This patient’s renal injury can be classified as Pre-renal Acute Kidney Injury due to the presented symptoms. He has been with vomiting and diarrhea for 48 hours, and also was not able to tolerate solids of liquid foods. Pre-renal conditions typically do not cause permanent kidney damage (and hence are potentially reversible) unless hypo-perfusion is severe and/or prolonged. Hypo-perfusion of an otherwise functioning kidney leads to enhanced reabsorption of sodium and water, resulting in oliguria (urine output < 500 mL/day) with high urine osmolality and low urine sodium. Pre-renal causes are often apparent clinically. If so, correction of an underlying hemodynamic abnormality should be attempted. For example, in hypovolemia, volume infusion can be tried, in heart failure (HF), diuretics and after load-reducing drugs can be tried. Abatement of AKI confirms a pre-renal cause.
With this patient we can rule out acute intrinsic kidney failure since the patient hasn’t had any direct trauma to the kidneys. Also, any viruses from the burritos he ate, wouldn’t be sufficient to cause toxins overload in the body. We can also eliminate the possibility of ischemia because he lacks of blood in his stools. (Paller, 2020)
There are numerous risks factors that Mr. J.R. could have, some of them are:
-His advanced age, after 65 years, the kidneys start to show deterioration in their structure and function.
-Gastroenteritis: these clinical manifestations, nausea, vomiting and diarrhea are usually associated with AKI.
-Dehydration: Having an inadequate fluid intake due to his many symptoms (diarrhea, excessive sweating, vomiting, the inability to tolerate solid or liquid foods), makes him vulnerable to kidney damage.
Patients with Chronic Kidney Disease can have many hematological complications due to different reasons, Healthy kidneys produce a hormone called erythropoietin, or erythropoietin for short. When the body senses low oxygen levels, it tells the kidneys to release erythropoietin. This hormone tells your bone marrow to make more red blood cells. More red blood cells in the bloodstream mean more oxygen can be transported. However, if the kidneys are damaged, they may make little or no erythropoietin. Iron is a mineral found in protein-rich foods that helps make hemoglobin, the protein in the red blood cell that carries oxygen. A major source of iron is red meat. Because patients in the early stages of kidney disease are advised to reduce the amount of protein they eat, they may not be getting adequate amounts of iron from their diet. The buildup of waste in the bloodstream can also affect red blood cells. Healthy kidneys filter toxins from the bloodstream but kidneys affected with chronic kidney disease are unable to filter as well as they should. Because the body is unable to get rid of this waste, it remains in the bloodstream where it can shorten the lifespan of the existing red blood cells.
She is probably suffering from Gonorrhea, some supporting symptoms for this diagnosis would be the vaginal discharge that is slightly green, she also presents pain in the lower abdomen and fever. Another supporting signs would be the presence of a Gram negative bacteria of the diplococcal type. (Hill, Masters, & Wachter, 2016)
The microorganism involved would be Neisseria Gonorrhea, the gonococcus, is a non-spore-forming, nonmotile bacterium that appears under the microscope as a Gram-negative coccus occurring in pairs (diplococci) with flattening of the adjacent sides. Gonococci are adapted to growth on mucous membranes and cannot tolerate drying. Their fragility limits their transmissibility to direct contact between mucous membranes or the direct exchange of infected secretions. In women, gonococci may cause asymptomatic or symptomatic endocervical infections, or upper genital tract disease. Gonococcal infections of women are closely associated with infertility and as a result, females disproportionately suffer the consequences of infection. For both men and women, but more commonly in women, local gonococcal infection can progress to bacteremia with attendant septic arthritis. In fact, gonococcal arthritis is the most common etiology of arthritis in young people. When infection involves the eyes, especially in newborns, blindness can result if treatment is not prompt. Rarely, bacteremia results in dissemination to the joints, skin , endocardium or meninges.
There are so many safe and effective single agent regimens that combination regimens, with their increased risk of adverse drug reactions, are unnecessary. For complicated infections, treatment with a higher dose of a single agent (e.g., 1 g instead of 125 mg of ceftriaxone for ophthalmia) or with multiple doses of a single agent (e.g., 4 weeks of therapy with ceftriaxone for endocarditis) is recommended, rather than adding a second antigonococcal agent.
Since Gonorrhea is a bacterial disease that can be treated with antibiotics; with only using a single dose of 250g of ceftriaxone and 1g of azithromycin, it can be cured. We need to let the patient know that her medication can not be shared, and that it is only for her.
Some criteria that could be used to recommend hospitalization for this patient will be based in different aspects: if her symptoms get worse, if she is pregnant, has a tubo-ovarian abscess, is immunocompromised, or is she fails to improve with outpatient treatment.
We need to explain her that importance of receiving treatment, because untreated gonorrhea infections in women may lead to several conditions, including: Pelvic inflammatory disease (PID): PID can develop from several days to several months after infection with gonorrhea. Left untreated, PID can cause infertility. Chronic menstrual difficulties. Postpartum endometritis: inflammation of the lining of the uterus after childbirth. Miscarriage. Cystitis: inflammation of the urinary bladder. Mucopurulent cervicitis: characterized by a yellow discharge from the cervix. About 1% of people with gonorrhea may develop disseminated gonococcal infection (DGI), which is sometimes called gonococcal arthritis. DGI occurs when gonorrhea infection spreads to sites other than genitals, such as the blood, skin, heart, or joints.