AKI Flashcards
AKI is classified as
rapid loss of kidney function with or with reduction in urine output (hours to days)
**REVERSIBLE, but HIGH mortality rate
**progresses rapidly
AKI lab values
decreased GFR <90mL/min
decreased UOP <30mL/hr
increased BUN >20
increased Cr >1.2
normal urine output
30 mL/hr
400 mL/day
who usually gets AKI
people with other life-threatening conditions
often follows severe, prolonged hypotension, hypovolemia, or exposure to a nephrotoxic agent
(decreased perfusion = kidneys quit)
mortality rate of AKI developed in ICU
70-80%
categories of AKI
prerenal
intrarenal
postrenal
most common cause of prerenal
decreased CO
hypotension
hypovolemia
decreased perfusion to kidneys
most common cause of intrarenal
acute tubular necrosis (ATN)
postrenal problems include
prostate swelling causing back up of urine
manifestations of AKI
oliguria
begins 1 day after hypotensive event + lasts 1-3 weeks
FVE
metabolic acidosis
hyponatremia (disoriented, confused)
hyperkalemia (if not voiding)
waste product accumulation (BUN)
neurologic disorders
phases of AKI progression
- oliguria (<400mL/day)
- diuretic
- recovery
treatment of AKI
-correct F&E imbalances (esp high K and FVE)
-manage BP
-prevent/treat infections
-maintain nutrition
-avoid nephrotoxic drugs
assessments for FVE
diuretics?
fluid restriction
monitor dilutional lab values
daily weights ***
treatment of hyperkalemia
*dietary restriction (prevents reoccurent, NOT acute)
*potassium binders in GI tract (cation resins)
*hemodialysis
temporary:
-calcium gluconate IV
-dextrose & insulin
-sodium bicarbonate
potassium binders in GI tract
-patiromer
-sodium zirconium cyclosilicate
-sodium polystyrene sulfonate
considerations with sodium polystyrene sulfonate
PO or enema
*do NOT use as emergency drug d/t delayed onset of action
*do NOT give if paralytic ileus –> bowel necrosis can occur
calcium glutinate IV
raises threshold for excitation, resulting in dysrhythmias
dextrose & insulin
help move K back INTO cells
sodium bicarbonate
correct acidosis and cause K to move back INTO cells
