A 57 year old female is … to the oncology unit for chemotherapy … to her to acute leukemia. Her initial dose of chemo was 2 days ago. While rounding today, the patients tells the NP that she feels so weak. The NP notes her heart rate is 44 today (down from 68 2 days ago). She has had less than ...
a 57 year old female is … to the oncology unit for chemotherapy … to her to acute leukemia her initial dose of chemo was 2 days ago while round
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• Question 1
Grading
A 57 year old female is admitted to the oncolog y unit for chemotherapy related to
her to acute leuk emia. Her initial dose of chemo was 2 days ago. While rounding
today, the patients tells the NP that she feels so weak. The NP notes her heart
rate is 44 today (down from 68 2 days ago). She has had less than 100 cc of urine
out over the last 24 hours .
Labs from this morning include:
LAB DATA:
-Sodium 131
-Potassium 7.8
-Chloride 105
-Bicarb onate 17
-BUN 67
-Creatinine 5.8
-Glucos e 83
-Calcium 7.6
-Phosphorus 6.8
-Uric acid 16.3
What is your working diagnosis for this patient? How would you treat her?
Correct
Answer: Diagnosis is hyperk almeia probably from tumor lysis syndrom e.
Chemo therap y has cause cells to die releasing potassiu m into the
circulation. The elevated uric acid, phsophorus, low calcium, and
acute renal failure all stem from tumor lysis.
Treatment
Check a 12 lead EKG
Give calcium gluconate to stabilize cardiac function
Begin insulin and dextros e to shift potassium into the intracellular
space.
Aggressively adminis ter fluids to treat potential pre-renal azotemia
Consider Kayexalate to remove potassium.
• Question 2
Grading
Using the Cockcroft and Gault formula, calculate the estimated GFR for the
following patient. 52 year old female weighting 177 pounds. Plasma creatinine is
3.3
Correct
Answer: The formula is:
, For this patient
In women you would multiple the result by 0.85 to reflect the
lower muscle mass in women.
30 x .85 = 25 ml/min
Medication doses in this patient would need to be altered due to
the low GFR
Response [None Given]
Feedback:
• Question 3
Grading
How would you calculate the fractional excretion of sodium? What does this
calculation tell you about the patient’s acute kidney injury?
Correct
Answ er: Calculating the fractional ex cretion of s odium in patient’s with
olig uria is helpful in dis ting uishing prerenal from intrinsic renal
causes of acute kidney injury.
The formula is:
A result of less than 1% indicates a prerenal cause of acute kidney
injury. A vale greater than 2 percent indicates an intrinsic renal
cause. This formula is less reliable in patients on diuretic therapy.
Respons [None Given]
e
Feedbac
k:
• Question 4
Grading
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