Nonmaleficence. monitoring renal function in critically ill patients

Abstract

Introduction: This case report examines the breach of the non-maleficence principle in monitoring renal function in a critically ill patient, highlighting the importance of accurate clinical documentation and effective communication in the intensive care setting.
 Case Presentation:
 The case describes the clinical course of a 48-year-old male with a history of hypertension who underwent a radical nephrectomy due to a large renal tumor. During transport to the ICU, the patient suffered two episodes of acute myocardial infarction, which necessitated the induction of a pharmacologic coma, intubation, and mechanical ventilation. Initial examinations indicated preserved renal function in the remaining kidney; however, errors in recording urine output—attributed to inadequate supervision of trainee staff—led to the erroneous administration of diuretics. This intervention resulted in significant glomerular damage, acute glomerulonephritis, and eventually renal failure requiring hemodialysis, culminating in the development of metastatic renal carcinoma and the patient’s subsequent death. Discussion: This case illustrates how the failure to verify critical data and inadequate communication during shift changes can trigger severe iatrogenic errors. It underscores the importance of adhering to strict protocols and fundamental bioethical principles, such as non-maleficence, to prevent complications that compromise patient safety. The experience highlights the need for double-check systems and a safety culture that promotes continuous improvement in clinical care. Conclusion: This case report emphasizes the urgent need for precise and coordinated monitoring in the ICU. Rigorous verification of clinical information, along with effective communication and ethical training of nursing staff, is essential to prevent interventions that may cause harm and worsen the patient’s prognosis.