Creatinine levels and need for dialysis

Had a pt this past week with a Cr of 52 and no urine output for about 24 hours. Lots of 3+ pitting edema. Dialysis catheter was inserted. She became hypoxic and ventilated. At sometime the docs decided she was dry. Infused about a liter, then tapped her and pulled 1.5 L out her R lung. Over the weekend she was on dopamine, and whadya know, started to pee. No dialysis started and her Cr was dropping nicely.

I definitely agree with traumaRUs's reply - there are a number of factors that go into deciding if a patient needs dialysis. In my unit, we recently started new dialysis on someone whose Crt was only 2.9, but they were not making urine, fluid overloaded, and not responding to IV diuretics and were becoming clinically unstable.

http://nursinginfluence.com

For us, I don't care what a chronic or acute creatine level is...... period. Is their electrolyes stable? Are they on a vent due to volume overload and you need to pull fluid?

The point is, forget the number, look at your patient, are they stable? Can you get a high K down with insulin and glucose and calcium? If not and they are in CHF and not oxygenating well drop a line, and pull off the fluid and fix the K.

I never jerk at a number, if I can't get my patient's electrolytes stable, or oxygenated them then we dialyze stat, you can always pull that line later. It is never about a creatinine level.