Abstract
Systemic inflammatory response syndrome (SIRS) is frequent after major surgery and may lead to multiple organ failure. Many classical parameters such as leukocytes and platelets count, lactate and c-reactive protein are measured sequentially during SIRS in order to quantify the severity of the inflammatory/metabolic stress. Blood urea nitrogen and creatinine are usually assessed to evaluate renal function since acute kidney injury (AKI) is a frequent complication of SIRS. The aim of this case report is to describe sequential serum phosphate and sodium and potassium measurement in urine in parallel with AKI development and recovery. The aim is to suggest that these parameters may help in AKI monitoring in the context of SIRS.
Highlights
Surgical procedures are a well-known trigger of the Systemic Inflammatory Response Syndrome (SIRS), which may be a threat to normal homeostasis and lead to multiple organ failure
Lab exams at Intensive Care Unit (ICU) admission revealed leukcocytosis with normal C-reactive Protein (CRP) (Figure 1A), an elevation of 0.3 mg/ dL in serum creatinine, configuring Acute Kidney Injury (AKI) stage 1 by acute kidney injury network (AKIN) criteria[6] (Figure 1B) and hyperlactatemia (Figure 1C)
In the case presented above, we have described the “up and down” and “down and up” behavior of many well-established parameters that we frequently monitor in SIRS
Summary
Surgical procedures are a well-known trigger of the Systemic Inflammatory Response Syndrome (SIRS), which may be a threat to normal homeostasis and lead to multiple organ failure. Renal recovery is usually followed by increased concentrations of NaU [4,5] and its fractional excretion [4] as well as decreases in serum phosphate [5] We hypothesize that this sodium-retaining state occurs in other non-septic SIRS states, including surgical trauma. Lab exams at ICU admission revealed leukcocytosis with normal C-reactive Protein (CRP) (Figure 1A), an elevation of 0.3 mg/ dL in serum creatinine (sCr), configuring AKI stage 1 by acute kidney injury network (AKIN) criteria[6] (Figure 1B) and hyperlactatemia (Figure 1C). Norepinephrine was stopped at D3 but persistent oliguria has led to furosemide administration (single dose of 20 mg in the entire ICU stay) Both blood Urea Nitrogen (BUN) and sCr had their peak value at D4; in parallel, leukocytosis had resolved and CRP level was consistently decreasing. At D8, both urinary and central venous catheters were removed. sCr returned to its baseline value at D11
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