General Orders for the Renal Failure Patient





  - Renal diet (Na < 4 gm, protein 1 gm/kg)
  - Fluids: D5 1/4 NS for total fluid < 1 liter qd (for insensible losses);
  - Daily Wts;
  - Useful Medications:
        - 1,25 OH Vit D, MVI, Ca acetate (if appropriate)
        - Erythropoietin 25-500 U per Kg wt;
        - Zantac 150 mg PO qhs;
        - MVI qd (loss of water soluble vits with dialysis)
        - DDAVP w/ bleeding
        - Calcium Supplements:
                - Ca Acetate 669 mg PO qAC, or CaCO3 0.5 to 1.5 gm tid w/ meals;
                    - binds more Phosphorous than Ca Carbonate;
                - Ca Carbonate: may need upto 8-12 gm/day;
                - PhosLo 1 tab qAC,

  - Harmful Meds:
        - KCL, Mg, PO4;
        - sulfonamides (w/ anemia)
        - amphogel & basaljel as these are associated with osteodystrophy;
        - demerol

  - Decrease Dosage:
        - Digoxin
        - Gentamicin
        - Betalactams
        - Phenothiazines
        - Insulin (decr renal catabolism)
        - Atenolol
        - Procainamide
        - H2 Blockers
        - Limit milk intake;

- Labs:
        - Chem 7, Ca, Mg, Phos qd, Alk Phos qod;
        - Dextrose Stick qAc and qHs
        - CBC q weekly (Hct > 25 w/ bleeding);
        - Urine Analysis qod /UCx
        - Urine Lites q24
        - 2 hr CrClr q12
        - Urine-Myo-Heme q12




Original Text by Clifford R. Wheeless, III, MD.