Acute Renal Failure - Essay Example

"Acute Renal Failure" is an exceptional example of a paper on the endocrine system.
Based on the symptoms and signs presented, the patient is suffering from acute renal failure caused by sepsis. This condition is related to illicit drug abuse (heroin, cocaine, and amphetamine); used for a period of ten years. The misuse of these drugs has led to renal failure, which in this case is brought about by sepsis. Sepsis is exemplified by a generalized inflammatory response and commencement of the coagulation and fibrinolytic cascades, leading to endothelial injury with electrolyte imbalances. This is evident from the case, as the patient has presented to the clinic with painful swollen right leg, hypotensive, hypothermic, and tachycardic; clearly, the patient has inflicted direct muscle injury to himself. This is via the administration of injections; resulting in a breakdown of muscle fibres.

History questions or physical exam aspects that might help support the diagnosis

Symptoms of the mentioned diagnosis are seen in a few patients presenting with this situation; thus direct diagnosis is not appropriate. Questions that ought to be asked to the patient to aid in proper diagnosis include muscle injury history (this is inclusive of where the patient directly injects himself; when? Where? How?), drug use (which drugs were used recently and currently), and history of urological obstruction (McCance & Huether, 2014). 

In addition to questions, comprehensive tests must be carried out. This is inclusive of laboratory tests i.e. urinalysis test, hypocalcemia or hypercalcemia test, hypophosphatemia test and elevated liver enzyme levels test. According to Rosen et al. (2010), intracellular products have to be analyzed for leakage, as myocytes destruction and muscle membranes result to leakage of intracellular products in the circulatory system (p. 1657). This is evident from a serum potassium level of 6.5 noted from lab tests. Physical examinations also have to be carried out. This includes a comprehensive examination of the skin for pressure necrosis.

Management recommendations

 The initial thing to do in managing this condition is aggressive fluid resuscitation of the patient via intravenous hydration. This is because when renal failure occurs, the systemic and local dysregulation of sepsis is compounded by the loss of metabolic, fluid, and electrolyte homeostasis. According to Brashers (2006), forced diuresis must be commenced within the initial six hours of admission, to reduce acute renal failure. In addition, as per Ronco et al. (2009), intravenous antibiotics must be administered within the first hour of diagnosing the condition linked to sepsis (p. 878). Hemodialysis is needed due to renal failure, in the extraction of byproducts of myocytes necrosis, in the correction of fluid overload and solutes removal. Moreover, lung-protective ventilation is a key management strategy. Also, a broad spectrum of antibiotics is required i.e. ceftriaxone, ticarcillin-clavulanate, piperacillin-tazobactam, imipenem-cilastatin, meropenem, cefepime, gentamicin, levofloxacin, and ciprofloxacin. Prescription medications i.e. vasopressors (norepinephrine, dopamine, and epinephrine). Vasopressin use has been noted to increase urinary output, increase in blood pressure, and creatinine clearance. As an essential management precaution for such a case in the future, the patient must be advised on the avoidance of muscle destruction; especially via illicit drug abuse. The best recommendation for this strategy is encouraging the patient to go to a rehabilitation centre so that he may be helped (Daugirdas, 2011).