18. A man, 67, is playing golf with friends when he becomes
confused and begins speaking in nonsense words. At first his
friends think he is joking with them about a bad swing, but then
he experiences numbness in his face and legs and collapses,
holding his head in pain. He is rushed to the hospital and
immediately undergoes coronary angioplasty to open a blocked
coronary artery. Prior to his surgery, he has had a history of
diabetes and hypertension and is a 2-pack-per-day smoker.
He has been taking an ACE-inhibitor for his hypertension and
heart failure from atherosclerotic cardiovascular disease. He is
of average weight. Within 24 hours after his surgery, he begins
to complain of severe back pain, lower limb edema, headache,
vomiting, as well as swelling around the eyes and shortness
of breath. Urinalysis and blood tests reveal high serum urea
and creatinine levels; glomerular filtration rate (GFR) test
reveals decreased kidney function, probably caused in part by
long-term effects of his ACE-inhibitor medication. He is now
diagnosed with acute renal failure. After in-hospital stabilization
and medication adjustments, he is referred to a dietician for
nutritional support focused on his recent acute renal failure to
help control and then maintain his fluid and electrolyte balance
in hopes of preventing complications such as infection.
