Questions regarding patients with chronic kidney disease.

[RSI Man]

New PGY-2 with some questions regarding patients with CKD that I hope some of the experts here can help me with.

With patients with CKD not on dialysis, who comes in for a procedure like dialysis catheter placement or AV fistula placement, would you cancel their case if they have K at 5.5 and what if at 5.8 or 6?

Another question, if someone with CKD following general anesthesia has a seizure, could the anesthetics have contributed to it?

---

Members don't see this ad.

 

[Planktonmd]

New PGY-2 with some questions regarding patients with CKD that I hope some of the experts here can help me with.

With patients with CKD not on dialysis, who comes in for a procedure like dialysis catheter placement or AV fistula placement, would you cancel their case if they have K at 5.5 and what if at 5.8 or 6?

Another question, if someone with CKD following general anesthesia has a seizure, could the anesthetics have contributed to it?

Are you sure you are a resident?

 

[toughlife]

Are you sure you are a resident?

Man you are ruthless!

 

[RSI Man]

I apologize if the simplicity of my questions offends anyone. I'm still learning and was just looking for some help. If someone can offer that, it will be of great help to my learning.

 

[Planktonmd]

I apologize if the simplicity of my questions offends anyone. I'm still learning and was just looking for some help. If someone can offer that, it will be of great help to my learning.

If a patient with chronic renal failure comes to you for dialysis catheter placement this means they are going to get dialysis as soon as you help them get dialysis access, so if the potassium is high a little bit the best thing you can do for them is let them have their catheter placed before the potassium gets really high.
So your question would probably be: How high is too high?
the answer: There is no simple answer and each patient is different, you have to remember that patients with CRF can tolerate higher numbers because it's usually chronic and not a sudden increase.
You have to come up with your own comfort level but I can tell you that anything under 6 is considered OK by almost everyone I know.
Now for your question about seizures after anesthesia in a renal failure patient:
This is why I asked you if you were really a resident because this is the type of question that a lay person would ask or maybe a lawyer trying to get free expert opinion on the internet.
As a physician you should know by now that there are multiple reasons for a seizure and that there is a difference between a seizure in someone with known seizure disorder or someone who never had a seizure before.
The anesthetic itself would probably be the last thing you should consider when you see a patient having a seizure post-op (with or without CRF), you need to figure out what caused the brain to have this electrical discharge and rule out all the possible causes.

 

[SleepIsGood]

If a patient with chronic renal failure comes to you for dialysis catheter placement this means they are going to get dialysis as soon as you help them get dialysis access, so if the potassium is high a little bit the best thing you can do for them is let them have their catheter placed before the potassium gets really high.
So your question would probably be: How high is too high?
the answer: There is no simple answer and each patient is different, you have to remember that patients with CRF can tolerate higher numbers because it's usually chronic and not a sudden increase.
You have to come up with your own comfort level but I can tell you that anything under 6 is considered OK by almost everyone I know.
Now for your question about seizures after anesthesia in a renal failure patient:
This is why I asked you if you were really a resident because this is the type of question that a lay person would ask or maybe a lawyer trying to get free expert opinion on the internet.
As a physician you should know by now that there are multiple reasons for a seizure and that there is a difference between a seizure in someone with known seizure disorder or someone who never had a seizure before.
The anesthetic itself would probably be the last thing you should consider when you see a patient having a seizure post-op (with or without CRF), you need to figure out what caused the brain to have this electrical discharge and rule out all the possible causes.

what he said...

but also we have a beautiful medicine called MIDAZOLAM..very rare to sz's nowadays as a result of it.