Answer Happy

Patient HS is a 53-year-old man who weighs 94 kg. He was
admitted to the hospital two days ago for an emergency
appendectomy. He has type 2 diabetes and receives metformin and
insulin. He has chronic kidney disease Stage 3 with proteinuria for
which he is taking ramipril 10 mg daily.
His latest serum creatinine taken preoperatively was 146
micromol/liter. He also takes omeprazole 20 mg when required for
indigestion. Prior to his emergency appendectomy he was given
gentamicin 300 mg and metronidazole 500 mg. During the operation he
was found to have a perforated appendix and was prescribed a
five-day course of co-amoxiclav postoperatively.
You visit the ward to review Patient HS’ antibiotics and told by
the nursing staff that he is now in a side room as he has
developed Clostridium difficile. You check his
U&E and find his serum creatinine is now 210
micromol/liter.
QUESTIONS:
1. What risk factors does Patient HS have for developing acute
kidney injury?
2. Has Patient HS developed hospital-acquired acute kidney
injury?
3. What changes to his medicines would you recommend at this
time?