13 - AKI Flashcards
ECG:
QRS > 0.12
No disernable waves
Peaked T waves
Hyperkalaemia
ECG:
Prolonged PR
Prominant U waves
ST depression
Hypokalaemia
What is SALFORD used for?
Used for treatment of AKI
What does SALFORD stand for?
Sepsis
Ace-i and NSAIDS
Labs and leaflets
Fliud assesment
Obstruction
Renal and critical care referral
Dip urine and document it.
Treatment of hyperkalaemia?
IV Calcium gluconate
IV insulin + glucose
Salbutamol nebulised
IV bicabonate
What is the treatment of non urgent hyperkalaemia?
PO Polystyrene sulfonate resin
Risk factors for AKI?
>65
history of AKI
CKD
obstruction
CCF
liver disease
DM
neurological disability
sepsis
hypovolaemia
oliguria < 0.5 mL/Kg/hour
nephritexic drugs
What drugs are nephrotoxic?
ACE-i
ARBs
diuretics
NSAIDS
How is eGFR calculated?
eGFR = 1/ creatinine
What does a protienuria > 3 from a urine dipstick indicate?
renal disease
What does blood with positive protien in dipstick indicate?
Glomulonephritis
Urea is a broken down from what?
Amino acids and ammonia
What is ATN?
Acute tubular necrosis
What are the 3 phases of ATN?
Oliguric
Maintenance
Polyuric recovery
What happens to creatin in the Oliguric phase of ATN?
rises quickly
What happens to creatin in the maintenance phase of ATN
rises slowly or remains the same
What happens to creatin in the polyuric recovery phase of ATN?
Decreases
What is the urine output for the oliguric phase of ATN?
<500 ml
What phase of ATN has a risk of hyperkalaemia?
Oliguric due to renal impairment
What phase of ATN is at risk of hypokalaemia?
Polyuric recovery phase - lots of water and electrolyte loss
What is urea recycling?
Urea can be excreted via the kidneys or the GI system. In the GI system microbes produce ammonia which is reabsorbed from the urea.
This means that urea is not a reliable indicator kidney function
What medicine should be stopped in AKI due to toxicity?
Digoxin
Lithium
Metformin
Should ACEi or ARB be continued or stopped during ATI?
Thye should be stopped
Should warfarin be continued during AKI?
Yes, warfarin should be continued
Should clopidogrel and asprin be stopped during AKI?
No, continue use of clopidogrel and aspirin
What are the criteria for AKI stage 1
< 0.5 ml per Kg for > 6 hours
50% increase serum creatinine
Definition of AKI?
increase of serum creatinine by 50%
< 0.5 ml/Kg of urine
-25% eGFR
Loop diuretics are not recommended in AKI excpet when?
Fliud overloaded
+ recovering renal function/ renal replacement therapy
Indications for renal replacment therapy?
Hyperkalaemia
Pulmonary oedema
Fluid overload
Metabolic acidosis
Ureamic complactions - pericarditis and encephalopathy
What is the intial fluid delivery in resuscitation?
500ml crystaloid in < 15 mins
What is a side effect of omeprazole?
Hyponatraemia
What is ACR?
Albumin creatinine ratio
What does ACR show?
Shows proteinurea
Clinically significant > 3mg/mmol
What is the most common intrinsic renal cause of AKI?
ATN - acute tubular necrosis
What are the pre renal cuases of AKI?
Hypoperfusion - spesis, hypovolaemia
Renal artery stenosis +/- ACEi
How much K+ is needed for fluid maintence?
1 mmol/kg/24hr
How much Na+ is needed for fliud maintenance?
2 mmol/kg/24 hr
NICE risk stratisification tool for sepsis
PLEASE LOOK UP YOU LAZY BASTARD
What affect does IV insulin and dextrose have on during hyperkalaemia?
A) Remove K+ from the body
B) Short-term shift in potassium from extracellular to intracellular fluid compartment
C) Stabilise cardiac membrane potential
B - Short-term shift in potassium from extracellular to intracellular fluid compartment
