question regarding lab values

CHF patients typically are retaining fluids, so the sodium would be diluted in a greater amount of fluid, not a true deficiency. Initial thought process would be to supplement sodium, but this would actually make the problem worse. Getting rid of excess fluid (by using diuretic) would correct the imbalance.

As for the BUN, this is usually associated with kidney failure. Perhaps the patient's kidneys are not being perfused correctly, so they are not able to filter properly leading to elevated BUN?

Best I can come up with.

In answer to your question: Yes. Both of these values can be traced to the dx of CHF. As I am sure you know, CHFers do not pump blood well and end up backlogged. Due to decreased hydrostatics, fluid is not shifted and eliminated well. Therefore, these patients often end up overhydrated (giving them their characteristic s/s).

In most cases of BUN elevation, the initial consideration is dehydration. However, over-hydration can cause it to be elevated. This is where looking at the ENTIRE patient picture is key. The fact that the sodium level is moderately low indicates that the patient has too much free water in the body.

These aren't so bad. If it were me, I would check allergies, creatinine and the blood pressure. Then, if normal, give lasix as tolerated. I would monitor kidney function, though, since it appears the pts renal compensatory mechanisms may be weakening under the CHF assault.

Good luck. I hope this helps.

SS - RN, BSN, CCRN, SRNA