1. Case 44 y.o. female s/p lap hernia repair Readmitted with acute cholecystitis poor appetite for 2 wks. 1 day Post op required reintubation Then developed renal failure

2. Case of ARF Normal Renal Ultrasound No IV contrast exposure. No ACE or nephrotoxic antibiotic. No urinary obstruction. Pt is feeling better and eating better, despite ARF.

3. Hypophosphatemia and ARF 1.4 0.4 4.7 8.8 1.0 3.1 6 15 46 8

4. Cause of ARF? A. Hemodynamic effect of surgery B. Dehydration C. Rhabdomyolysis D. Obstruction of ureter?

5. ARF Case Classic presentation of Hypophosphatemic rhabdomyolysis. Prolonged NPO status/starvation Resp failure requiring reintubation after extubation or surgery. Due to resp muscle weakness. Phos goes very low, then suddenly climbs without any supplementation. Associated with high K and Low calcium. Creatinine climbs more than 1.0 mg/dl/day, suggesting increased creatinine production.

6. Hypophosphatemia and ARF 1.4 0.4 4.7 8.8 1.0 3.1 6 15 46 8

7. Markers of Malnutrition K Albumin Phos BUN Calcium 3.0 1.2 2.0 3 7.0 Labwork on admission, May 2008