76-year-old woman with a history of type 2 diabetes mellitus, dyslipidaemia and depressive syndrome. She was being treated with metformin 850 mg/8 hours, escitalopram 20 mg/24h, mirtazapine 30 mg/24h and simvastatin 40 mg/24h. In a blood test carried out six months earlier he had a Cr of 0.81 mg/dl.
Two weeks before admission, he started treatment with ibuprofen (600 mg/8 hours) for low back pain. A week earlier she had experienced nausea, vomiting and diarrhoea, for which she went to the emergency department. On examination she had dry skin and mucous membranes and her blood tests showed plasma Cr was 9 mg/dl, glucose 189 mg/dl, urea 196 mg/dl, haemoglobin 10.9 g/dl, sodium 125 mEq/l, potassium 8.6 mEq/l and lactic acid 6.3 mmol/l. Arterial blood gas analysis showed a pH of 7.23 and bicarbonate of 15 mEq/l. An abdominal ultrasound showed bilateral ureterohydronephrosis due to bladder neoplasia. Given the patient's haemodynamic instability, haemodialysis was performed for two hours, with a 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 normalisation of the analytical figures with Cr of 1.1 mg/dl, pH of 7.31 and bicarbonate of 23 mEq/l.