From the Guidelines
A patient with a BUN of 120 mg/dL requires immediate medical attention, and the primary intervention should be prompt nephrology consultation and likely hospital admission for urgent dialysis, while also considering the management of potential heart failure as indicated by the elevated BUN level, which may involve the use of intravenous diuretics as recommended by the 2013 ACCF/AHA guideline for the management of heart failure 1. The management of such a patient involves a multifaceted approach, including:
- Discontinuation of any nephrotoxic medications, including NSAIDs, certain antibiotics, and ACE inhibitors/ARBs, as these can exacerbate kidney dysfunction, and monitoring of serum creatinine and potassium levels as recommended by the 2014 standards of medical care in diabetes 1.
- Implementation of strict fluid balance monitoring with accurate intake and output records to avoid volume overload, which is crucial in patients with severe kidney dysfunction and potential heart failure, as guided by the recommendations for therapies in hospitalized heart failure patients 1.
- Dietary protein restriction to 0.6-0.8 g/kg/day may help reduce nitrogenous waste accumulation, although the evidence on this is mixed, and the 2014 standards of medical care in diabetes do not recommend reducing dietary protein below usual intake for people with diabetes and diabetic kidney disease 1.
- Electrolyte abnormalities, particularly hyperkalemia, should be addressed with medications like sodium polystyrene sulfonate (Kayexalate) 15-30g orally or rectally, or insulin with glucose if severe, as part of the comprehensive management of kidney dysfunction and potential complications. The underlying cause of kidney injury must be identified and treated specifically, whether it's pre-renal (dehydration, heart failure), intrinsic renal damage, or post-renal obstruction requiring catheterization or other interventions, and consideration of referral to a physician experienced in the care of kidney disease for uncertainty about the etiology of kidney disease, difficult management issues, or advanced kidney disease, as recommended by the 2014 standards of medical care in diabetes 1.
From the FDA Drug Label
Reversible elevations of BUN may occur and are associated with dehydration, which should be avoided, particularly in patients with renal insufficiency
The patient with a BUN of 120 should be given fluids to avoid dehydration, particularly if they have renal insufficiency.
- Monitor the patient's renal function and electrolyte levels.
- Furosemide may not be the best option in this case, as it can worsen dehydration and electrolyte imbalances.
- Consider consulting a nephrologist for further guidance on managing the patient's renal insufficiency and elevated BUN 2.
From the Research
Patient Treatment for High BUN Levels
- A patient with a BUN of 120 may require careful management of fluid and diuretic therapy, as high BUN levels can indicate dehydration or renal impairment 3.
- Loop diuretics, such as furosemide, are commonly used to control edema and manage fluid overload in patients with high BUN levels 4, 5.
- However, the use of high-dose loop diuretics (HDLDs) has been associated with increased mortality in patients with high BUN levels, particularly in those with acute heart failure 3.
- The dosage and administration of loop diuretics should be carefully considered, taking into account the patient's renal function, fluid status, and other clinical factors 4, 5.
- In patients with high BUN levels, it is essential to monitor their fluid status and adjust diuretic therapy accordingly to avoid dehydration or fluid overload 6.
- Other strategies, such as hydration management and careful monitoring of fluid balance, may also be necessary to manage patients with high BUN levels 7, 6.