. Soon thereafter, he began to feel achy and warm. His temperature at the time was 100. 5°F. He has continued to experience nausea, vomiting, and a fever. He has not been able to tolerate any solid foods or liquids. Since yesterday, he has had 5–6 watery bowel movements. He has not noticed any blood in the stools. His wife brought him to the ER because he was becoming weak and dizzy when he tried to stand up. His wife denies any recent travel, use of antibiotics, laxatives, or excessive caffeine, or that her husband has an eating disorder.
Case Study Questions

The attending physician is thinking that Mr. J.R. has developed an Acute Kidney Injury (AKI). Analyzing the case presented name the possible types of Acute Kidney Injury. Link the clinical manifestations described to the different types of Acute Kidney injury.
Create a list of risk factors the patient might have and explain why.
Unfortunately, the damage on J.R. kidney became irreversible and he is now diagnosed with Chronic kidney disease. Please describe the complications that the patient might have on his Hematologic system (Coagulopathy and Anemia) and the pathophysiologic mechanisms involved.

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Sample Answer

 

 

Mr. J.R.’s Case: Acute and Chronic Kidney Injury

1. Possible Types of Acute Kidney Injury (AKI):

Mr. J.R.’s presentation suggests several potential types of AKI:

  • Prerenal AKI: Caused by decreased blood flow to the kidneys. Dehydration from gastroenteritis, medications like Pepto-Bismol, or low blood pressure due to fever could contribute.
  • Intrarenal AKI: Direct injury to the kidneys. Toxins in the burritos (food poisoning), fever, or underlying kidney disease could be factors.
  • Postrenal AKI: Blockage in the urinary tract preventing urine flow. Less likely due to lack of urinary retention or blood in stool.

Full Answer Section

 

 

Linking Symptoms to Types of AKI:

  • Prerenal AKI: Dehydration leads to decreased urine output, weakness, and dizziness.
  • Intrarenal AKI: Fever, metallic taste, nausea, and vomiting point toward direct kidney injury.
  • Postrenal AKI: Urinary retention or blood in stool might suggest blockage.

3. Risk Factors for AKI:

  • Age: Mr. J.R.’s advanced age (73) puts him at higher risk.
  • Dehydration: Gastroenteritis with vomiting and diarrhea suggests potential dehydration.
  • Underlying conditions: Unknown comorbidities like chronic kidney disease, diabetes, or hypertension could increase risk.
  • Medications: Pepto-Bismol can sometimes affect kidney function, though unlikely in this case.
  • Recent exposure to toxins: The suspect burritos raise concern about potential toxins affecting the kidneys.

4. Complications in Chronic Kidney Disease (CKD):

  • Coagulopathy: Kidney dysfunction can affect production of clotting factors, leading to increased bleeding risk (anemia is another complication).
  • Anemia: Reduced kidney function may impair production of erythropoietin, a hormone stimulating red blood cell production, leading to anemia (fatigue, weakness).

5. Pathophysiology of Complications:

  • Coagulopathy: Impaired kidney function disrupts production of various clotting factors like antithrombin and protein C, leading to a pro-coagulant state and increased bleeding risk.
  • Anemia: CKD disrupts erythropoietin production, reducing red blood cell production and oxygen-carrying capacity, leading to anemia and related symptoms.

Note: This information is for educational purposes only and should not be considered as medical advice. It’s crucial to consult a qualified healthcare professional for diagnosis and treatment of any medical condition.

Recommendations:

  • Further tests are needed to confirm the type and severity of AKI.
  • Treatment should address the underlying cause and support kidney function.
  • Management of chronic kidney disease (if confirmed) requires close monitoring and interventions to control complications like anemia and coagulopathy.

I hope this analysis is helpful for your understanding of Mr. J.R.’s case. Please remember that additional information from medical professionals is necessary for proper diagnosis and treatment.

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