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Mr.Bellbottom, a 58 year male patient went to theatre for coronary artery bypass graft procedure. His normal BP pre.op is approximately 140/90mmhg.He weighs 80 kg.He had only two grarfts done, is haemodinamically stable and is only ventilated post op because he is extreemly hypothermic.Plan is to ventilate him for just 3--4 hrs and then extubate . Unfortunately he starts bleeding from his drains with in the first few hrs from theatre. He receives blood products including FFP and packed cells.Mr. Bellbottom is now severly haemodinamically unstable and is taken back to theatre after 4 hrs in the unit to re-open the chest. A bleeding anstomosis is found and repaired.He comes from theatre and the second hr back in the unit his vital data looks as follows.
BP:90/45mmhg
Hb 7g/dl
CVP 5
Pulse 135/mt
urine out put 25 ml/hr
Peripheral perfusion is poor.
Mr. bellbottom,s clinical signs and symptoms are managed with fluid boluses and a nor-adrenaline infusion.He also receives 5 more units of packed cells.
on the second day post op he is diagnosed with acute renal failure and his blood results are found to be as given on the relevent document attached.

Q1:What could have beem the possible causes of Mr.b going in to renal failure? Give three reasons and why you think these could have led to renal failure?
Q2: What type of renal failure do you think Mr.B has?What phase of renal falilure is he in?Motivate tha answer.
Q3: At one stage during Mr.B,s treatment he was receiving fluid boluses. If you could choose ,which fluid do you think would be most appropriate? Motivate the answer.

Q4:Interpret Mr.B,s U&E results.Give attention to the urea,creatinine,Na,K+ and Phosphate.What are the implications of the measurement as it is at present?

Q5:If it comes to doing RRT in Mr.B what type would be chosen?Motivate the answer.
Na 135
K+ 5.6
Bicarbs 26
chloride 91
urea 13.9
cratinine 201
glucose 9.5
calcium 2.28
calcium corrected 2.68
meg 1.38
Inorganic phosphate 0.90
total protien 48
Albumin 23
Globulin 25
Total bilurubin43
Alk. phos.113
AST 74
ALT 88
GT 158