Oliguria with fatigue, somatic pain, vomiting, and diarrhea

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

Abbreviations: ABG = Arterial blood gases, BUN = Blood urea nitrogen, CBC = Complete blood count, CT = Computed tomography, CRP = C - reactive protein, ECG = Electrocardiogram, ESR = Erythrocyte sedimentation rate, IVP = Intravenous pyelography, KFT = Kidney function test, GI = Gastrointestinal, GFR = Glomerular filtration rate, MRI = Magnetic resonance imaging, PT = Prothrombin time

Etiology Clinical manifestations Paraclinical findings Comments
Symptoms and signs Lab findings Imaging
Fatigue/

Lethargy

Thirst Dizziness/

Confusion

Muscle weakness/

cramp

Somatic/

visceral pain

Vomiting Diarrhea Tachypnea Edema Blood indices Renal Funtion test Electrolytes Urine analysis ABG Other Ultrasound X-ray CT MRI Other
Prerenal causes Alcohol poisoning[1][2] + - +/- - +/- + +/- - - ↑PT ↑BUN, ↑Cr (isopropyl alcohol) ↓Na Not applicable ↓HCO3 LFT Not applicable Not applicable Not applicable Not applicable - Thiamine must be given to prevent Wernicke's encephalopathy
Drugs/toxins[3][4] +/- +/- +/- +/- +/- +/- +/- +/- +/- Not applicable ↑BUN, ↑Cr, ↑CK ↑K, ↓Mg, ↓Ca, ↓P Ingested drug, Glucose, Aminoacid, Phosphate, Ketone, Hyaline cast, RBC ↑Lactate, Metabolic acidosis Toxicology, Rapid immunoassay Nephropathy Radioopaque substances, Ingested drug packets Not applicable Not applicable - -
Peritonitis[5][6] +/- - +/- - +/- +/- +/- - - Leukocytosis Not applicable Not applicable Not applicable Not applicable Ascitic fluid neutrophil count > 500 cells/µL Not applicable Not applicable Not applicable Not applicable - -
Toxic megacolon[7] +/- +/- +/- - + + +/- - - Leukocytosis, Anemia, ↑ESR and CRP ↑BUN, ↑Cr ↓Na Not applicable Not applicable Loss of haustra, Hypoechoic and thick bowel walls, Dilated colon > 6cm, Dilatation of ileal loops Dilated colon, Free intraperitoneal air Bowel perforation, Abscess Not applicable Not applicable Endoscopy and colonoscopy -
Renal causes Acute interstitial nephritis[8][9] +/- - +/- - +/- +/- +/- +/- +/- Eosinophilia ↑BUN, ↑Cr, ↑FENa Not applicable Eosinophiluria, Sterile pyuria, Microscopic hematuria, Proteinuria Not applicable ↑Total IgG, ↑IgG4 Normal-sized kidneys Not applicable Not applicable Not applicable - History of long term analgesic use
Hemolytic uremic syndrome[10][11][12] +/- - +/- +/- +/- + + - +/- Severe anemia, Thrombocytopenia, ↑ aPTT ↑BUN, ↑Cr Not applicable Mild proteinuria, Red blood cells, Red blood cell casts Not applicable Schistocytes, ↑FDP and D-dimer, ↑ Bilirubin, ↑LDH, ↓Haptoglobin, Stool culture (for E coli 0157:H7 or shigella), ↓ADAMTS-13 activity Ruling out obstruction Not applicable Not applicable Not applicable Diffuse thickening of the glomerular capillary wall, Swelling of endothelial cells, Fibrin thrombi in renal biopsy -

References

  1. ↑ Pletcher MJ, Maselli J, Gonzales R (December 2004). "Uncomplicated alcohol intoxication in the emergency department: an analysis of the National Hospital Ambulatory Medical Care Survey". Am. J. Med. 117 (11): 863–7. doi:10.1016/j.amjmed.2004.07.042. PMID 15589492.
  2. ↑ Cherpitel CJ (March 1989). "Breath analysis and self-reports as measures of alcohol-related emergency room admissions". J. Stud. Alcohol. 50 (2): 155–61. PMID 2927129.
  3. ↑ Toto RD, Mitchell HC, Lee HC, Milam C, Pettinger WA (October 1991). "Reversible renal insufficiency due to angiotensin converting enzyme inhibitors in hypertensive nephrosclerosis". Ann. Intern. Med. 115 (7): 513–9. PMID 1883120.
  4. ↑ Bismuth C, Gaultier M, Conso F, Efthymiou ML (1973). "Hyperkalemia in acute digitalis poisoning: prognostic significance and therapeutic implications". Clin. Toxicol. 6 (2): 153–62. doi:10.3109/15563657308990513. PMID 4715199.
  5. ↑ Such J, Runyon BA (October 1998). "Spontaneous bacterial peritonitis". Clin. Infect. Dis. 27 (4): 669–74, quiz 675–6. PMID 9798013.
  6. ↑ Runyon BA (October 1990). "Monomicrobial nonneutrocytic bacterascites: a variant of spontaneous bacterial peritonitis". Hepatology. 12 (4 Pt 1): 710–5. PMID 2210672.
  7. ↑ Jalan KN, Sircus W, Card WI, Falconer CW, Bruce CB, Crean GP, McManus JP, Small WP, Smith AN (July 1969). "An experience of ulcerative colitis. I. Toxic dilation in 55 cases". Gastroenterology. 57 (1): 68–82. PMID 5305933.
  8. ↑ Schwarz A, Krause PH, Kunzendorf U, Keller F, Distler A (September 2000). "The outcome of acute interstitial nephritis: risk factors for the transition from acute to chronic interstitial nephritis". Clin. Nephrol. 54 (3): 179–90. PMID 11020015.
  9. ↑ Praga M, González E (June 2010). "Acute interstitial nephritis". Kidney Int. 77 (11): 956–61. doi:10.1038/ki.2010.89. PMID 20336051.
  10. ↑ Noris M, Remuzzi G (April 2005). "Hemolytic uremic syndrome". J. Am. Soc. Nephrol. 16 (4): 1035–50. doi:10.1681/ASN.2004100861. PMID 15728781.
  11. ↑ Goodship TH, Cook HT, Fakhouri F, Fervenza FC, Frémeaux-Bacchi V, Kavanagh D, Nester CM, Noris M, Pickering MC, Rodríguez de Córdoba S, Roumenina LT, Sethi S, Smith RJ (March 2017). "Atypical hemolytic uremic syndrome and C3 glomerulopathy: conclusions from a "Kidney Disease: Improving Global Outcomes" (KDIGO) Controversies Conference". Kidney Int. 91 (3): 539–551. doi:10.1016/j.kint.2016.10.005. PMID 27989322.
  12. ↑ Loirat C, Fakhouri F, Ariceta G, Besbas N, Bitzan M, Bjerre A, Coppo R, Emma F, Johnson S, Karpman D, Landau D, Langman CB, Lapeyraque AL, Licht C, Nester C, Pecoraro C, Riedl M, van de Kar NC, Van de Walle J, Vivarelli M, Frémeaux-Bacchi V (January 2016). "An international consensus approach to the management of atypical hemolytic uremic syndrome in children". Pediatr. Nephrol. 31 (1): 15–39. doi:10.1007/s00467-015-3076-8. PMID 25859752.
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