Comments on: 17 days at the VA – day 17

By: ErnieG

ErnieG — Thu, 03 Dec 2009 01:05:49 +0000

The labs don't seem worrisome. You have clear evidence ACE-I prevents progression of renal disease in proteinuric states, his acidosis is minimal, and there seem to be no clinical problem with his electrolyte abnormality. Membanous nephropathy can lead to dialysis with close to 20% mortality in the first year; type IV RTA almost never leads to severe life threatening acidosis or severe hyperkalemia leading to dysrhythmia.. Are you treating the patient, or treating yourself?

By: cory

cory — Wed, 02 Dec 2009 11:40:07 +0000

The Potassium is within normal range and the sodium and bicarb are very minimally down.
Why do anything other than continue meds?

By: Happy Hospitalist

Happy Hospitalist — Wed, 02 Dec 2009 05:19:42 +0000

I think the need for decreasing proteinuria with ACEi trumps the mild hyperkalemia and acidosis from IV RTA. Never seen someone die from that.

By: Pro Nephros

Pro Nephros — Wed, 02 Dec 2009 03:18:24 +0000

People with sickle cell disease can get tubular hyperkalemia even without an ACE-I. This being said, I personally would not consider a K of 5.1 a good enough reason to stop the ACE-I. I would put the patient on oral sodium bicarbonate tablets or Shohl's solution, and add furosemide or torsemide if necessary, in order to keep the ACE-I.