S3379 Acute Renal Failure in a Patient With Salmonella Gastroenteritis

Abstract

INTRODUCTION: Salmonella is a common cause of gastroenteritis worldwide. Typically, this condition is self-limited, and resolves within seven to ten days without severe complications. However, patients with CKD are susceptible to developing acute renal failure. This has been attributed to shock, dehydration, or rhabdomyolysis as well as immunologic mechanisms. Our case follows a patient who developed Salmonella gastroenteritis prior to hospital admission and presented with severe dehydration and decreasing urinary output. Although the patient’s renal function and diarrhea resolved after aggressive fluid resuscitation, it is crucial to initiate early treatment and to be cognizant of the potential of co-morbidities associated with Salmonella gastroenteritis. CASE DESCRIPTION/METHODS: A 77 year old female with a past medical history of CKD IV, type II DM, HTN presented to the emergency department with a chief complaint of abdominal pain along with 5 to 6 diarrheal episodes for the preceding week. Symptoms started after eating a hamburger at a restaurant. The patient also endorsed a fever, decreased oral intake and urinary output for the three days prior to the emergency department visit. At admission, labs revealed a BUN/Cr of 86/10.63 with a GFR of 3. CT abd/pelv w/out contrast revealed a distended gallbladder with a small gallstone, duodenal diverticulum, and fluid in the colon reflecting a diarrheal state. Aggressive rehydration was initiated and stool studies were obtained. Nephrology consultation was placed for further evaluation. During the first two days of admission, the patient remained oliguric with < 1L of output. A temporary trialysis catheter was placed in preparation for hemodialysis on day two of admission, however the patient was unable to undergo dialysis due to clot formation in the catheter. At that time, the patient’s diarrhea continued and she was treated with Lomotil along with continued hydration with renal function steadily improving. On day six of admission, stool studies resulted revealing Salmonella enterica. As the patient was afebrile and showed clinical improvement, no antibiotics were initiated. On day eight, the patient was discharged, with plan for outpatient Nephrology follow up. Labs revealed a BUN/Cr of 49/2.16 with a GFR of 23.0 on day of discharge. DISCUSSION: Initiating early aggressive rehydration may help to reduce significant co-morbidities associated with the development of renal pathology in Salmonella infection and to avoid the need for hemodialysis and further workup.