snake0613
Forum Elite
Topics: 97
Posts: 194
|
A 54-year-old woman with a 10-year history of
progressive systemic sclerosis (scleroderma)
undergoes an emergency laparotomy for a
perforated appendix with peritonitis. During the
immediate postoperative period, she has a blood
pressure of 180/110 mm Hg. Over the next 3
days, her serum creatinine concentration increases,
and her urinary output decreases to 250 mL/day.
On postoperative day 4, she has mild shortness of
breath. Her peripheral oxygen saturation on room
air is 89%. Serum studies show a potassium
concentration of 6.2 mEq/L, a urea nitrogen
concentration of 34 mg/dL, and a creatinine
concentration of 3.9 mg/dL. Which of the
following is the most appropriate next step in
management?
(A) Intravenous administration of ACE
inhibitors
(B) Intravenous administration of morphine
(C) Fluid bolus with 2 L of lactated Ringer
solution
(D) Hemodialysis
(E) Peritoneal dialys
please give your answer and explanations thanks
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| move along
Forum Senior
Topics: 11
Posts: 188
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she has indications for dialysis.....definitely
hyperkalemic, seemingly volume overloaded ( droopped u.o.), creat shooting,
peritoneal dialysis is out coz she is just recoviering from peritonitis
i would go or D hemodialysis.
A ace inhibitor contraindicated with such high creatinine
b morphine is pointless
c fluid bolus can t help either....she is not in prerenal ....taking the bun and creat into consideration....
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| prasannakumar
Forum Senior
Topics: 24
Posts: 55
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D. Hemodialysis
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| dr in trouble
Forum Guru
Topics: 62
Posts: 610
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i will go for D, but why the pt develop those symptoms (is it due to constrictive pericarditis??)
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| snake0613
Forum Elite
Topics: 97
Posts: 194
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yes it is sure to be D, I found the explanation of kaplan for USMLE CD test 3 was wrong, it gave the A choice;
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| tanmaynator
Forum Senior
Topics: 12
Posts: 153
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i think she probably went into a scleroderma renal crisis.. Hemodialysis as she has all the indications.. but once it is settled use ACEIs as they are indicated for the scleroderma renal crisis..
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| arlete
Forum Fanatic
Topics: 50
Posts: 3,726
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OK, but be always very careful with ACEI in the presence of hyperkalemia.
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Que sera sera whatever will be will be...
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| virgola82
Forum Guru
Topics: 85
Posts: 348
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I agree, i think hemodialysis is the best treatment now. Later the patient should get ACEI if the K is not high and possibly peritoneal dialysis if long term renal replacement is needed
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