Elevated BUN and Creatnine

jnette, ASN, EMT-I · Mar 9, 2005

A buildup of metabolic wastes in the blood can certainly cause sensory changes; ie. decreased mentation, confusion, coma.

You may want to check this patient's calcium and potassium levels as well.

webblarsk · Mar 9, 2005

My problem with this patient is he is schizophrenic. Takes Seroquel for behaviors. Also has a history of seizure disorder. Takes dilantin for this. What I am wondering is with the kidney's failing, is the medications being metabolized as they should. So I don't know if the behavior issues are related to elevated BUN and creatnine or because the medications aren't being metabolized correctly. Am I making sense or just rambling? He is a hospice patient and I am trying to do what I can to make him comfortable.

jnette, ASN, EMT-I · Mar 9, 2005

My problem with this patient is he is schizophrenic. Takes Seroquel for behaviors. Also has a history of seizure disorder. Takes dilantin for this. What I am wondering is with the kidney's failing, is the medications being metabolized as they should. So I don't know if the behavior issues are related to elevated BUN and creatnine or because the medications aren't being metabolized correctly. Am I making sense or just rambling? He is a hospice patient and I am trying to do what I can to make him comfortable.

I understand.. you are making sense. I'm not knowlegeable enough to answer this, however. Sorry.

It is possible.. then again, the seroquel has some wicked side effects as recently discussed in another thread here not too long ago.. agitation being one of them. Then again, just being terminal causes a whole other set of issues in itself.. a good hospice/palliative care nurse would be best to advise you here. :)

nosonew, BSN, RN · Mar 10, 2005

I have a patient with end stage renal failure with elevated BUN and Creatnine. (Of course) My question is can elevated BUN and Creatnine cause seizures, delusions, aggitation? If so do ya all know of any meds that may help with symptoms. Thanks in advance!

Is he ON dialysis currently? If not, the toxins building up in the blood can certainly cause these symptoms...and you should likely call his nephrologist and discuss how those meds interfere with his lack of kidney function. Good luck and let us know!

webblarsk · Mar 10, 2005

Thanks for the input. He isn't on dialysis because of his schizophrenia. He is paranoid and thinks that everyone is trying to hurt him or drain his blood, for example. I have been trying to get in touch with his nephrologist to get some input but unfortunatley he isn't very cooperative. Thanks again for any input.

mommatrauma, RN · Mar 13, 2005

My problem with this patient is he is schizophrenic. Takes Seroquel for behaviors. Also has a history of seizure disorder. Takes dilantin for this. What I am wondering is with the kidney's failing, is the medications being metabolized as they should. So I don't know if the behavior issues are related to elevated BUN and creatnine or because the medications aren't being metabolized correctly. Am I making sense or just rambling? He is a hospice patient and I am trying to do what I can to make him comfortable.

Dilantin and Seroquel are both metabolized primary by the liver...so the fact that his renal status is poor should not effect the metabolism too greatly...However, people that are on dilantin often have to higher maintenence doses of Seroquel because the dilantin decreases the effects of Seroquel. Also both can cause hyperglycemia in diabetics...hope this helps...

webblarsk · Mar 16, 2005

Thanks for the info. Doing research I learned that Seroquel and Dilantin were metabolized in the liver. :rolleyes: The guy has calmed down a little!

EricTAMUCC-BSN, BSN, RN · Mar 16, 2005

does he have any benzodiazepins you can give?

RRN · Mar 16, 2005

does he have any benzodiazepins you can give?

You think he needs MORE drugs.. His liver's shot and so are his kidneys...What are you aiming for now..His heart?

EricTAMUCC-BSN, BSN, RN · Mar 16, 2005

Good point, you have reached an all too familiar ethical realm.

You think he needs MORE drugs.. His liver's shot and so are his kidneys...What are you aiming for now..His heart?

RRN · Mar 16, 2005

Good point, you have reached an all too familiar ethical realm.

Sorry rather sarcastic on my part..I've just seen so many patients just have meds thrown at them without any real investigation of what's really going on.