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Case of the Month

  June 2015

A 74 male patient admitted to hospital being unwell. He was found to have AKI and his blood urea was 16.5 mmol/l and S.Creatinine was 370 m mol/l ( was 77 m mol/l last year) . He had recent onset back pain for which he was on Naproxen daily over the last 10 days . He was also on Ramipril for hypertension and his Diabetes was controlled by metformin. On admission Naproxen, Metformin and Ramipril all stopped and he commenced on Atenolol for blood pressure control.Patient showed good response to IV fluids and workup started to find out the cause of his AKI.

Results came back as the following:

B. Urea 13 mmol/l
S.Creatinine 300 mmol/l
HB 94 g/l
S. Na 139 mmol/l
S. K 3.2 mmol/l
S.Calcium 2.64 mmol/l
S.Phosphorus 0.60 mmol/l
UPCR 209 mg /mmol
Urine dipstick Blood ++, Glucosuria
US KUB Normal Kidneys

This patient has an acidosis. Which of the following is most likely?

Read: 258 times Answered: 63 times Top score: 100%

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