High, or Low Creatinin values

[Falafel]

My instructor wants me to present general information about what the nurse should do if a patients lab value of creatinine was either High or Low. I was reading somewhere that the treatment was similar to one like the BUN level.

[kristandrews]

Here's some stuff from my lab test book. Most of it's on the causes of increased/decreased creatinine and not really interventions, but maybe you can come up with interventions from this info. (you may not need all of this, but I'm not sure how much you need because I imagine you're farther along in school than me to be learning this!) hope this helps somehow!:

"Creatinine is the end product of creatine metabolism. Creatine resides almost exclusively in skeletal muscle, where it participates in energy-requiring metabolic reactions. In these processes, a small amount of creatine is irreversibly converted to creatinine, which then circulates to the kidneys and is excreted. The amount of creatinine generated in an individual is proportional to the mass of skeletal muscle present and remains fairly constant, unless there is massive muscle damage resulting from crushing injury or degenerative muscle disease. Creatinine values also decrease with age owing to diminishing muscle mass. Blood urea nitrogen (BUN) is often ordered with creatinine for comparison. The BUN/creatinine ratio is also a useful indicator of disease. The ratio should be between 10:1 and 20:1. Creatinine is the ideal substance for determining renal clearance because a fairly constant quantity is produced within the body. The creatinine clearance test measures a blood sample and a urine sample to determine the rate at which the kidneys are clearing creatinine from the blood; this reflects the glomerular filtration rate..." (p. 476)

Blood Creatinine can be increased in:

acromegaly (related to increased muscle mass)

congestive heart failure (related to decreased renal blood flow)

dehydration (hemoconcentration)

gigantism (related to increased muscle mass)

poliomyelitis (increased release from damaged muscle)

renal calculi (related to decreased renal excretion due to obstruction)

renal disease, acute & chronic renal failure (related to decreased urinary excretion)

rhabdomyolysis (increased release from damaged muscle)

shock (increased release from damaged muscle)

diet high in meat

ketosis

decreased in:

decreased muscle mass owing to debilitating disease or increasing age

hyperthyroidism (related to increased GFR)

inadequate protein intake (related to decreased muscle mass)

liver disease (severe) (related to fluid retention)

muscular dystrophy (related to decreased muscle mass)

pregnancy

small stature (related to decreased muscle mass)

"Drugs and substances that may increase creatinine levels include acebutolol, acetaminophen (overdose), acetylsalicylic acid, aldatense, amikacin, amiodarone, amphotericin B, arginine, orificenicals, ascorbic acid, asparaginase, barbiturates, capreomycin, captopril, carbutamide, carvedilol, cephalothin, chlorthalidone, cimetidine, cisplatin, clofibrate, colistin, corn oil (Lipomul), cyclosporine, dextran, doxycycline, enalapril, ethylene glycol, gentamicin, indomethacin, ipodate, kanamycin, levodopa, mannitol, methicillin, methoxyflurane, mitomycin, neomycin, netilmycin, nitrofurantoin, NSAIDs, oxyphenbutazone, paromomycin, penicillin, pentamidine, phosphorus, plicamycin, radiographic agents, semustine, streptokinase, streptozocin, tetracycline, thiazides, tobramycin, triamterene, vancomycin, vasopressin, viomycin, and vitamin D." (p. 478)

"Drugs that may decrease creatinine levels include citrates, dopamine, ibuprofen, and lisinopril." (p. 478)

"Note and immediately report to the health care provider (HCP) any critically increased values and related symptoms. Chronic renal insufficiency is identified by creatinine levels between 1.5 and 3.0 mg/dL; chronic renal failure is present at levels greater than 3.0 mg/dL. Possible interventions may include renal or peritoneal dialysis and organ transplant, but early discovery of the cause of elevated creatinine levels might avoid such drastic interventions" (p. 478)

Here's the reference in case you need it!:

Davis's Comprehensive Handbook of Laboratory and Diagnostic Tests with Nursing Implications, 3rd Edition. Authors: Anne M. Van Leeuwen & Debra J. Poelhuis-Leth. (2009) F.A. Davis Company, Philadelphia, Pennsylvania

[Falafel]

thanks that helped a lot actually.