So H&H are 2 different labs: why only say one value?

[COVIDNURSE]

Hey guys! New nurse here. Kinda confused. If hemoglobin and hematocrit are two different values why do I hear people say things like “her H&H was 6.6”.

Is that just the hemoglobin? Why don’t they say 2 different values for the 2 different labs?

[Rose_Queen, BSN, MSN, RN]

It’s only the value of one H. My guess would be they know the normals but aren’t sure which H it belongs to, so they just say both.

[KatieMI, BSN, MSN, RN]

Because everybody knows how to work with "upper H" (hemoglobin), but people who know how to access "lower H" (hematocrit) and what to do with it are mostly within Hematology/Oncology specialty.

[Wuzzie]

Yeah, we never combine them. We report the Hgb singularly. If the crit is pertinent to the patient’s diagnosis we will also report it on its own. This goes along with nurses calling O2 saturations “O2 stats”. Both make me wonder if the person saying it actually knows what they are reporting. ??‍♀️

[KatieMI, BSN, MSN, RN]

Those who are interested, solve the clinical problem ?

45 years old male w/o significant PMH brought in rehab after 2 weeks in hospital due to MVA, b/l hip fracture s/p ORIF x2, shock (combined), emergency HD due to hyperkalemia x3, VAP (treated with vanco/cefepime/flagyl), critical care myopathy. Extubated 1 week ago, now on RA. HD was discontinued before discharge. Report says "now making urine". Abxs completed. Progresses very well rehab-wise.

Hb/Ht day before discharge: Hb 8.5 Ht 25 Na 135 K 4

After 24 h in rehab, patient made 4 L of clear pale urine. Hb 8.8 Ht 35 Na 128 K 3.1

- what is going on pathophysiologically? ("hypokalemia" is not counted as an answer)

This is USMLE Step 1 type and level question. I do not give pertinent multiple choices so not to make things too simple ?

[buckchaser10]

11 hours ago, Wuzzie said:

Yeah, we never combine them. We report the Hgb singularly. If the crit is pertinent to the patient’s diagnosis we will also report it on its own. This goes along with nurses calling O2 saturations “O2 stats”. Both make me wonder if the person saying it actually knows what they are reporting. ??‍♀️

O2 stats is one of my biggest pet peeves. Drives me nuts.

[sevensonnets]

Aquachecks make me want to pinch somebody!

[NotMyProblem MSN, ASN, BSN, MSN, LPN, RN]

19 hours ago, KatieMI said:

Those who are interested, solve the clinical problem ?

45 years old male w/o significant PMH brought in rehab after 2 weeks in hospital due to MVA, b/l hip fracture s/p ORIF x2, shock (combined), emergency HD due to hyperkalemia x3, VAP (treated with vanco/cefepime/flagyl), critical care myopathy. Extubated 1 week ago, now on RA. HD was discontinued before discharge. Report says "now making urine". Abxs completed. Progresses very well rehab-wise.

Hb/Ht day before discharge: Hb 8.5 Ht 25 Na 135 K 4

After 24 h in rehab, patient made 4 L of clear pale urine. Hb 8.8 Ht 35 Na 128 K 3.1

- what is going on pathophysiologically? ("hypokalemia" is not counted as an answer)

This is USMLE Step 1 type and level question. I do not give pertinent multiple choices so not to make things too simple ?

Only guessing on the fly, but I’d say diabetes insipidus might be worth a discussion, given the volume and characteristics of the urinary output, which is depleting the patient’s electrolytes.

[KatieMI, BSN, MSN, RN]

10 minutes ago, BSNbeDONE said:

Only guessing on the fly, but I’d say diabetes insipidus might be worth a discussion, given the volume and characteristics of the urinary output, which is depleting the patient’s electrolytes.

Sorry, that's incorrect. You're going for zebra hunt but you need to find your horse first.

Classic mistake (for USMLE, NCLEX, AANP and ANCC board exams and pretty much every such exam): you think about a process about which you nothing written in the question, just because "it might look like it". But you have no info about that "might be". Think ONLY about what you have ?

[NotMyProblem MSN, ASN, BSN, MSN, LPN, RN]

9 minutes ago, KatieMI said:

Sorry, that's incorrect. You're going for zebra hunt but you need to find your horse first.

Classic mistake (for USMLE, NCLEX, AANP and ANCC board exams and pretty much every such exam): you think about a process about which you nothing written in the question, just because "it might look like it". But you have no info about that "might be". Think ONLY about what you have ?

OK, then my initial thought was hyperdiuresis. This, along with my ‘incorrect’ response, were the only two conditions that I came to mind. If this one is incorrect as well, I have nothing else since the h/h appears to be stable and increasing. ?

[KatieMI, BSN, MSN, RN]

12 minutes ago, BSNbeDONE said:

OK, then my initial thought was hyperdiuresis. This, along with my ‘incorrect’ response, were the only two conditions that I came to mind. If this one is incorrect as well, I have nothing else since the h/h appears to be stable and increasing. ?

"Hyperdiuresis" is not an answer, as well as "hypokalemia" or "hyponatremia". These are just facts. The answer should explain them both as well as change in Hb/Ht ratio.

Think WHY patient pees like a faucet and WHY Ht is growing MORE than Hb (pay attention to the change of Hb/Ht ratio - it is a cue). Also, think what might happen with kidneys as a result of shock and massive soft tissue injury (rhabdomyolysis is not the answer as well but a step to the right one).

[LovingLife123]

The body is now correcting itself. We often see this happen with traumas. They get a ton of fluid and product in the beginning. They can go into AKI and require short term dialysis. With shock, I’m surprised HD is used instead of CRRT with shock. CRRT is better with blood pressure.

They body holds onto this fluid. The amount of fluid can also dilute blood making the Hgb lower. Those numbers will go up as they don’t receive lots of IV fluids anymore. The electrolytes will go down with the immense urine output but are easily corrected.