An alert and oriented patient presents with a pulmonary artery wedge pressure of 4 mm Hg and a cardiac index of 0.8. The BUN is 44 mg/dL, creatinine is 3.2 mg/dL, and BP is 88/36 mm Hg
Urine output is 15 mL/hr. Lungs are clear to auscultation with no peripheral edema noted. Which of the following treatments would the physician most likely order?
a. Lasix 40 mg intravenous push
b. 0.9% normal saline at 125 mL/hr
c. Dopamine 15 mg/kg/min
d. Transfuse 1 U of packed red blood cells
B
The patient's hemodynamic parameters are most consistent with hypovolemia. The renal failure would then most probably be prerenal from inadequate blood flow. The treatment of choice for hypovolemia is fluid resuscitation. Important criteria when calculating fluid volume replacement include baseline metabolism, environmental temperature, and humidity. The rate of replacement depends on cardiopulmonary reserve, adequacy of kidney function, urine output, fluid balance, ongoing loss, and type of fluid replaced.
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