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After visit summary listed things I wasn't aware of!
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beenblessed_nana posted:
I don't know about you and your doctor's but mine are all part of a system that requires them to give you an after visit summary. It consists of mostly everything you already know like your current med list. It also shows your upcoming appointments which is nice. It shows your vitals which are too often made up but we won't go there right now.

Today I saw my nephrologist. I read the "conditions discussed today or other-related diagnoses" and was completely shocked.

I had asked him why I was found to be anemic in the hospital and no one treated it but just listed it as another health issue.

So here are the "conditions, et al"
1.) Acute Renal Failure (primary)
2.) Chronic Kidney Disease Stage III (moderate)
3.) Generalized edema (which my PMD blame all of this on)
4.) Hypokalemia
5.) Hyponatremia
6.) Metabolic alkalosis
7.) Anemia

He ordered blood work and an arterial blood draw. My venous blood comes back high in carbon dioxide so he was checking to see how my arterial blood came back. Apparently, that was ok. However, I am still anemic and now I have to set up times for 3 infusions of iron.

I am on 3 different diuretics. He has added an extra potassium to what I am already taking. Two of the diuretics are potassium-sparing but I had been on Lasix for so many years that I don't slide down, I fall off a cliff and both he and my PMD know it. Hence the bolster since my potassium is at 3.4 prior to his BMP today. I haven't seen that lab work yet.

Does anyone have anything to offer about all of those diagnoses all of a sudden all at one and not one word to me about it? If so, I would appreciate it! Thank you!
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john-skpt responded:
I have to be brief right now, but:

What you mention states that you "discussed" kypokalemia and hyponatremia, low potassium and low sodium, respectively. But it doesn't say how low the levels are. You need to be cautious about the potassium especially. Both are important but the potassium can be far more dangerous.

Metabolic acidosis and the low serum CO2 are very probably related. The CO2 has to strike a balance with the Chloride, or Cl, to maintain a proper blood pH. However, ALKALOSIS and low CO2 is rather hard to figure. Seeing the Chloride and other lab numbers all together will help.

Anemia, in the absence of bleeding, generally is caused by to renal failure, but this can be treated rather easily with Procrit or Epogen or sometimes Aranesp.

Sorry I haven't any good guesses but the lab numbers might help a lot.
 
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beenblessed_nana replied to john-skpt's response:
The paperwork states we 'discussed' these diagnoses but we did not. I brought up the anemia and asked why I wasn't treated for it while I was actually IN the hospital when then tested for it and it was very low then. They just added it to my list of medical conditions. The hypokalemia is something that both my PMD and my nephrologist know that I don't slide down but drop off a cliff so being that the last labs show me at 3.4, he wanted me to add another 20 meq at hs. Being that I have COPD, I had expected to find fluctuations in my venous CO2. The hyponatremia was a surprise to me as was the metabolic alkalosis.


To be quite honest with you, I was shocked by the acute renal failure and the chronic kidney disease stage III (moderate) was quite shocking to me! I had no idea I had either of these. I know that last year after I came home after my back surgery, I went into acute renal failure and just missed going on dialysis.


I'm on an 1800ml fluid restriction. I have a problem with chronic edema which has cause chronic lymphedema and my PMD says the anemia is related to the edema.


I have a port so having to go to the DTC for the infusion is ok with me. But I am obviously not producing enough red blood cells, and hemoglobin, hence, enhancing my shortness of breath. I will take that up with my pulmonologist when I see him next. Perhaps now I will qualify for portable oxygen. I don't know. I don't understand how these diagnoses can suddenly pop up and no one has ever talked to me or my husband about them!


Thank you for your input, John-skpt! It is appreciated!


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