A 53-year-old presented in the emergency department reporting shortness of breath, fatigue, and abdominal bloating with pain over the last 4 days.

A 53-year-old presented in the emergency department reporting shortness of breath, fatigue, and abdominal bloating with pain over the last 4 days. The client received furosemide 40 mg IV and supplemental oxygen prior to transfer to the cardiac intensive care unit.

 

Laboratory Test                                 Normal Rang                                                            Patient Value

Serum Potassium                          3.5 to 5.0 mEq/L                                                         4.4 mEq/L

Serum Creatinine 41 to 61 years   Male 0.6 to 1.3 mg/dL                                                1.46 mg/dL

                                                        Female 0.5 to 1.1 mg/dL

 

BUN Blood Urea Nitrogen                   10 to 20 mg/dL                                                       27 mg/dL

Serum Sodium                                       135 to 145 mEq/L                                              139 mEq/L

 

 

During the first 24 hours of admission, an additional dose of furosemide 40 mg was administered that resulted in 2400 mL of urine output. Client reported a lessening of dyspnea as well as an improvement of abdominal symptoms. Home medications including hydrochlorothiazide, spironolactone, carvedilol, and lisinopril were continued as previously prescribed.

Subsequent Laboratory Values (24 hours Later)

 

Subsequent Laboratory Values (24 hours Later)                    

Laboratory Test                                         Normal Range                                           Patient Value

Serum Potassium                                 3.5 to 5.0 mEq/L                                         3.8 mEq/L

Serum Creatinine                           Male 0.6 to 1.3 mg/dL                                       1.87 mg/dL

41 years to 61 years                    Female 0.5 to 1.1 mg/dL                                     

BUN                                                    10 to 20 mg/dL                                              27 mg/dL

Blood Urea Nitrogen

Serum Sodium                     135 to 145 mEq/L                                                  142 mEq/L

 

Based on the comparison of admission and subsequent laboratory values, ___1___ presents a major concern for ___2 _____ and requires ___3 ____ (Please fill in the blanks)

 

Laboratory Values (Option 1)                                       Concern (Option 2)                                    Required Intervention (Option 3)

A. Serum Potassium                                  A. Increase in glomerular filtration                               A. Discontinuation of lisinopril

B. Serum Creatinine                                  B. The onset of acute kidney injury                          B. Decrease of hydrochlorothiazide dosage

C. BUN                                                      C. Exacerbation of hypertension                               C. Decrease of spironolactone dosage

D. Serum Sodium                        D. Exacerbation of congested heart failure (CHF)              D. Discontinuation of furosemide

 

Provide a written up rationale for each of your choices."

 

 

Based on the comparison of admission and subsequent laboratory values, let's analyze the concern and required intervention:Based on the comparison of admission and subsequent laboratory values, let's analyze the concern and required intervention:

 

 Analysis

 Serum Potassium:

 

 Admission Value: 4. 4 mEq/L (Normal)

 Subsequent Value: 3. 8 mEq/L (Normal)

 Rationale: This has lead to reduction in serum potassium level although they are still within the normal limits. There is no significant issue in regard to this aspect in the given context.

 Serum Creatinine:

 

 Admission Value: 1. 46 mg/dL (Elevated)

 Subsequent Value: 1. 87 mg/dL (Further Elevated)

 Rationale: Serum creatinine level has raised and that suggest us a poor renal function. This points towards the emergence or calendaring of AKI – acute kidney injury, according to the scope of the matter.

 BUN:

 

 Admission Value: 27 mg/dL (High)

 Subsequent Value: 27 mg/dL (from ST)

 Rationale: The BUN level remains high, and that is going with the impaired renal function, but it is not as sensitive to the immediate action as changes in serum creatinine.

 Serum Sodium:

 

 Admission Value: Sodium; 139 mEq/L (Normal)

 Subsequent Value: 142 mMol/L (Normal)

 Rationale: Serum sodium levels remain essentially normal and are in fact the least changed of all the total serum electrolytes. This is not much of an issue as far as this discussion is concerned.

 Filled-in Statement

 1. Serum Creatinine is a potential concern in two. The patient has developed acute kidney injury at this early stage and needs 3. Discontinuation of lisinopril.

 

 Rationale

 1. Serum Creatinine:

 

 Reason for Concern: The raise of serum creatinine from 1. 46 mg/dL to 1. Therefore, only patients with values below 87 mg/dL demonstrate worsening renal function. This indicates AKI, or progression of chronic kidney diseases if present in the patients.

 2. The onset of acute kidney injury:The onset of acute kidney injury:

 

 Reason: The use of serum creatinine is effective in the determination of acute kidney injury because it is an indication of the kidneys’ capacity to clear products from the blood.

 3. Discontinuation of lisinopril:

 

 Reason: Lisinopril is an ACE inhibitor that may cause renal adverse effects particularly to those patients with kidney problems or those patients taking diuretics. It will be useful to stop lisinopril so as to prevent further renal compromise. Furthermore, the patient is on diuretics including furosemide and due to this, modification of the dosage of ACE inhibitors is very important so as not to worsen the situation of the kidneys.

 Other Options Analysis:

 

 A. Increase in glomerular filtration: Although an increase in GFR would be expected, the current results show the actual worsening of renal function, not an improvement of it.

 

 B. Decrease of hydrochlorothiazide dosage: The management here is not actually hydrochlorothiazide because it is a thiazide diuretic that appears not to be exerting a dramatic effect influence on the serum creatinine levels here.

 

 C. Decrease of spironolactone dosage: Spironolactone is a potassium sparing diuretic, the potassium is still within normal range. This intervention is not the urgency of the present data.

 

 D. Discontinuation of furosemide: As anticipated, furosemide is a potent diuretic; however, the patient’s condition has been stabilised using the drug and the serum potassium is still within a normal range. The use of furosemide might not be the cause of renal impairment; therefore, its withdrawal will not solve the problem.