A 56-year-old man presented to the emergency room
(ER) with complaints of chest pain and shortness of breath. The patient
reported a sudden experience of tightness in his chest while doing yard work 4
hours prior to the ER visit. He has subsequently been experiencing episodes of
nausea and periods of coughing. His past medical history is significant for
hypertension, type 2 diabetes mellitus, and hypercholesterolemia. His current
home medications are metoprolol, metformin, and simvastatin; his wife pointed out
that he does not take his medications regularly.
He has no known allergies.
He smoked 30 packs of cigarettes per year for the past 30 years, and consumes 2 to 3 glasses of wine per day in addition to 2 cups of coffee. The patient denies any history of recreational drug use.
The patient does not exercise regularly.
In this case, a patient presented to the emergency department with symptoms characteristic of a myocardial infarction and subsequently underwent emergency CABG surgery. Following surgery, the patient remained relatively stable on the first postoperative day. By day 2, the patient had become oliguric and elevations in serum BUN and creatinine were noted. Despite volume challenges, these levels rose for a second day. A diagnosis of AKI was made, most likely secondary to multiple insults: hypotension, radiocontrast dye, and cardiac surgery. Approximately 5% to 15% of patients undergoing cardiac surgery with the use of cardiopulmonary bypass have AKI, and roughly 10% of these cases require dialysis. The in-hospital mortality rate associated with postoperative AKI requiring dialysis is upwards of 35% with a 2-year survival rate less than 20%.
He has no known allergies.
He smoked 30 packs of cigarettes per year for the past 30 years, and consumes 2 to 3 glasses of wine per day in addition to 2 cups of coffee. The patient denies any history of recreational drug use.
The patient does not exercise regularly.
In this case, a patient presented to the emergency department with symptoms characteristic of a myocardial infarction and subsequently underwent emergency CABG surgery. Following surgery, the patient remained relatively stable on the first postoperative day. By day 2, the patient had become oliguric and elevations in serum BUN and creatinine were noted. Despite volume challenges, these levels rose for a second day. A diagnosis of AKI was made, most likely secondary to multiple insults: hypotension, radiocontrast dye, and cardiac surgery. Approximately 5% to 15% of patients undergoing cardiac surgery with the use of cardiopulmonary bypass have AKI, and roughly 10% of these cases require dialysis. The in-hospital mortality rate associated with postoperative AKI requiring dialysis is upwards of 35% with a 2-year survival rate less than 20%.
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