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Dr. Andrew Rynne

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What do these creatinine, sodium and potassium levels in a blood test indicate?

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Dr. Rakesh Madhyastha

Nephrologist

Practicing since :2009

Answered : 4361 Questions

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Posted on Tue, 27 Oct 2015 in Kidney Conditions
Question: Hi,
A Patient who was admitted in the hospital with a high Creatinine level of 18 mg/dl, High Potassium of 7 and mildly low Sodium of 124. The patient completed 10 days today in the hospital and 3 days back his Creatinine level was 13 mg/dl and yesterday it was 10 mg/dl. Throughout the admission he has received 3 Hemodialysis Sessions lasting 4 hours approximately each. Yesterday his creatinine level is 10 mg/dl. Patient is with no complaints for the past 5 days and only admitted for the High Creatinine and Hemodialysis session. The patient is diabetic and was in a poor control for the past 1 year but his blood sugars were controlled in this admission.
Does such a patient need to be admitted in the hospital for Hemodialysis or it can be done as an Outpatient? as the patient is with absolutely no complaints at all except the high creatinine
What are the possible management in this patient?
The treating doctor has requested for XXXXXXX and GBM antibodies 3 days back as to know the etiology of the High Creatinine and still the results are pending. What is he looking for? And does the patient still need to be in the hospital till the results are out? Will is change anything in the management?
doctor
Answered by Dr. Rakesh Madhyastha 2 hours later
Brief Answer:
Can be done on an outpatient basis

Detailed Answer:
Hello

Thanks for the query

It looks like you are dealing with an End stage renal disease patient. Here is how you should go about it:-

1. Establish the diagnosis

Get a urine routine test to look for protein loss, Hemoglobin to see for anemia, check calcium and phosphorus levels.

Fundoscopy most often will reveal retinopathy changes

Check iron profile to see for iron deficiency

2. Get a permanent access done once the ESRD is established in the form of either a permanent catheter or AV fistula

3. Restrict potassium, salt and fluid in this patient

4. I usually advise dialysis to patients 3 times a week in such a situation, each session lasting for 4 hours

Now to answer your questions
1. If the vitals are stable and he is not breathless, then dialysis can be done as an outpatient
2.Management would be renal replacement therapy, correction of anemia with iron supplements and erythropoetin. Correction of calcium, vit d and phosphorus to prevent CKD MBD
3. It is unlikely to be XXXXXXX or anti gmb however there is not harm in checking for it. Once the reports arrives the management will change accordingly
He is looking for acute causes for renal failure
4. Patient need not be in the hospital if he is stable. Management will change accordingly

I hope I was of help, if you have any further queries please get back to me

Regards
Above answer was peer-reviewed by : Dr. Sonia Raina
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