09-05-2011, 12:21 PM
A 55-year-old man with severe headache and fever is admitted to the hospital. He has a past medical history of diabetes mellitus. He is disoriented and lethargic. There is no history of alcohol or cigarette use. Vital signs are temperature 40°C (104°F), pulse 100 beats/min, respirations 22 breaths/min, and blood pressure 100/60 mm Hg. A complete blood count shows an elevated white blood cell count and anemia. Cerebrospinal fluid analysis reveals gram-negative diplococci. The patient is started on intravenous antibiotic therapy. Later that day, the patient is noted to have generalized tonic-clonic seizures. He is intubated, and the seizures are controlled with benzodiazepines. Despite antiseizure medications, he continues to have intermittent episodes of seizures. The following day, the nurse notes decreased urine output with onset of brown-colored urine. Urinalysis reveals hematuria. Laboratory examination reveals elevated serum creatinine level. The laboratory study that would be most beneficial in determining the cause of his renal problems is
A. Peripheral blood smear analysis
B. Serum creatine kinase
C. Urine cytology
D. Urine microscopy
E. Urine toxicology screen
A. Peripheral blood smear analysis
B. Serum creatine kinase
C. Urine cytology
D. Urine microscopy
E. Urine toxicology screen