study_ing
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51 year old gentleman with cirrhosis presents with increasing abdominal distention. his treatment reghimne was amnded 3 days ago when furosemide wasa dded to spironolactone and sodium/water restriction. however the distension persisits, and today he is very somnolent and has passed very litle urine. His PMH is remarkable for chronic hep B, cirrhosis, encephalopathy, and 2 bleeding episodes from esophageal varices. afebrile, BP=90/60, pulse=80, RR-18/min. abd exam--distension, shifting dullnes and no tenderness. bowel sounds are present. labs show
Hb--11
wbcs 3,500/mm3
na 125
K 5.5
cl- 103
BUN 60
Cr1.8
PT 18s
PTT=35s
urinalysis n
US kub normal
next most appropriate step in management?
A. IVP
B. Renal biopsy
C. tapping of the ascites
D careful volume loading and d/c of furosemide and spironolactone
E.increase the dose of furosemide
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| tolito
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D.
pre renal azot from third space loss
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| saadtazjam
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C?
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| MDcooper
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yes prerenal azotemia as BUN/creatinine is more than 20.The reason is third spacing of fluids.treatment is usually remove the cause .I would go with D.
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| study_ing
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good going ppl. d is the answer. the pt developed hepatorenal syndrome due to the use of diuretics. renal arterioconstriction is oimplicated in the pathogenesis. hence u try to restor evolume.
( i had chosen tapping of ascites too)
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