Question

A 72 year old patient gets admitted to the hospital for dehydration after 3 days of poor PO intake, vomiting, and diarrhea. The patient has dry mucous membranes, skin tenting, and no edema. Patient has a history of HTN for which he takes lisinopril and Lasix and osteoarthritis for which he takes Advil BID. On admission, his creatinine was 2.6 mg/dl. What would you expect? A patient admitted to the hospital for an emergency appendectomy gets a CT scan with contrast before labs come back. Patient has a history of CKD with a baseline GFR if 32 mL/min/1.72 m. After the contrast dye GFR decreases to 19 ml/min/1.72 m. How is this classified? - A 67 year old male presents to the ED very SOB and reports to you that he is worried that he's "got too much water and tells you that he usually takes a "water pill" but his prescription ran out four days ago and he couldn't afford to buy a new bottle. Lung exam reveals bibasilar crackles and he has +2 pitting edema. CXR shows cardiomegaly. Labs: Na 128, K 4.2, BUN 22, creatinine 1.0, glucose 94, BNP 3400, serum osmolality 270. What can you conclude?

Answer 1

The patient taking Lasix this drug eliminates water and reduces high blood pressure. It makes adverse effects of vomiting and diarrhea and causes severe kidney disease. lisinopril with Lasix causes drug interaction, Lasix affects the way lisinopril work. Diuretics' actions of furosemide cause hypovolemia and dehydration. Diuretics decrease blood pressure and increase the risk of high serum creatinine and metabolic complications and increase the chance of CKD.
The patient is CKD there is a high risk of nephropathy after contrast dye used because dye decreases the kidney function over 48 to 72 periods of time. people with CKD the kidney can not filter the waste and toxins. In advance CKD this contrast dye slower the kidney function than normal.
lasix reduces extra fluids from the body and lessen the symptoms of shortness of breath and swelling. when patients not taking the water pills it causes accumulation of water and salt in the lungs, heart and causes shortness of breath and edema in the hands and feet. Diuretics reduce volume overload and excretes salt and water, it increases plasma BNP level and cause high cardiac output state and increase the BNP level. high BNP cause renal dysfunction, and heart failure.