in a teaching session, Dr H, my boss told about this patient:
40 years old man, premorbid well, ASA 1
in ICU with acute liver failure, acute renal failure and in sepsis
high dose of broad spectrum antibiotic given, but seem not to be responding
CT scan shown cirrhotic liver, most probably due to chronic alcohol consumption, with portal hypertension..
so his question is: tell me 3 reasons that why this patient would have acute renal failure.
i gave the first reason:" because of sepsis."
"yes" he replied: "what others reason?"
"err...." i started struggling.... u know the pressure of Q&A in front of group of fearful specialists...
finally the answer came out from my mouth: "hepatorenal syndrome."
hahahaha... a great laugh came out from the mouth of all bosses..
and Dr H said: "this is the classical example of 'digging ur own grave', you wake all the sleeping dragon up and they start to fire on u..."
seem hepatorenal syndrome has the strict criteria to fulfill before u diagnosed it..
p/s: the other 2 reasons can be
1) antibiotic related, could be hepatotoxic
2) contrast related, from CT scan
