Holding Lasix

[roxie144]

I have asked aroung at work and can't seem to get a straight answer. If a patient has lasix ordered and BUN/cr are elevated at what number(s) do you call the Dr. to see if they want to hold it. Do any of Dr's have a standard order. Also, is it because if the kidneys are in trouble and you give Lasix are you doing more damage because they just arn't going to kick in?

[netglow, ASN, RN]

Think of what Lasix does. As soon as you give it, ususally if IV the patient reacts quickly... how does it impact the patient's physiology? There in you have your answer, in what all needs to be considered.

[roma4204, BSN, RN]

This can vary from hospital to hospital

doctor to doctor

and of course patient to patient

best to check with them

[Corey Narry, MSN, RN, NP]

There's no designated BUN and creatinine level that will prompt providers to hold giving Lasix to a patient. Because Lasix is a diuretic, it is indicated in patients where fluid removal is necessary. It is therefore important to know what the patient's fluid status is in giving the Lasix as well as the underlying reason for the elevation in BUN and creatinine. Patients with a rising BUN and creatinine could be having a process called acute kidney injury. It is important to know what type of AKI is going on because there are 3 possible causes: Prerenal which is an adaptive response to severe volume depletion and hypotension, with structurally intact nephrons; Intrinsic which happens in response to cytotoxic, ischemic, or inflammatory insults to the kidney, with structural and functional damage; and Post-renal which occurs from obstruction to the passage of urine.

Obvioulsy, if it is determined that the patient's AKI is prerenal, the Lasix should be stopped as it will worsen the condition. If the cause is intrinsic, continuing the diuretic is a decision that will be driven by how much the patient needs fluid removal. If extremely fluid overloaded, the provider may decide to continue the Lasix if the fluid overload is affecting other organ systems such as the lungs (hyoxemia secondary to pulmonary edema, for example) and diuresis could still be achieved by giving Lasix. Post-renal AKI has to be diagnosed with a test such as a renal ultrasound to check for hydronephrosis and requires an intervention other than a diuretic such as placement of stents if blockages are found within the urinary system. It could also simply be due to urinary retention were a foley catheter could alleviate the obstruction.

To answer your question, what you should do is to discuss you patient's labs with the provider every day and get a sense of what the provider's thoughts are regarding the rising BUN and creatinine. That way, both you and the provider can collaborate on the decision to continue or hold the Lasix and the provider will think you're a smart nurse :).

[All4NursingRN]

Can't really answer your question, but this reminds of the time I had to give Bumex 6mg to a ARF patient for a renal trial of some sort. That was my first time doing that. I asked a fellow nurse and she said give it it in divided doses not to overload the kidney, but I still questioned why a diuretic was being given to a ARF anyway. Anyway the patient wasn't putting out any urine from the beginning, I think nephrology just wanted to do a trial to see if the patient could pass any urine at all. Which she didn't. But it did spike her BP.

Anyway I'm off topic.

[All4NursingRN]

There's no designated BUN and creatinine level that will prompt providers to hold giving Lasix to a patient. Because Lasix is a diuretic, it is indicated in patients where fluid removal is necessary. It is therefore important to know what the patient's fluid status is in giving the Lasix as well as the underlying reason for the elevation in BUN and creatinine. Patients with a rising BUN and creatinine could be having a process called acute kidney injury. It is important to know what type of AKI is going on because there are 3 possible causes: Prerenal which is an adaptive response to severe volume depletion and hypotension, with structurally intact nephrons; Intrinsic which happens in response to cytotoxic, ischemic, or inflammatory insults to the kidney, with structural and functional damage; and Post-renal which occurs from obstruction to the passage of urine.

Obvioulsy, if it is determined that the patient's AKI is prerenal, the Lasix should be stopped as it will worsen the condition. If the cause is intrinsic, continuing the diuretic is a decision that will be driven by how much the patient needs fluid removal. If extremely fluid overloaded, the provider may decide to continue the Lasix if the fluid overload is affecting other organ systems such as the lungs (hyoxemia secondary to pulmonary edema, for example) and diuresis could still be achieved by giving Lasix. Post-renal AKI has to be diagnosed with a test such as a renal ultrasound to check for hydronephrosis and requires an intervention other than a diuretic such as placement of stents if blockages are found within the urinary system. It could also simply be due to urinary retention were a foley catheter could alleviate the obstruction.

To answer your question, what you should do is to discuss you patient's labs with the provider every day and get a sense of what the provider's thoughts are regarding the rising BUN and creatinine. That way, both you and the provider can collaborate on the decision to continue or hold the Lasix and the provider will think you're a smart nurse :).

Awesome answer!

[nerdtonurse?, BSN, RN]

I wanna work with Juan!

[loveslife]

Think about what diuretics do and what they are for. Loop Diuretics (lasix) are the type of diuretic that are BEST for renal failure because they do not accumulate in the kidneys like thiazide diuretic or cause hyperkalemia like potassium sparing diuretcs. The BUN/cr levels if elevated wouldn't indicate holding Lasix because Lasix is what is used for renal fauilre

[roxie144]

Thanks for your input, I appreciate it.