# Mr. X., a 63-year-old white man, was admitted for ST elevation MI. He was in his...

###### Question:

Mr. X., a 63-year-old white man, was admitted for ST elevation MI. He was in his normal state of health until 6 hours before admission, when he developed substernal chest pain (SSCP) with radiation to his left arm. Pain was accompanied by mild diaphoresis. After self-administering antacids without relief, he asked his wife to take him to the emergency department (ED). In the ED, he was found to be anxious and diaphoretic, and he complained of dyspnea and 9/10 SSCP. Initial vital signs were as follows: temperature 37.5°C, BP 90/60, pulse 105, respiratory rate 24, peripheral capillary oxygen saturation 92% on 4 L nasal cannula. The physical exam was significant for an elevated jugular venous pressure and pulmonary crackles halfway up bilaterally. Mr. X. did not have any peripheral edema. His past medical history included hypertension for 22 years with variable control, hyperlipidemia, CKD (baseline serum creatinine of 1.8 mg/dL), and type II diabetes mellitus for 15 years. Initial labs in the ED were notable for a serum creatinine of 1.9 mg/dL, an elevated troponin, and 2+ protein on urinalysis. EKG revealed 3 mm ST elevation in leads II and AVF. Chest x-ray revealed moderate pulmonary artery prominence. Home medications include aspirin 81 mg QD, Lisinopril 20 mg QD, Lantus 15 units QHS, Lasix 20 mg, and atorvastatin 20 mg QHS. Aside from supplemental oxygen, Mr. X received aspirin 325 mg and nitroglycerin SL 0.4 mg in the ED. Post SL nitroglycerin, his chest pain remained unchanged and his BP decreased to 85/50; HR 110. The patient was evaluated by the cardiology department and emergently taken to the catheterization laboratory; coronary angiography revealed a 95% stenotic lesion in the mid-right coronary artery. The remaining arteries showed no flow limiting. The patient underwent percutaneous transluminal angioplasty and placement of a bare metal stent. He received 175 mL of IV contrast dye. Following the procedure, the patient started on Plavix, SSI, beta-blocker therapy, and continued on daily aspirin. On postprocedure day 1, the patient was feeling well and chest pain free. BP was 140/85, HR 70, SPO2 95% on RA. Urine output was 1,100 mL and serum creatinine was 1.8 mg/dL. On postprocedure day 2, urine output had decreased to 600 mL. Serum creatinine was 1.9 mg/dL. By postprocedure day 3, the patient was oliguric with a total urine output of 200 mL and required 4 L nasal cannula supplemental oxygen to maintain SPO2 over 92%. Serum creatinine was 2.7 mg/dL. Chest x-ray revealed pulmonary edema and retained contrast could be seen in the visible portion of the kidneys. 1. What information supports the diagnosis of AKI in Mr. X. versus progression of his CKD? 2. What makes Mr. X. at risk for contrast-induced nephropathy? 3. In caring for Mr. X., what fluid and electrolyte and acid–base alterations may be anticipated?

#### Similar Solved Questions

##### Question 9 A thin rod of length 0.73 m and mass 100 g is suspended freely...
Question 9 A thin rod of length 0.73 m and mass 100 g is suspended freely from one end. It is pulled to one side and then allowed to swing like a pendulum, passing through its lowest position with angular speed 3.28 rad/s. Neglecting friction and air resistance, find (a) the rod's kinetic energy...
##### Draw the product of the reaction. Select Draw Rings M ore Erase Pt + H2
Draw the product of the reaction. Select Draw Rings M ore Erase Pt + H2...
##### New York is getting ready for a busy tourist season. They want to increase production or...
New York is getting ready for a busy tourist season. They want to increase production or at least produce the same amount as last year, depending on the demand level for the coming season. NY estimates the probabilities for high, medium and low demands to be 0.5, 0.3, 0.2 respectively. These estimat...
##### Two identical guitar strings are prepared such that they have the same length (0.67 m) and...
Two identical guitar strings are prepared such that they have the same length (0.67 m) and are under the same amount of tension. The first string is plucked at one location, primarily exciting the fifth harmonic. The other string is plucked in a different location, primarily exciting the fourth harm...
##### Need correct answer. No solution needed Question 20 Find the interval of convergence for the power...
Need correct answer. No solution needed Question 20 Find the interval of convergence for the power series_1 Un=1 73 0 (-1,1) (-1,1) O [-1, 1) (-1,1]...
##### 35 of 75 When can implied agency arise in Tennessee? If the parties act as if...
35 of 75 When can implied agency arise in Tennessee? If the parties act as if they have an agency agreement. It can't. Agency agreements must be explicit and in writing. If a seller deals directly with a buyer. If an agreement expires without being terminated....
##### A 10.0 L gas cylinder is filled with 9.60 moles of gas. The tank is stored...
A 10.0 L gas cylinder is filled with 9.60 moles of gas. The tank is stored at 55 ∘C . What is the pressure in the tank? Express your answer to three significant figures and include the appropriate units....
##### A copper penny has a mass of of 3gram
A copper penny has a mass of of 3gram. The atomic number of copper is 29 and the atomic mass is 63,5gram/mol.what is the total charge of all electrons in the penny?...
##### SSG Cycles manufactures and distributes motorcycle parts and supplies. Employees are offered a variety of share-based...
SSG Cycles manufactures and distributes motorcycle parts and supplies. Employees are offered a variety of share-based compensation plans. Under its nonqualified stock option plan, SSG granted options to key officers on January 1, 2021. The options permit holders to acquire 7 million of the company&r...
##### Problem 6: The weight of a sophisticated running shoe is normally distributed with a mean of...
Problem 6: The weight of a sophisticated running shoe is normally distributed with a mean of 14 ounces. (a) What must the standard deviation of weight be in order for the company to state that 95% of its shoes weight less than 15 ounces? (b) Suppose that the standard deviation is actually 0.83. If ...
##### What is the membrane sac that encloses each lung?
What is the membrane sac that encloses each lung?...
##### Heights of men on a baseball team have a​ bell-shaped distribution with a mean of 183...
Heights of men on a baseball team have a​ bell-shaped distribution with a mean of 183 cm183 cm and a standard deviation of 6 cm6 cm. Using the empirical​ rule, what is the approximate percentage of the men between the following​ values? a. 165165 cm and 201201 cm b. 177177 cm and 1...
##### Ford Motor Company had realized returns of 10%, 20%, -10%, and -10% over four quarters. What...
Ford Motor Company had realized returns of 10%, 20%, -10%, and -10% over four quarters. What is the quarterly standard deviation of returns for Ford? O A. 13.5% O B. 12.75% O C. 15% OD. 14.25%...