[Expert Solution]: Case 2 P.W

Case 2 P.W. is 23 years old. He was the victim of a hit-and-run auto-pedestrian accident and suffered multiple abrasions, a concussion, and a deep laceration of his left thigh. He was discovered approximately 2 hours after the incident and is now in the emergency department. P.W.’s vital signs and hematocrit suggest that he has had a blood loss of about 2500 ml. A urinary catheter is inserted to monitor urine output, and fluid resuscitation is initiated while his wounds are cleaned and sutured. The urine output is averaging 15 ml/hr, with a high urine osmolality and low urine sodium. Discussion Questions 1. What type of renal failure is P.W. likely developing? What data support this conclusion? 2. Without adequate therapy, what may develop? Why? What is the best therapy for preventing this from occurring? 3. In addition to urine output, what laboratory data should be monitored to assess changes in P.W.’s renal function? 4. If P.W.’s renal function does not return to normal, but continues to be diminished, what are the subsequent stages of his renal disorder and what clinical problems do they present?