Stacy E. F. Melanson, Author at Oncology Nurse Advisor - Page 3

Stacy E. F. Melanson

All articles by Stacy E. F. Melanson

Ketonuria

Differential Diagnosis Diabetic ketoacidosis (DKA) Starvation Continue Reading Suggested Additional Lab Testing Anion gap is commonly measured in patients with DKA. Management of DKA involves serial measurements of electrolytes, glucose, and blood gases in the acute setting to follow clinical progress. Clinical Considerations History of diabetes in a patient who presents with ketonuria and appropriate…

INR Above or Below the Therapeutic Range

Differential Diagnosis Increased INR, Coumadin over-dosage; low INR, inadequate Coumadin dosage Clinical conditions that increase Coumadin effect and elevate INR include: Continue Reading Hyperthyroidism Low vitamin K intake Poor nutritional state Diarrhea Liver disease Congestive heart failure Cancer Connective tissue diseases High fever Conditions known to decrease Coumadin effect and decrease INR include: Hypothyroidism High…

Increased Urinary Protein

Differential Diagnosis Glomerular membrane damage Impaired tubular reabsorption of protein Continue Reading Multiple myeloma Preeclampsia Diabetic nephropathy Suggested Additional Lab Testing Initial evaluation for renal function with serum or plasma BUN and/or creatinine If there is concern about an undiagnosed case of diabetes mellitus, evaluation for diabetes If there is concern about multiple myeloma, serum…

Increased Serum Aldosterone

Differential Diagnosis Primary hyperaldosteronism Secondary hyperaldosteronism Continue Reading Suggested Additional Lab Testing Primary hyperaldosteronism Serum potassium is usually low, but a low-sodium diet may result in a normal value. Serum sodium is mildly elevated in most cases. Plasma renin activity is low for most cases of hyperaldosteronism. The low value for plasma renin makes the…

Increased Urinary Glucose

Differential Diagnosis Diabetes mellitus Impaired tubular reabsorption of glucose Continue Reading Pregnancy with latent diabetes mellitus Suggested Additional Lab Testing Serum or plasma BUN and/or creatinine is useful to initially evaluate renal function. Evaluate for diabetes mellitus if not already done.

Increased PTT Only: A Prolonged PTT with a Normal PT

Differential Diagnosis Heparin in the specimen, which may be a result of heparin treatment of the patient Treatment with low molecular weight heparin, argatroban, or lepirudin Continue Reading A lupus anticoagulant (i.e., lupus inhibitor) Deficiency of factor VIII (hemophilia A) or IX (hemophilia B) Deficiency of factor VIII (mild or severe) associated with von Willebrand’s…

Increased PT Only: A Prolonged PT with a Normal PTT

Differential Diagnosis Initiation of Coumadin therapy or a very low dose of Coumadin Inadequate intake of foods rich in vitamin K, such as cauliflower, broccoli, chick peas, other leafy vegetables Continue Reading A stimulus for disseminated intravascular coagulation (DIC) Evidence of liver disease from clinical or laboratory parameters Family history of bleeding that could be…

Increased PT and Increased PTT

Differential Diagnosis Coumadin therapy in the therapeutic or supratherapeutic range Moderate to severe vitamin K deficiency Continue Reading Treatment with high doses of heparin or low molecular weight heparin Treatment with direct thrombin inhibitors, such as hirudin or related compounds (i.e., lepirudin, refludan) or argatroban Moderate to severe DIC Moderate to severe liver disease A…

Increased D-Dimer or FDP

Differential Diagnosis DIC Thrombosis: can be venous with pulmonary embolism (PE) and/or deep vein thrombosis (DVT) or arterial, as caused by peripheral artery thrombosis, myocardial infarction, and stroke Continue Reading Pulmonary Embolism Infections Complications of pregnancy Malignancy Trauma Burns Suggested Additional Lab Testing D-dimer levels over the course of hours to days to determine if…

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