I recently began working at a smaller hospital in a rural area. We have an 8 bed ICU. We see alot but do ship some out that require any cardiac intervention or more intesive care etc. I am new to being at such a small hospital and was recently caring for a patient that was on a vent, on fluids, abx's, levophed, dopamine, dobutamine, and creatinine was 4.8. (we don't do dialysis). Liver enzymes were way high and he originally came in just for a kidney stone. While I took care of him I asked the internal med doc to recommend a transfer since I thought his kidneys were showing signs of impending trouble. we only have nephro. come one time per week. IM said no. The next day the family pursued transferring the pt themself and the patient was transferred to a large facility. Just thoughts on this. Why would internal med want him to stay?
Jun 28, '09
Possibly the rising creatinine and LFT's were a result of hypotension which they thought they could correct with fluids and pressors. With both kidney and liver effected it is highly probable that they are right but the first question needing to be asked is what were admitting levels?