02-24-2008, 02:36 PM
A previously healthy 15-year-old boy is brought to the
physician because of a 5-day history of fever, intractable
nausea and vomiting, sore throat, and muscle pain. His mother has been giving him ibuprofen and
amoxicillin that was remaining from a previous streptococcal throat infection. He appears ill, and his lips are parched.
His temperature is 38.9 C (102 F), blood pressure is 120/74 mm Hg while supine and 100/70 mm
Hg while standing, and pulse is 92/min while supine and 120/min while standing. Examination shows dry mucous membranes. The oropharynx is erythematous without exudate. There is shotty cervical adenopathy. The
abdomen is soft without organomegaly. Laboratory
studies show:
Serum
Na+ 138 mEq/L
Cl“ 98 mEq/L
K+ 3.4 mEq/L
HCO3“ 21 mEq/L
Urea nitrogen (BUN) 55 mg/dL
Glucose 105 mg/dL
Creatinine 1.3 mg/dL
Amylase 40 U/L
Urine
Ketones moderate
WBC negative
RBC negative
Na+ 8 mEq/L
Protein negative
Which of the following is the most likely explanation
for this patient's renal insufficiency?
A Acute tubular necrosis
B Amoxicillin-induced acute interstitial nephritis
C Ibuprofen-induced renal failure
D Post-streptococcal glomerulonephritis
E Severe volume depletion
thanx
physician because of a 5-day history of fever, intractable
nausea and vomiting, sore throat, and muscle pain. His mother has been giving him ibuprofen and
amoxicillin that was remaining from a previous streptococcal throat infection. He appears ill, and his lips are parched.
His temperature is 38.9 C (102 F), blood pressure is 120/74 mm Hg while supine and 100/70 mm
Hg while standing, and pulse is 92/min while supine and 120/min while standing. Examination shows dry mucous membranes. The oropharynx is erythematous without exudate. There is shotty cervical adenopathy. The
abdomen is soft without organomegaly. Laboratory
studies show:
Serum
Na+ 138 mEq/L
Cl“ 98 mEq/L
K+ 3.4 mEq/L
HCO3“ 21 mEq/L
Urea nitrogen (BUN) 55 mg/dL
Glucose 105 mg/dL
Creatinine 1.3 mg/dL
Amylase 40 U/L
Urine
Ketones moderate
WBC negative
RBC negative
Na+ 8 mEq/L
Protein negative
Which of the following is the most likely explanation
for this patient's renal insufficiency?
A Acute tubular necrosis
B Amoxicillin-induced acute interstitial nephritis
C Ibuprofen-induced renal failure
D Post-streptococcal glomerulonephritis
E Severe volume depletion
thanx