Case

• 44 y.o. female s/p lap hernia repair

• Readmitted with acute cholecystitis poor appetite for 2 wks.

• 1 day Post op required reintubation

• Then developed renal failure

Case of ARF

• Normal Renal Ultrasound

• No IV contrast exposure.

• No ACE or nephrotoxic antibiotic.

• No urinary obstruction.

• Pt is feeling better and eating better, despite ARF.

Hypophosphatemia and ARF

0

10

20

30

16 18 19 20

Creat

Phos

BUN

CreatPhosBUN

1.40.4

4.78.8

1.0 3.1

615

46

8

Cause of ARF?

• A. Hemodynamic effect of surgery

• B. Dehydration

• C. Rhabdomyolysis

• D. Obstruction of ureter?

ARF Case• Classic presentation of Hypophosphatemic

rhabdomyolysis.• Prolonged NPO status/starvation• Resp failure requiring reintubation after extubation

or surgery. Due to resp muscle weakness.• Phos goes very low, then suddenly climbs without

any supplementation. Associated with high K and Low calcium.

• Creatinine climbs more than 1.0 mg/dl/day, suggesting increased creatinine production.

Hypophosphatemia and ARF

0

10

20

30

16 18 19 20

Creat

Phos

BUN

CreatPhosBUN

1.40.4

4.78.8

1.0 3.1

615

46

8

Markers of Malnutrition

• K• Albumin• Phos• BUN• Calcium

• 3.0• 1.2• 2.0• 3• 7.0

Labwork on admission, May 2008