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How would you answer this question?

Lab values suspicious of gastrointestinal bleeding include:

a. Increased BUN, increased creatinine
b. Decreased BUN, increased RBC count
c. Increased BUN, decreased HCT
d. Decreased HCT, decreased Hb

The correct answer is "c," increased BUN, decreased HCT.

A decrease in the hematocrit associated with an increase with BUN signals gastrointestinal bleeding.  Look for concomitant non-steroidal anti-inflammatory (NSAID) use.  Anemia is a common problem in our hospitalized patients.  However, one way to help differentiate the etiology of anemia is to take a look at the patient’s BUN.  The blood urea nitrogen (BUN) will increase and hematocrit will decrease if your patient has gastrointestinal bleeding.  Dehydration can also increase the BUN; but with dehydration you will see an increase in hematocrit, not a decrease.

 

What happens is when the patient has GI bleeding the blood is digested and proteins from the blood get back into the bloodstream in the form of urea nitrogen.  By assessing the BUN together and independent of creatinine you will be able to differentiate between renal problems, dehydration and gastrointestinal bleeding.

 

 

Here is how to use it in your practice.  A drop in hematocrit with no change in BUN indicates that the patient is bleeding elsewhere, maybe from a wound site.  A drop in hematocrit associated with an increase in BUN indicates gastrointestinal bleeding.  An increase in BUN and an increase in hematocrit indicates dehydration.

 

	HCT	BUN
GI Bleed	Dec.	Inc.
Dehydration	Inc.	­­ Inc.
Hemorrhage	Dec.	Norm.

Congratulations to Roni Kozlowski who won an autographed copy of my101 Tips to Improve Your Nursing Care book for answering this week's question correctly.  Congratulations Roni!   

Best wishes,
David W. Woodruff, MSN, RN-BC, CNS, CEN
President, Ed4Nurses, Inc.

PS. This week's question came from our Expert Assessment program.

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