Urinary Disorders Q 30

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In a client with renal failure, which assessment finding may indicate hypocalcemia?

  

    A. Headache

    B. Serum calcium level of 5 mEq/L

    C. Increased blood coagulation

    D. Diarrhea

    

    

Correct Answer: D. Diarrhea

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In renal failure, calcium absorption from the intestine declines, leading to increased smooth muscle contractions, causing diarrhea. The presence of chronic diarrhea or intestinal disease (e.g, Crohn’s disease, sprue, chronic pancreatitis) suggests the possibility of hypocalcemia due to malabsorption of calcium and/or vitamin D.

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Option A: CNS changes in renal failure rarely include headache. Chronic renal failure causes a variety of neurologic disorders affecting the central nervous system and the peripheral nervous system. These complications include diffuse encephalopathy, seizures, stroke, movement disorders, sleep alterations, polyneuropathy, mononeuropathies, and myopathy.

Option B: A serum calcium level of 5 mEq/L indicates hypercalcemia. Hypercalcemia is defined as serum calcium concentration two standard deviations above the mean values. The normal serum calcium ranges from 8.8 mg/dL-10.8 mg/dL. Primary hyperparathyroidism and malignancy account for 90% of the cases of hypercalcemia.

Option C: As renal failure progresses, bleeding tendencies increase. Bleeding has been reported in 40–50% of patients with chronic renal failure or on hemodialysis (HD). Another study reported bleeding events in 24% of patients on HD. A hospital-based study showed that the risk of bleeding episodes is increased ?2-fold in patients with renal failure.

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