Bumex Drip Medication Error

[nurseclairebear]

So yesterday as I was rounding on my patients I received for my 3-11 pm shift I found that my patient's Bumex drip was completed. Since this patient was supposed to be a on a continuous Bumex drip, I called pharmacy to ask them to send another dose to me stat. The pharmacist was shocked, said that the drip should have lasted until 10 pm (it was 3:30pm). The pharmacist came up to the floor and spoke to the offgoing nurse and we discovered that the Bumex drip had accidentally been administered over 5 hours instead of 12....

The offgoing nurse reported the safety event and she notified the renal doctor who ordered the drip. He held the Bumex drip until 1am.

As I assessed the patient, this 37 year old was very lethargic/drowsy and difficult to arouse. She oriented to name, place, and event only. The patient had been on our unit about 2 weeks ago and was quite awake/alert and fully oriented. I looked into the meds she was on (Gabapentin, Ultram, Oxycodone scheduled), held the Gabapentin and Neurontin...checked her sugar (she's diabetic), sugar was 71 but I called to clarify with the MD and gave an amp of dextrose and hung D5 1/2NS. There was an order to insert a foley around 8pm since her urinary output was not where it should have been. From 8-11pm, the patient had nearly 4 liters of urinary output.

I called the renal MD and notified him, scared that her electrolytes were all out of whack so I called for labs, ABGs, and to ask to hold the bumex/diuril scheduled for later on.

So sorry for this long story, but my question is...can a bumex drip administered too quickly be the cause for her lethargy??? My charge nurse said yes. Just curious!

[RoyalPrince]

Yes - but we need labs.. how much was the Na? K? Mg?

[nurseclairebear]

That's the problem...don't have 'em. I got them ordered at the end of my shift and am not back to work until Thursday.... I guess I'm just looking for a hypothetical answer. Could that volume of fluid loss potentially cause lethargy? I assume that it affected her electrolytes, and I am really hoping that patient is okay...

[akulahawkRN, ADN, RN, EMT-P]

I would say in and of itself, no. However, it causes loss of sodium, potassium, calcium, chloride, and magnesium. I would expect that those effects you observed very well could be the result of all those electrolytes being lost. It apparently can be given over 5 minutes or as long as 12 hours (as in that case) for renal impairment. The more I think about it, the more I suspect that it's either electrolyte loss that caused the symptoms or some other underlying issue that is causing the lethargy. Is it possible that the patient has a UTI?

[nurseclairebear]

Hmmm...not sure. Definitely a chance she did. I will be asking my coworkers what happened when I get back to work tomorrow for sure. She also has this really bizarre disease called Weber-Christian's which causes strange skin sores, but it didn't look like that would cause the lethargy.