RENAL PROBLEMS AND CRITICAL CARE

A 64 year old male is admitted following a motor vehicle accident. He has a compound fracture of his femur, a fractured acetabulum and a widened mediastinum. He has a history of type II diabetes (12 years) and hypertension (for which he takes lisinopril). Arch aortogram is negative (for aortic dissection). The patient is brought to the operating room for repair of his compound fracture and fixation of his pelvis. He requires 12 units of blood in the operating room, and has a standard anesthetic – fentanyl, propofol, atracurium and isoflurane. He is given morphine and ketoralac for pain and ampicillin, gentamycin and metronidazole for his leg fracture.

The patient is extubated post op and sent to the floor. 36 hours after this he becomes oliguric, and his creatinine rises to 3.0

Why?

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