pl Dietetic F ES Tools Window Help Module 4 - Interpreting Labs.pd X CB CastleBranch Login zm X Merged-TDL-Files--2024103012280X Bda1k6uo8tbjf.cloudfront.net/68f85c32-16e5-11ef-925e-aaa4f1cd8999?response-content-disposition=inlin + 90% CASE STUDIES - DISCUSSION Case 1 His lower BUN, K+ and phosphorus are consistent with his reported decrease in intake due to the flu. His high calcium level is a consequence of taking his prescribed amount of PhosLo while eating less food. Thus, he absorbed more calcium from his phosphate binder. In this patient, with adynamic bone disease (low PTH without IV vitamin D therapy), he is unable to deposit calcium in his bones, so serum level rose quickly. PhosLo was held and the next week his calcium was 11.0 and phosphorus 5.8. Other possibilities for a rise in calcium might be that patient took Tums (or another calcium-containing antacid) because of the flu or heartburn; took phosphate binders between meals rather than with meals; was consuming calcium-fortified foods in fairly large amounts or, if patient was on active Vitamin D, that the dose needed to be reduced or discontinued. Case 2 Her URR and Kt/V appear adequate. However, the concurrent rise in BUN, creatinine, K+ and PO4 along with decline in CO2 indicate access recirculation. It is likely that the post-BUN sample was drawn without waiting the designated time (15 seconds for a graft or fistula; 30 seconds for a catheter) for the recirculated blood to clear. Because this patient's labs were elevated despite no significant change in the URR or Kt/V, it is especially important for the dietitian to bring it to the attention of the charge nurse and/or physician so the patient can be evaluated for access recirculation. The patient was referred for a fistulagram and had angioplasty of two stenosed areas. These chemistry changes might also be seen if the patient had missed a treatment prior to having the blood tests. Case 3 The significant increases in BUN, K+ and PO4 in conjunction with the dramatic decline in hemoglobin indicate the likelihood of a GI bleed. The symptoms of weakness and SOB can be caused by the decrease in Hb. Case 4 Possible reasons for higher BUN, K+ and PO4 might be: • Increased intake of high potassium, high phosphorus food(s) Increased intake of low biological protein food Snacking on high phosphorus food(s) without taking binder Ran out of binders a few days prior to blood tests in conjunction with drinking milk or a milkshake (high in phosphorus and potassium) FEB 5

zm Module 4 - Interpreting Labs.pd X CB CastleBranch Login X Merged-TDL-Files--2024103012280X marks Tools Window Help 100% E pl Dietetic Practitioners s://d3da1k6uo8tbjf.cloudfront.net/68f85c32-16e5-11ef-925e-aaa4f1cd8999?response-content-disposition=inline + 90% DaVita Dietitian Reference Manual Module 4-Evaluating Laboratory Values REVIEW QUESTIONS 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. True False A patient who has a low bicarbonate level will also have a low potassium level. Causes of low albumin include low protein intake, infection, proteinuria and severe liver disease. Inaccurate handling of the blood specimen can result in a falsely low PTH. In a patient on hemodialysis, a potassium level of 6.0 is acceptable. An excessive intake of meat will result in higher levels of BUN, phosphorus and potassium. In a patient without kidney function, hyperglycemia will be accompanied by hypokalemia. A patient with access problems is likely to have increased levels of potassium, BUN, creatinine…

Tools Window Help zm Module 4 - Interpreting Labs.pd X CB CastleBranch Login x Merged-TDL-Files--2024103012280X pl Dietetic Prac Halk6uo8tbjf.cloudfront.net/68f85c32-16e5-11ef-925e-aaa4f1cd8999?response-content-disposition=inlin - + 90% CASE STUDIES-DISCUSSION Case 1 His lower BUN, K+ and phosphorus are consistent with his reported decrease in intake due to the flu. His high calcium level is a consequence of taking his prescribed amount of PhosLo while eating less food. Thus, he absorbed more calcium from his phosphate binder. In this patient, with adynamic bone disease (low PTH without IV vitamin D therapy), he is unable to deposit calcium in his bones, so serum level rose quickly. PhosLo was held and the next week his calcium was 11.0 and phosphorus 5.8. Other possibilities for a rise in calcium might be that patient took Tums (or another calcium-containing antacid) because of the flu or heartburn; took phosphate binders between meals rather than with meals; was consuming…

Module 4 - Interpreting Labs.pd X CB CastleBranch Login Merged-TDL-Files--2024103012280X pl Dietetic Practitic 6uo8tbjf.cloudfront.net/68f85c32-16e5-11ef-925e-aaa4f1cd8999?response-content-disposition-inline DaVita Dietitian Reference Manual - + 90% Module 4-Evaluating Laboratory Values Case 3 Ray dialyzes three times a week on 2 K+ bath. His appetite is fair and he takes ReGen (4 oz. TID) to supplement his intake. His medications include: Nephrovite RX, PhosLo (1 at breakfast, 1 at lunch, 2 at supper) Prilosec, Imdur, Zemplar and Epogen. He says he's been feeling weak and tired and has SOB (shortness of breath). He reports having diarrhea for 2 days. His blood pressure is low Date PreBUN PostBUN URR KUV Creat Alb CO2 K+ Ca PO4 PTH- Hgb intact 5.3 9.0 4.9 160 11.5 5.4 8.9 5.4 6.5 9.3 6.1 01/01 02/01 03/01 37 8 40 9 104 missed 78% 1.6 7.7 3.2 25 78% 1.6 3.5 22 3.0 21 7.5 7.6 10.8 8.4 What do you suspect is the reason for his change in lab values? Case 4 Margaret is a 78-year-old woman…