Acute Kidney Injury Management Flashcards
(15 cards)
What do you monitor in AKI?
Fluid balance - urinary catheter and urine output Potassium Acidosis Observations every 4 hours Lactate if sepsis signs Daily creatinine
How do you manage AKI?
Supportive: Treat sepsis Stop nephrotic medications Stop drugs that increase complications Check all drugs are appropriate for renal impairment Consider gastroprotection Nutritional support Fluids if hypovolaemic Avoid radiological contrast
What drugs should you stop in AKI?
NSAIDs, Aminoglycosides ACEi ATII RBs Diuretics
May increase risk fo toxicity:
Metformin
Lithium
Digoxin
What drugs are safe to continue?
Paracetamol Warfarin Statins Aspirin Clopidogrel Beta blockers
What is treatment for pre-renal disease?
Correct volume depletion ardor increase renal perfusion by circulatory or cardiac support
Treat sepsis
What is treatment for renal disease?
Refer for biopsy - specialist treatment of intrinsic disease
What is treatment of post-renal disease?
Catheter
Nephrostomy
Urological intervention
How can you assess for hypovolaemia?
Reduced BP Reduced urine volume JVP not visible Poor tissue turgor Tachycardia Weight loss Slow capillary refill
How can you assess for fluid overload
Raised BP Raised JVP Lung crepitations Peripheral oedema Gallop rhythm
What should you do if a patient is hypovolaemic shock?
Give 500ml crystalloid over 15 minutes
Reassess fluid state - get expert help if patient remains shocked
Further boluses of 500ml crystalloid with clinical review
Stop when euvolaemic or 2L given–>ICU help
How should you treat fluid overload?
Oxygen supplementation
Fluid restrict - monitor fluid output and input
Diuretics only in symptomatic overload
RRT
What are ECG changes in hyperkalaemia?
Tall tented T waves
Increased PR interval
Small/absent P wave
Wide QRS
Sine wave pattern
tReat K>6.5mmol/L or ECG changes
How do you treat hyperkalaemia?
Stabilise the cardiac membrane:
10% Calcium glutinate IV (or calcium chloride) via big vein over 5-10mins. repeat if ECG changes persist
Shift of K from extracellular to intracellular fluid:
Insulin IV with dextrose solution stimulates intracellular uptake of K, lowering serum K. Monitor for hypoglycaemia
Salbutamol nebulisers causes intracellular K shift, causes tachycardia
Removal of K from body:
Treat cause
Loop diuretics
Dialysis
What are indication for RRT in AKI?
Fluid overload unresponsive to medical treatment
SEvere/prolonged acidosis
Recurrent, persistent hyperkalaemia despite treatment
Uraemia - pericarditis, encephalopathy
What are implications of RRT?
Dialysis catheter insertion risk Procedural hypotension Bleeding due to anticoagulant requirement Altered nutrition Drug clearance
