Prerenal acute kidney injury Quiz: Ace Your Exams
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A 72-year-old man comes to the emergency department with a 3-day history of vomiting and diarrhea. The patient had seafood at a restaurant three days ago and subsequently developed intractable nausea, vomiting, abdominal pain, and diarrhea. He has not been able to tolerate oral intake for the past 3 days. He has a past medical history of hypertension and type 2 diabetes mellitus. Temperature is 99.9 F, pulse is 114/min, blood pressure is 96/56 mmHg, respiratory rate is 14/min, and oxygen saturation is 99% on room air. Physical examination reveals dry mucous membranes and decreased skin turgor. Abdominal exam is significant for mild diffuse abdominal tenderness without rebound or guarding. Laboratory studies are shown below. Which of the following is the best next step in management?
| Laboratory Test | Result | Reference Range |
| Sodium | 134 mEq/L | 136-146 mEq/L |
| Potassium | 3.3 mEq/L | 3.5-5 mEq/L |
| Chloride | 105 mEq/L | 95-105 mEq/L |
| Bicarbonate | 31 mEq/L | 22-28 mEq/L |
| BUN | 30 mg/dL | 7-18 mg/dL |
| Creatinine | 1.6 mg/dL (Patient’s baseline is 0.9 mg/dL) | 0.6-1.2 mg/dL |
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