A 45-year old man presented to the hospital with alcohol withdrawal. After drinking a pint of brandy daily for the past 5-6 years, he decided to stop drinking 4 days ago. he experienced tremors and then visual and auditory hallucinations. On arrival at the hospital, he was diaphoretic and tachycardiac, with a pulse rate of 102. His chemistry results are shown below:
Na+
130 mmol/L
K+
3.7 mmol/L
Cl-
90 mmol/L
CO2
20 mmol/L
BUN
81 mg/dL
Creatinine
4.0 mg/dL
Magnesium
1.4 mg/dL
Alcohol
Negative
Total Protein
7.1 g/dL
Albumin
3.7 g/dL
Medical history included arthritis, hypertension, depression, and alcoholism. He had been taking an anti-inflammatory medication for arthritis and an antidepressant. Overnight, he became agitated and required increasing doses of a benzodiazepine, together with physical restraints for behavior control. The next morning, he was transferred to the ICU where he was evaluated for acute renal failure. The patient was rehydrated and his arthritis and antidepressant medication were withheld. Lab test results are listed below:
Na+
139 mmol/L
K+
3.5 mmol/L
Cl-
107 mmol/L
CO2
23 mmol/L
BUN
16 mg/dL
Creatinine
1.4 mg/dL
Questions:
Is the patient still in acute renal failure? Explain your answer.
What was the cause of his acute renal failure?
Why has the patient's electrolyte status improved?
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