A 76-year-old woman with a history of type 2 diabetes mellitus, dyslipidemia and depressive syndrome.
She was being treated with metformin 850 mg/8 hours, escitalopram 20 mg/24h, myzapine 30 mg/24 hours and simvastatin 40 mg/24 hours.
An analytical performed six months before had a Cr of 0.81 mg/dl.
Two weeks before admission, he was treated with ibuprofen (600 mg/8 hours) for low back pain.
One week before she had nausea, vomiting and diarrhea, so she went to the emergency room.
The physical examination revealed dry skin and mucous membranes and the serum Cr was 9 mg/dl, glucose 189 mg/dl, urea 196 mg/dl, hemoglobin 10.9 g/dl, potassium acid 125 mEq/dl.
Arterial gas showed pH 7.23 and bicarbonate of 15 mEq/l.
An abdominal ultrasound showed bilateral hydronephrosis due to bladder neoplasia.
Hemodynamic instability of the patient underwent hemodialysis for two hours, with subsequent Cr of 5.9 mg/dl, potassium of 6.1 mEq/l, pH of 7.39 and bicarbonate of 22 mEq/l.
Subsequently, bilateral nephrostomy was performed, with improvement of the clinical picture and normalization of analytical figures with Cr of 1.1 mg/dl, pH of 7.31 and bicarbonate of 23 mEq/l.
