Burns and Burn Injury Q 60

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The nurse uses topical gentamicin sulfate (Garamycin) on a client’s burn injury. Which laboratory value will the nurse monitor?

  

    A. Creatinine

    B. Red blood cells

    C. Sodium

    D. Magnesium level

    

    

Correct Answer: A. Creatinine

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Gentamicin is nephrotoxic and sufficient amounts can be absorbed through burn wounds to affect kidney function. Any client receiving gentamicin by any route should have kidney function monitored. In burn patients, the systemic absorption of topical gentamicin may be enhanced, and one should be watchful for the potential repercussions.

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Option B: Topical gentamicin will not affect the red blood cell count. The gentamicin is prone to accumulate in the renal proximal tubular cells and can cause damage. Hence, mild proteinuria and reduction of the glomerular filtration rate are potential consequences of gentamicin use, achieving 14% of gentamicin users in a review.

Option C: Topical gentamicin will not affect sodium. In cases of renal impairment, dosing adjustment should be made based on the glomerular filtration rate (GFR); for a high-dose, extended interval dosing approach, the dose can be preserved, but the interval between doses should increase in line with GFR decrease.

Option D: Topical gentamicin will not affect the magnesium level. Renal function should be evaluated twice-weekly in patients without previous renal disease through serum creatinine and blood urea nitrogen. Periodic microscopic urinalysis is also vital to detect proteinuria and casts, which may indicate kidney injury.

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