Acute Kidney Injury
A 62-ycar-old woman was initially seen in the emergency department for reports of continued, intense abdominal pain with nausea and vomiting. Following a computed tomography (CT) scan, she was taken to the operating room (OR) where surgical exploration revealed 5 ft of necrotic bowel, hemorrhagic ascites, and gross peritonitis. The bowel was excised and 460 mL of ascitic fluid was drained.
Upon admission to the critical care unit, the patient was intubated and ventilated and had a pulmonary artery catheter, urinary catheter, and nasogastric tube for intermittent suction placed. The assessment revealed the following:
Vital Signs
During the first 8 hours postoperatively, she received 5 L of lactated ringer solution in an effort to stabilize her blood pressure (BP) and increase her urine output.
Aggressive fluid resuscitation was continued throughout her first postoperative day to manage her continued labile blood pressure and poor urine output. Tests at that time revealed the following:
Arterial Blood Gases
A norepinephrine infusion was initiated. Ventilator changes were made and 88 mEq ofNaHC03 given IV.
On the second postoperative day, continuous renal replacement therapy (CRRT) was initiated to correct her metabolic acidosis and hyperkalemia sencodary to AKI (BUN 50 mg/dL; creatinine 2.8 mg/dL; K+ 6.2 mEq/L; arterial pH 7.26). The following day her blood pressure began to stabilize, her BUN, creatinine, and K+ were lower, and her pH returned to normal levels.
What type of renal failure may she be at riakfor?
Why was CRRT cho1en instead of intermittent hcmodialysia?