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Old 02-27-2011
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Emergency Multiple Injuries and Blood Loss what caused the renal failure?

A 40 year old man had a road traffic accident. He fractured his right femur, had a deep cut on the upper arm and injuries to his abdomen. Reached a hospital 6 hours later. He was conscious but disoriented, BP was 80/40, extremities were cold and clammy. X ray confirmed the # femur, broken ribs with a hemothorax. On ultra-sound ...of abdomen the spleen was ruptured. His Hb was 6 gm/dl. He was given IV saline, 3 units of blood, and rushed to surgery. Splenectomy was done, a liter of blood-stained fluid was removed from his abdomen, a chest tube was put in the chest and 600ml of blood was aspirated, his femur was splinted and arm wound was stitched.
4 hours post-op he had passed only 20 ml of urine. Initial S creatinine was 1.1 mg/dl & 12 hours later the creatinine was 2.2 mg/dl.

What is the diagnosis?
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Old 02-27-2011
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multiple injuries leading to blood loss ( abdomen , thorax , thighs) , hypovolemic shock >> renal hypoperfusion and shut down >> low urine output and doubled creatinine
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Old 02-27-2011
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1st possibility.......... rhabdomyolysis
2nd .... prerenal failure 2ny to hypovolemic shock -- renal hypoperfusion then shut down
.???are there any choices..or it is a real case??
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Old 02-27-2011
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it was a real case of renal failure 2ndry to shock
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