Renal failure Quiz: Ace Your Exams
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A 48-year-old woman presents to the emergency department for evaluation of intractable vomiting for the past 24 hours. Last night she ate a hamburger from a local restaurant, and since then she has had multiple episodes of bilious emesis. Past medical history is significant for osteoarthritis and hypertension. Current medications include ibuprofen and lisinopril. Her temperature is 36.6°C (97.8° F), pulse is 110/min, respirations are 21/min, and blood pressure is 101/62 mm Hg. Physical examination demonstrates decreased skin turgor and dry oral mucosa. A liver function assay is within normal limits. The remainder of the laboratory studies are shown below.
Which of the following is the most likely etiology of this patient's clinical condition?
| Laboratory value | Result |
| Complete blood count | |
| Hemoglobin | 13 g/dL |
| Leukocytes | 10,000 /mL |
| Platelets | 330,000/mm3 |
| Serum chemistry | |
| Sodium | 136 mEq/L |
| Potassium | 2.8 mEq/L |
| Chloride | 85 mEq/L |
| Bicarbonate | 29 mEq/L |
| Creatinine | 1.7 mg/dL |
| Blood urea nitrogen (BUN) | 40 mg/dL |
| Urinalysis | |
| Erythrocytes | 1-2/hpf |
| Leukocytes | 1-2/hpf |
| Fractional excretion of sodium (FENa) | <1% |
| Urine osmolality | 650 mOsm/kg |
| Sediment | None |
Which of the following is the most likely etiology of this patient's clinical condition?
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