Mr. S., a 38 y.o. African American male, came to the hospital with nausea, vomiting and fatigue. Initial creatinine was 36.2 mg/dl. After hydration overnight it came back at 38 mg/dl.
Update: one of the comments asked about the patients body habitus, rhabdo and BUN.
- Mr S. is muscular but no body builder
- He was not in rhabdo. I would not include an elevated creatinine due to muscle breakdown under the crazy numbers tag as it essentially represents a lab error, in that the creatinine is no longer a measure of severity of the renal failure or the chronicity but rather a measure of the aggregate muscle damage.
- His BUN was 139 mg/dL
This patient had a remote diagnosis of hypertension but had been out of any medications for months. The computer showed a 2 year old creatinine of 2 but the patient denied any memory of being told he had CKD.
One of my co-fellows, Rajiv Poduval, used to call this acute ESRD. Chronic kidney disease that goes unrecognized until the patient rolls into the ED in need of dialysis.
Tragic
wow, it was ALMOST higher than his age!
What was the BUN? Did he have rhabdo? was he muscular?
I have updated the post with answers to your questions.
We had a patient with a creatinine of 50 mg/dL.
from Brazil
What was going on with Mr. Brazil. 50 is crazy!