More confusion about abnormal labs

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First I'll fill you in on my patient...Male, 51 years old. Admitting Diagnoses are interstitial lung disease and pneumothorax. He reported having a cough for past 5 years, productive and worse in mornings. Also reported increased chest discomfort for past several months. But he has not had a lung biopsy, so they are unsure what exactly is going on with that. They just know he has some fibrotic changes in his right lung. So anyways, he also has Crohn's (33 years) and a Ileostomy. He isn't having any problems with bowels. He has Osteoporosis and gout. He had a PE in 94' after a procedure. Other history...bronchitis, pneumonia, abd hernia, GERD, cataracts. During my clinical day he had a sinus/brady rhythm and his heart rate stayed between 54-60. Overall his vital signs were normal. No signs of anything wrong, other than the low HR. He was having trouble with breathing, SOB, and pain when he coughed, breathed deep, and moved. But O2 sat and RR were good and he was being weaned off of oxygen when I left. He had a chest tube that had drained 870ml in about 2 days, Serosanguinous.

His Hgb (12.9) and RBCs (4.33) were low. His CO2 was low as well. (20) And I'm trying to figure out if it was because of blood loss, anemia, or something else.

Also his BUN (26) & serum creatinine (1.53) were high and albumin (2.9) & GFR (48) were low. Everything that I have read points to kidney failure or some kind of renal problem when it comes to the above lab results. I'm confused about why he would have kidney damage and why he isn't being treated for it. I don't know a whole lot about this kind of thing since this is the first semester I've really had to interpret these labs. It's very confusing to me and I find myself completely lost, especially with a patient who's diagnosis isn't even certain. Does anybody have any advice or ideas for what might be the problem with this patient? It's driving me crazy.

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Specializes in Family Nurse Practitioner.

Dehydration

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

what meds was he on at home? what meds was he receiving in the hospital? Was the rest of the CBC/diff normal? Did they do ABG's on this patient?

He has had a cough or 5 years and only just now sought treatment? He may have had the renal issue for sometime....he has another disease process going on not yet discovered

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His meds were aspirin, plavix, Pepcid, prednisone, oxycodone, imdur, zyloprim, pravastatin, allopurinol. And he was taking all of these at home plus albuterol. And yes, obviously there is something else going on here, which is making this care plan extremely difficult.

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Oh and yes, the rest was normal.

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Specializes in Family Nurse Practitioner.

He could have underlying kidney disease leading to gout (on allopurinol)...buildup of uric acid...

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Ok... Let me preface this with I'm only in block two...

His meds say he's on an two anti-platelets and a statin drug, so he has/had cholesterol issues and clotting issues. Couple that with his long history of serious medical issues (stress), the cough, SOB, chest discomfort, and labs that indicate kidney issues, which we know are sensitive to poor perfusion... maybe something with his heart?

Just a shot in the dark. I'm probably way off...

But it does suck to try to figure out what's going on when when his doctors haven't figured it out yet.

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Specializes in Pedi.

A Hemoglobin of 12.9 is pretty normal. Perhaps a little low for an adult male but nothing to be alarmed about. I'm walking around with a hemoglobin of 10.3 and no one thinks it's a big deal. What about Crohn's could cause mild anemia? Remember the patient has an ileostomy- how does that possibly affect this? He also has a chest tube that's draining serosanguineous fluid... what does that mean? What are they replacing the lost volume with?

What is venous CO2 a measurement of? If you know that, it will help you here.

Kidney labs are mildly abnormal. What medications is he on that could cause kidney issues? What else going on with him could cause a transient elevation in these levels?

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Work-up for a cause of all of the above-- interstitial fibrosis, renal involvement, anemia, cardiac probs-- lupus, drug toxicity, poisoning?

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These labs can be very simply explained. The low H&H are from a combined Crohn's disease and the output in the chest tube. Serosangious is blood tinged correct? So, your losing blood from the chest tube as well. CO2 is from his disease in the early stages. In COPD patients CO2 tends to be high, but with him having PNA as well, he will be hyperventilating trying to compensate for this. His CO2 levels will eventually go back up in the mid 40's to low 50's due to his COPD. It would be interesting to see what his ABG's are to see his actual pH, p02 and pCO2 levels. His Cr and BUN are elevated due to dehydration. Hope this helps!

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His Co2's were low could that be from being hyper oxygenated since he is now being weaned of of o2? She said his sats and RR were normal?? This is interesting.

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Specializes in Pedi.
His Co2's were low could that be from being hyper oxygenated since he is now being weaned of of o2? She said his sats and RR were normal?? This is interesting.

It's venous CO2 which is a measurement of bicarb.

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