Which of the following clients are at risk for hepatitis D?

A. hypokalemia, hypernatremia, and hypoalbuminemia: Hypokalemia and hypernatremia are not expected early findings after a major burn. Potassium initially rises due to massive cell destruction, and sodium commonly falls because of fluid shifts into the interstitial space, making this pattern inconsistent with the emergent phase.

B. hyperkalemia, hypernatremia, and hyperalbuminemia: Although hyperkalemia is expected, hypernatremia is unlikely because sodium shifts into the tissues with extensive edema. Albumin levels usually fall due to increased capillary permeability and plasma protein loss, so hyperalbuminemia would not be seen.

C. hyperkalemia, hyponatremia, and metabolic alkalosis: The potassium and sodium patterns fit early burn physiology, but metabolic alkalosis does not. Massive fluid loss, hypoperfusion, and lactic acid accumulation commonly produce metabolic acidosis rather than alkalosis during the emergent period.

D. hyperkalemia, hyponatremia, and metabolic acidosis: This combination reflects typical early burn responses. Potassium rises from cellular lysis, sodium falls due to third spacing, and acidosis develops from tissue hypoxia and anaerobic metabolism.

A. acute glomerulonephritis: Acute glomerulonephritis typically presents with hematuria, proteinuria, and edema, but it is not directly related to crush injuries. It is an immune-mediated condition rather than a consequence of muscle trauma.

B. myoglobinuria: Crush injuries release myoglobin from damaged muscle into the bloodstream, which can accumulate in the kidneys and cause acute tubular necrosis. Dark, cola-colored urine is characteristic of myoglobinuria. This is a common cause of acute kidney injury following severe trauma.

C. embolus in a renal artery: A renal artery embolus can cause sudden flank pain and oliguria, but it is less likely in the context of a crush injury. It does not typically produce dark-colored urine.

D. bilirubinemia: Bilirubinemia causes jaundice and dark urine from liver dysfunction, not directly from muscle trauma. The client’s history and urine color are more consistent with myoglobinuria than liver-related causes.