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Mr. J.R. is a 73-year-old man, who was admitted to the hospital with clinical manifestations of gastroenteritis and possible renal failure. The patients chief complaints are fever, nausea with vomiting and diarrhea for 48 hours, weakness, dizziness, and a bothersome metallic taste in the mouth. The patient is pale and sweaty. He had been well until two days ago, when he began to experience severe nausea several hours after eating two burritos for supper. The burritos had been ordered from a local fast-food restaurant.  The nausea persisted and he vomited twice with some relief.  As the evening progressed, he continued to feel very bad and took some Pepto-Bismol to help settle his stomach. Soon thereafter, he began to feel achy and warm. His temperature at the time was 100. 5F. He has continued to experience nausea, vomiting, and a fever. He has not been able to tolerate any solid foods or liquids. Since yesterday, he has had 56 watery bowel movements. He has not noticed any blood in the stools. His wife brought him to the ER because he was becoming weak and dizzy when he tried to stand up. His wife denies any recent travel, use of antibiotics, laxatives, or excessive caffeine, or that her husband has an eating disorder.

Case Study Questions

Based on the information provided above, which two types of acute renal failure are most likely.
List four major risk factors that are likely to be contributing to the patients kidney failure.
If acute renal failure progresses to chronic renal failure, hemoglobin and hematocrit may decrease significantly and a peripheral blood smear may indicate a normocytic, normochromic anemia. Suggest two pathophysiologic mechanisms that explain the abnormal hemoglobin level, hematocrit, and peripheral blood smear.
Which laboratory data suggest that the infection is probably viral and not bacterial?
Why is it appropriate that a serum creatinine phosphokinase assay was not ordered?
Submission Instructions:

Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.)
All replies must be constructive and use literature where possible.
Please post your initial response by 23:59 ET Thursday, and comment on the posts of two classmates by 23:59 ET Sunday.
You can expect feedback from the instructor within 48 to 72 hours from the Sunday due date.

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