a BNP of over 4000?

UM Review RN, ASN, RN · Mar 25, 2009

A high BNP usually means Congestive Heart Failure. Sometimes this will not be reflected in the Xray because by the time Xray gets to the patient, Lasix has already been given.

CHF can also be confirmed by EKG. You will usually hear crackles in the patient's lungs.

Hope that helped.

jennifers · Mar 25, 2009

no crackles... would anything else be elevated in chf? It seems so high for him to not even be on tele. no edema.... it just seems weird. Do you think it could be a lab error?

UM Review RN, ASN, RN · Mar 25, 2009

Could be, but I'd look at this http://www.medterms.com/script/main/art.asp?articlekey=30739 and also see if the patient had recently been on any Natrecor.

Virgo_RN, BSN, RN · Mar 25, 2009

Have you ever seen a BNP of over 4000? I'm not sure what this means? Not 400....4000.
The pts troponin was only .01 above range and the CK was normal. Pt was admitted with a GI bleed. crit was a 4 so bad kidneys. I thought BNP went with heart but not evidence of heart problems. I'm confused...

A hematocrit of 4? You must mean a hemoglobin of 4, in which case I hope they are in ICU receiving blood transfusions, like yesterday.

BNP is a marker for heart failure. A low hematocrit would be related to the GI bleeding in this instance. Kidney function would be best measured by looking at the BUN and Cr and GFR.

Remember what BNP does. It increases sodium excretion by the kidneys, and where sodium goes, water follows. If the person is compensating well, they might have an elevated BNP without peripheral edema or pulmonary congestion.

UM Review RN, ASN, RN · Mar 25, 2009

I kinda assumed she meant a creatinine level, but you're right, at this stage you need to be correct and exact. My bad.

Virgo_RN, BSN, RN · Mar 25, 2009

I kinda assumed she meant a creatinine level, but you're right, at this stage you need to be correct and exact. My bad.

She must have meant creatinine. I didn't even think of that. I saw "crit" and thought "hematocrit", and thought "Geez, a person would be dead with a crit of 4, she must mean hemoglobin." Didn't even think of creatinine, which 4 would be a much more reasonable number, and goes with the kidney function being bad.

discontentment · Mar 25, 2009

I have seen a BNP of 12000 on a patient weighing 135 pounds..... BNP stands for brain natriuretic peptide. here is a link so simple explanation (you could use it for the patient education) http://www.webmd.com/heart-disease/brain-natriuretic-peptide-bnp-test

Christie RN2006 · Mar 25, 2009

If that is the creatinine level, it sounds like this patient is in CHF and renal failure... it's probably acute renal failure due to the GI bleed. Has the patient been on lasix, bumex or any drugs of that nature? Or have they been on medications for heart failure such as coreg? What were the other labs like? How was the urine output? Occasionally our docs will either place the pt on a Natrecor drip or even CRRT to help with the CHF and renal failure. Watch this patient carefully for signs of fluid overload! Ask the patients doctor why he/she thinks it is elevated so high and what they plan to do to correct the problem.

tencat · Mar 26, 2009

Saw a BNP on a hospice patient of 28000 once....boy was there a LOT of debate over the accuracy of THAT value. Turns out the hospital had run it twice to make sure it was right, and apparently it was.

jennifers · Mar 26, 2009

Yes i meant creatinine...i see how that could of been confusing. he had some blood when he came in 4 units..then the day i was there he got a unit. I'm a student so i wasn't sure. I asked the nurse but she wasnt sure either. I was going to ask the dr today if I saw him but I didn't He was transfered to the critical care unit today so i wont know unless he comes back. i'm off to read some of the links you guys posted :) thanks so much!