Aminoglycoside nephrotoxicity
1988; Elsevier BV; Volume: 33; Issue: 4 Linguagem: Inglês
10.1038/ki.1988.83
ISSN1523-1755
Autores Tópico(s)Biomedical Research and Pathophysiology
ResumoCase presentationA 74-year-old man with a history of peptic ulcer disease arrived at the hospital complaining of persistent midepigastric pain that had lasted 3 days but which had worsened over the previous 24 hours.Because he was nauseated, he had taken little by mouth except ginger ale over the 2 days prior to admission.Physical examination revealed a temperature of 99.rF, an orthostatic blood pressure drop from 120/82mm Hg lying to 90/58 mm Hg standing, and an orthostatic pulse rate elevation from 90/minto 120/mm.He had abdominal tenderness without rebound in the midepigastrium.Laboratory data disclosed BUN, 40 mg/dl; serum creatinine, 1.8 mgldl; and amylase, 190 Somogyi units/dI (normal, 80-200 units).Urinalysis was normal and examination of a random urine collection revealed a sodium concentration of 4 mEq/liter, urine osmolality of 750 mOsm/kg HO, and FEN., of 0.4c.The patient was treated with intravenous fluids and nasogastric suction.Six hours after admission, he developed severe midepigastric pain with rebound tenderness and a temperature of l02.5F.The clinical diagnosis of perforated peptic ulcer was confirmed at operation and an exploratory taparotomy was done.Immediately postoperatively, the BUN was 28 mg/dI and serum creatinine 1.4 mg/dl.The patient was given clindamycin, 500 mg every 6 hours, and gentarnicin.80 mg every 8 hours.Three days later, blood cultures grew Pseudomonas aeruginosa sensitive to gentamicin and tobramycin.Both antibiotics were continued.The patient stabilized and improved, maintaining a urine output of 1500 mI/day.Six days after operation.laboratory studies revealed a BUN of 30 mg/dl and a serum creatinine of 2.7 mg/dl; no BUN and creatinine determinations had been done in the interval.
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