AKI Flashcards

Question

What would be seen on blood gas analysis?

Answer 1

Patients with AKI often suffer from severe metabolic acidosis due to decreased renal excretion of acid. A pH of less than 7.1 is critical as this can lead to significant cardiovascular depression and damage to enzymatic pathways.

Answer 2

Monohydrate calcium oxalate crystals are compatible with ethylene glycol toxicity. Urine sediment may also contain evidence of acute tubular injury with fine or coarse granular casts

Answer 3

Glucosuria without systemic hyperglycaemia may also be noted, which is strongly suggestive of renal injury to the proximal tubule

Answer 4

If lower titres are present, but suspicion is strong, a second MAT should be performed within two to four weeks. An increasing level would be suggestive of active infection

Answer 5

Ehrlichia canis, Borrelia burgdorferi, Rickettsia rickettsii (Rocky Mountain spotted fever) and Leishmania species

Answer 6

inhibition of alcohol dehydrogenase with the use of ethanol or 4-methylprazole (4-MP) in dogs with ethylene glycol toxicity is most effective within six to eight hours of ingestion, cats 4

Answer 7

Dogs that do not have evidence of another cause of AKI should be treated with antibiotics that target Leptospira species while diagnostic results are pending. Intravenous ampicillin or amoxicillin are commonly used initially to reduce multiplication, shedding and transmission of the organism. Oral tetracyclines, such as doxycycline, or fluoroquinolones are then used for elimination of the carrier state.

Answer 8

severe respiratory depression, coma, hypothermia, metabolic acidosis, serum hyperosmolality and diuresis

Answer 9

``` Peripheral oedema – particularly easy to note as swelling around the hock, Achilles tendons and intermandibular space Exophthalmos Serous nasal discharge Ascites or pleural fluid Tachypnoea/dyspnoea Pulmonary crackles and oedema ```

Answer 10

inhibiting the sodium-potassium-chloride (Na+-K+-2Cl−) cotransporter located on the apical membrane of the renal tubular cells of the thick ascending limb of the loop of Henle Likely only helpfull for its diuretic effects

Answer 11

elevates plasma osmolality resulting in expansion of the intravascular volume. osmotic diuretic as it is filtered freely through the glomeruli and is not reabsorbed by the renal tubules. been shown to cause significant natriuresis by either direct or indirect stimulation of atrial natriuretic peptide release or inhibition of sodium and water reabsorption in the collecting ducts of the nephron, resulting in further diuresis. Other proposed benefits of mannitol include renal arteriole dilation, decreased vascular resistance and blood viscosity, and scavenging of oxygen free radicals. Cannot be excreted by anuric kidneys so contraindicated in volume overloaded patients

Answer 12

Potassium-free or potassium-deficient isotonic crystalloid fluid such as Lactated Ringer's or Hartmann's Discontinue all potassium supplementation 10 per cent calcium gluconate intravenously over five to 10 minutes with electrocardiogram monitoring for (worsening of) bradycardia 0.25 to 0.55 IU/kg regular insulin with 2 g of 50 per cent glucose per unit of insulin intravenously (subsequent evaluations of serum glucose and potassium concentrations are indicated to avoid hypoglycaemia and evaluate the effects of therapy) 2.5 to 5 per cent glucose infusion intravenously; monitor blood glucose periodically If hyperglycaemia occurs with persistence of hyperkalaemia, repeat a low dose of regular insulin If normoglycaemic and normokalaemic, glucose infusion can be discontinued 1 to 2 mEq/kg sodium biocarbonate intravenously 1 to 4 mg/kg furosemide intravenously If severe hyperkalaemia persists with the above treatments, consider renal replacement therapy in those with potentially reversible disease and committed owners

Answer 13

Often due to polyuric phase of AKI | If persists over 48 hours should be corrected very slowly to prevent cerebral oedema

Answer 14

``` AKI, chronic kidney disease, hyperadrenocorticism, diabetes mellitus, phaeochromocytoma, hyperthyroidism obesity ```

Answer 15

Once eating, drinking, azotaemia stable or resolved, taper fluids by 25% each day and ensure are stable

Answer 16

RRT is indicated in severe cases of AKI in which renal function is expected to be, at least partially, reversible. Animals that are anuric, refractory to fluid therapy or severely uraemic with life-threatening electrolyte abnormalities benefit most from RRT

Answer 17

peritoneal dialysis (PD), intermittent haemodialysis (IHD) and continuous renal replacement therapy (CRRT)

Answer 18

ARF‐ “a rapid loss of nephron function leading to retention of nitrogenous wastes” AKI – “a spectrum of disease associated with a sudden onset of renal parenchymal injury

Answer 19

An abrupt drop in kidney function • results in abnormal GFR, tubular function and urine production • a sudden inability to maintain fluid, acid‐base, and electrolyte balance • it may result in azotaemia

Answer 20

Initiation phase - damage starts Extension phase - ischaemia, hypoxia, inflammatory response ongoing cellular injury, cell death. Maintenance phase - stabilisation of GFR, typically see azotaemia, uraemia,urine production is variable Recovery phase - azotaemia improves and the tubules undergo repair can be marked polyuria during this stage

Answer 21

Community acquired | Hospital acquired

Answer 22

misoprostol, for at least 3 days

Answer 23

Just enough to restore perfusion. Agressive 'flushing' is not effective Get an acurate weight twice daily

Answer 24

Re-assess hydration and BP. Give 3-5% of bodyweight in fluid, re-assess INI, place urinary catheter and start treatment

Answer 25

1. Furosemide • increases urine output but does not improve GFR or outcome • Allows you to carry on with IVFT • initial bolus of 1‐2mg/kg IV followed by a CRI of 0.5‐1mg/kg/h 2. Mannitol • 20% mannitol can be given‐ 0 5. ‐1 /k g g over 20 mins • Can repeat it q 4‐6h, or give a CRI • Avoid more than 2‐4 g/kg/d

Answer 26

•Vomiting - H2 antagonists, PPIs maropitant, metoclopramide or ondansetron •Hypertension exacerbated by overhydration overhydration reduce ivft, give diuretics. If persistent‐ can use antihypertensives but most are oral Nitroprusside Hydralazine Amlodipine ACEi are associated with worsening of renal function in humans * Nutrition - AKI is a highly catabolic disease * Pancreatitis and/or lung injury seem to be common in acute uraemia

Answer 27

``` •Hyperkalaemia •low albumin •decreased bicarbonate at presentation •degree of azotaemia and changes in calcium or phosphate did NOT predict survival ethylene glycol = grave once azotaemic ```

Answer 28

``` >900 azotaemia Anuria Anaemia Hypocalcaemia Azotaemia that worsens despite IVFT Lepto has a better prognosis ethylene glycol = grave once azotaemic ```

Answer 29

approx 50%

Answer 30

Typically abscent at the start of AKI, often present in CKD

AKI Flashcards

(55 cards)