PMC10165981_01
Daily and accumulated evolution of hydric balance and radiological findings at the time the patient was intubated and extubated
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F1
The clinical picture was progressively aggravated by respiratory insufficiency due to acute pulmonary oedema, and invasive mechanical ventilation was required a few hours later (Figure 1). The administration of the first bolus of 20% mannitol (100 mL) was followed by an increase in urine output (1 mL kg-1 h-1), allowing for a negative fluid balance to be achieved that day (-2000 mL) (Figure 1). X-ray findings and ventilatory requirements also improved, making weaning from mechanical ventilation possible (Figure 1).
Time evolution of diuresis, administered diuretics, and results of the studies of the glomerular and tubular function
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F2
Creatinine clearance showed mild renal insufficiency (CrCl: 74 mL min-1); the fractional excretion of sodium was very low in spite of the natriuretic treatment with furosemide (FeNa: 0.4 %); and free water clearance was negative (ClH2O: -0.6 mL min-1), indicating water reabsorption (Figure 2). Results for both glomerular (CrCl: 73 mL min-1) and tubular (FeNa: 0.4%) functions remained stable but, interestingly, free water clearance had turned positive (ClH2O: +0.4 mL min-1) (Figure 2).