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Discussion

Renal Function - Be afraid, be VERY afraid!

  • Expert

Okay so I have a dialysis patient who has had ear pain x1 month. He has been seen by ENT and diagnosed with "fungal infection" of unknown type. He was given "drops" and that hasn't helped. He has also had a round of oral antibiotics - again unknown type.

He comes back today, telling me he had a head CT because he is still having ear pain. The CT was negative. However, he still has pain...

So - back to his PCP c/o pain. PCP says "we can't give you norco because you are on dialysis."

Instead - gives him Toradol 60mg IM!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Geez - so I wrote for norco....ugh!!!!!!

This bring me to anti-virals for shingles - dose for renal function. Otherwise my pts become goofy and fall and go boom and break things!

Okay - rant over....thanks for listening or passing this up as the case may be!

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    Them renalz'ull getcha

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    • Author
    • Expert

    Yep all the time.

    Had a very nice dentist call me also recently who wanted some help with antibiotic dosing for one of my pts.

    He wanted penicillin 500mg every 6 hours. When I explained the renal dosing for ESRD was 250mg twice/day or 500mg once per day, he told me that the half-life of the med was very short so it had to be dosed more frequently. However, as I explained to him, its renally excreted and if your kidneys don't filter, it doesn't go anywhere. He thanked me and took my cell number and asked if he could contact me again?

    Many pts, not necessarily only dialysis pts have CKD - I'm extremely cautious dosing meds and try to always look at labs prior to dosing. Another hint I use is if they see a nephrologist for ANY reason, I look up labs. I'm always surprised when pts (non-dialysis) tell me they are perfectly healthy, pull out a list of 20 meds and when I ask which docs they see, they give me another list of every "ologist" in town.

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    • Expert
    Another hint I use is if they see a nephrologist for ANY reason, I look up labs. I'm always surprised when pts (non-dialysis) tell me they are perfectly healthy, pull out a list of 20 meds and when I ask which docs they see, they give me another list of every "ologist" in town.

    Excellent thread and as for the above, lol yeah "perfectly healthy" as in my experience most of the folks with CKD have labs that make me feel a bit faint. :) I'm blessed to have a near brilliant nephrologist in my cell phone and several other very good ones who work for our hospital system and they are invaluable.

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