Vascular Access in a Child with Acute Kidney Injury

A 7-year-old male was admitted to the pediatric intensive care unit (PICU) after suffering internal injuries after a motor vehicle accident. Specifically, he sustained a liver laceration, from which he hemorrhaged, requiring multiple blood transfusions. His urine output has progressively decreased over the past 4 days, and now, on hospital day 5, his urine output has been less than 5 mL/h. He remains intubated and sedated, requiring ventilator support. You have been involved with his care since hospital day 2, and you have obtained a renal ultrasound which showed normal-sized kidneys with increased echogenicity and poor corticomedullary differentiation, consistent with medical renal disease. His serum creatinine on admission was 0.7 mg/dL and has progressively increased to 4.8 mg/dL at the present time. His serum chemistries at the present time are presented below.