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Originally Posted by Rhetts_mama  There is a problem with your statement that the lower BUN and Cr levels are a sign of improvement.
If you are assuming that the rapidly lowered Hematocrit is a result of the fluid overload (as opposed to an acute hemorrhagic event) then the lowered Bun and Cr numbers would also be reflective of that dilution as can the decreasing ALP and Alk Phos levels. You would need to look at the rest of the serum electrolytes to determine if the fluid balance was correct or not.
Of greater concern is the fact that the fluid was given at such an exaggerated rate. You don't normally run IVF at such high levels in order to increase the preload unless hypovolemia is suspected or confirmed since one of the main causes of renal failure is decreased cardiac output. Smaller, repeated boluses are much more effective and safer. You need to manage the cardiac output first. Fluid overload can lead to congestive heart failure which in turn decreases renal perfusion even more. The sudden appearance of a 2/6 murmur is of real concern. A blood transfusion can exacerbate the situation even more if her fluid balance is not managed correctly.
Again, at this point there is no definitive diagnosis, so what is or is not an appropriate or even effective treatment can not be said for certain. What's causing the renal failure at this point is still anyone's guess until she is seen by a specialist. Is it pre-renal, post renal or intrinsic failure? Is this an oliguric or non-oliguric failure? Those are just some of the questions that need to be answered by a specialist. The sooner the better. |
I see this a lot...people trying to read and interpret numbers without the educational background that such requires. Everyone thinks elevated this means this and lowered this means that and they don't know how they interact...not to mention the fact that the patient must be seen and examined. It all works together. It takes years of schooling to be able to do this.