13 - AKI Flashcards by Mark Brown

ECG:

QRS > 0.12

No disernable waves

Peaked T waves

Hyperkalaemia

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ECG:

Prolonged PR
Prominant U waves

ST depression

Hypokalaemia

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What is SALFORD used for?

Used for treatment of AKI

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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.

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Treatment of hyperkalaemia?

IV Calcium gluconate

IV insulin + glucose

Salbutamol nebulised

IV bicabonate

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What is the treatment of non urgent hyperkalaemia?

PO Polystyrene sulfonate resin

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Risk factors for AKI?

>65

history of AKI

CKD

obstruction

CCF

liver disease

neurological disability

sepsis

hypovolaemia

oliguria < 0.5 mL/Kg/hour

nephritexic drugs

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What drugs are nephrotoxic?

ACE-i

ARBs

diuretics

NSAIDS

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How is eGFR calculated?

eGFR = 1/ creatinine

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What does a protienuria > 3 from a urine dipstick indicate?

renal disease

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What does blood with positive protien in dipstick indicate?

Glomulonephritis

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Urea is a broken down from what?

Amino acids and ammonia

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What is ATN?

Acute tubular necrosis

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What are the 3 phases of ATN?

Oliguric

Maintenance

Polyuric recovery

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What happens to creatin in the Oliguric phase of ATN?

rises quickly

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What happens to creatin in the maintenance phase of ATN

rises slowly or remains the same

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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