إسهال خمجي Infectious Diarrhea 2

Nine days after the diarrhea ended, the patient develops decreased urine output, darkening of his urine, dyspnea on exertion, and swelling of his legs and feet. On physical examination, temperature is 37.5 °C (99.5 °F), pulse rate is 118/min, respiration rate is 22/min, and blood pressure is 184/102 mm Hg. Prominent bibasilar crackles are auscultated. Cardiac rhythm is regular, and an S3 is heard. Abdominal examination is normal. There is 2+ pitting edema of the lower legs and feet. Neurologic examination is normal.

Laboratory Studies
Hemoglobin: 7.9 g/dL (79 g/L)
Hematocrit: 23%
Leukocyte count: 33,500/μL (33.5 × 109/L)
Platelet count: 90,000/μL (90 × 109/L)
Blood urea nitrogen: 88 mg/dL (31.42 mmol/L)
Serum creatinine: 7.2 mg/dL (636.62 µmol/L)
Serum sodium: 132 meq/L (132 mmol/L)
Serum potassium: 6.1 meq/L (6.1 mmol/L)
Serum chloride: 104 meq/L (104 mmol/L)
Serum bicarbonate: 18 meq/L (18 mmol/L)
Liver chemistry studies: Normal
Urinalysis:
2+ blood, 15–20 leukocytes and 25–50 erythrocytes/hpf ; protein 550 mg/dL.

A peripheral blood smear shows many fragmented erythrocytes (schistocytes) and platelet clumping. A chest radiograph shows pulmonary congestion and small bilateral pleural effusions. Plain radiographs of the abdomen and renal ultrasonography are normal