During the first few hours after admission, Ms. Leaper notes
that Ms. Devak’s hourly output has dropped from 55 mL to 45 mL
to
28 mL of clear yellow urine. The physician orders a 500 mL in-
travenous fluid challenge, STAT urinalysis, BUN, and serum creati-
nine. The fluid challenge elicits only a slight increase in urine out-
put. Urinalysis results show a specific gravity of 1.010 and the
presence of WBCs, red and white cell casts, and tubular epithelial
cells in the sediment. Ms. Devak’
s BUN is 28 mg/dL; her serum cre-
atinine, 1.5 mg/dL. The physician diagnoses probable acute renal
failure and orders a nephrology consultation. In addition, the
physician orders aluminum hydroxide, 10 mL every 2 hours per na-
sogastric tube, and ranitidine 50 mg intravenously every 8 hours.