First, we had a remarkably light admission day. We often cap at 10 patients. When you have a light day, the attending must provide more discussion and chalk talks. The ideal is 6 or 7 admissions.
Second, the team is stable. We are still puzzled about why our patient has SIADH.
Yesterday's teaching session covered reasons for an increased creatinine in a patient with known Stage III CKD. We imagined a patient with a creatinine of 2.5 last year who now comes either to clinic or the hospital with a creatinine of 3.5.
Here is my synopsis:
1. Plot 1/creatinine vs. time to look for natural progression of disease
2. Rule out obstruction – always rule out obstruction in any patient with newly elevated creatinine
3. Are the kidneys receiving adequate perfusion? This includes volume contraction and worsened CHF.
4. Drug toxicities – we mentioned (among many others) NSAIDs, Bactrim, aminoglycosides
5. A second kidney disease – patients with CKD are not immune from a second insult
6. IV contrast
7. Infection
For each step we included a discussion to provide more depth.
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