sandra
Forum Guru
Topics: 180
Posts: 425
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A previously healthy 15-year-old boy is brought to the
physician
because of a 5-day history of fever, intractable
nausea and vomiting, sore
throat, and muscle pain. His mother has been giving
him ibuprofen and
amoxicillin that was remaining from a previous
streptococcal throat
infection. He appears ill, and his lips are parched.
His temperature is
38.9 C (102 F), blood pressure is 120/74 mm Hg while
supine and 100/70 mm
Hg while standing, and pulse is 92/min while supine
and 120/min while
standing. Examination shows dry mucous membranes.
The oropharynx is
erythematous without exudate. There is shotty
cervical adenopathy. The
abdomen is soft without organomegaly. Laboratory
studies show:
Serum
Na+ 138 mEq/L
Cl– 98 mEq/L
K+ 3.4 mEq/L
HCO3– 21 mEq/L
Urea nitrogen (BUN) 55 mg/dL
Glucose 105 mg/dL
Creatinine 1.3 mg/dL
Amylase 40 U/L
Urine
Ketones moderate
WBC negative
RBC negative
Na+ 8 mEq/L
Protein negative
Which of the following is the most likely explanation
for this
patient's renal insufficiency?
A
) Acute tubular necrosis
B
) Amoxicillin-induced acute interstitial nephritis
C
) Ibuprofen-induced renal failure
D
) Post-streptococcal glomerulonephritis
E
) Severe volume depletion
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| hope4dabest
Forum Elite
Topics: 16
Posts: 433
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Pre-renal failure....E ?????
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| nyimalay
Forum Elite
Topics: 9
Posts: 280
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Yes E
BUN:creatinine > 20:1
Urinary Na <10 mEq /L
Ketone: because of starvation
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| shahnaz.r
Forum Junior
Topics: 6
Posts: 72
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E
pre-renal azotemia
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| mesh
Forum Guru
Topics: 77
Posts: 401
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E dehydration
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