A 72-year-old male was admitted to ICU five days ago following primary resection and anastomosis of a perforated sigmoid diverticulum. He is receiving antibiotic treatment with ciprofloxacin, vancomycin and metronidazole.
Over the last 12 hours he has produced a total of 200 mis of urine, and his creatinine has doubled from baseline to a value of 300 µmol/L.
a) Outline how the renal dysfunction will influence antimicrobial dosing for the three antibiotics in use. (30% marks)
His abdomen becomes progressively distended, and he develops anuria and a metabolic acidosis. The surgical team requests a contrast CT scan.
b) Outline possible strategies to minimise the risk of further renal injury from the CT scan. (30% marks)
c) List the factors that would influence your decision to start renal replacement therapy in this case. (40% marks)