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Kidney Week

Abstract: FR-PO208

Putting the Pieces Together: A Multifaceted Elevation in Creatinine

Session Information

Category: Acute Kidney Injury

  • 103 AKI: Mechanisms

Authors

  • Parghi, Devam, Southeast Health, Dothan, Alabama, United States
  • Mandyam, Saikiran, Southeast Health, Dothan, Alabama, United States
  • Patel, Juhi, Rutgers New Jersey Medical School, Newark, New Jersey, United States
  • Medal, Jocelyn Z., Alabama College of Osteopathic Medicine, Dothan, Alabama, United States
  • Patel, Priyanka, Southeast Health, Dothan, Alabama, United States
  • Ibie, Nowoghomwenma Charles, Southeast Health, Dothan, Alabama, United States
Introduction

Goody Powder is OTC medicine containing aspirin, caffeine, and acetaminophen. When taken in excess and combined with alcohol it can induce undesirable elevations in blood pressure that can exacerbate renal dysfunction in an already compromised kidney. It can also cause severe gastric irritation with the risk for gastrointestinal bleeding. GI bleed could lead to blood loss, uremia, and dehydration. Furthermore, caffeine and alcohol exhibit diuretic properties intensifing dehydration and exacerbate AKI through the reduction of blood volume. Although aspirin and alcohol have been linked to kidney damage, there are few case reports demonstrating the rapid progression to ESRD.

Case Description

33 y/o African American male BMI 37 and no reported PMH presented with complaints of fatigue, generalized weakness, nausea, vomiting, and diarrhea x 1 month. Reported daily episodes of vomiting with intermittent hematemesis. He also complains of dizziness, abdominal pain, decreased urine output. He denies fever, chills, chest pain, or dyspnea. The patient also reports prior heavy drinking with multiple alcoholic beverages/day till recently, and combining it with Goody powders for his abdominal pain.

BP 175/88, HR 96. Lab Na 131, K 6.0, bicarb 6, BUN 238, creatinine 50, and eGFR 1, Hb 6.6. The patient was admitted for further workup where electrolytes were replenished, his hypertensive emergency was appropriately controlled, and he underwent dialysis. A renal biopsy demonstrated accelerated hypertension as one of the prime causes for his renal failure.

Discussion

Even though Goody Powders’ controlled use is generally safe, its combined use with alcohol possibly accelerated the progression to ESRD in our patient. This patient possibly had baseline CKD due to uncontrolled hypertension that was never controlled but in the setting of above, he progressed to ESRD rather quickly. Also, he had concurrent hemolysis secondary to severe hypertension on top of potential GI bleed. It is important to note that combining caffeine with alcohol can have contradictory CNS manifestations especially when uremia sets in. Therefore, timely identification of metabolic abnormalities along with prompt management is crucial. Patient education should be emphasized to avoid prior behaviors and to avoid further damage.