AKI

Question 1

Patient after major surgery ( Right hemicolectomy ) , the nurses noticed decrease in The UOP .

Q1. what is your diganosis From the chart?

Answer 1

AKI

Question 2

Q2: What is the DD for AKI ?

Answer 2

Pre-Renar – > Dehydration / Hypovolemia
Renal – > ATN / Nephrotoxic drugs
Post – > Obstructive by stone or malignancy

Question 3

Q3: pathophysiology of polyuric phase in AKI ?

Answer 3

Happens after recovery of glomeruli without recovery of distal tubules

Question 4

Q4: why are uremic patients Anemic ?

Answer 4

Decrease in secretion of erythropoietin due to Kidney pathology
Circulating bone marrow toxins
Bone marrow fibrosis from OstitsFibrosaCys
Red cell fragility from uremic toxins

Question 5

Q5: What is the electrolyte imbalance cause This ECG changes ?

Answer 5

HyperKalemia

Question 6

Q7: homeostasis of potassium in body ?

Answer 6

GIT—Diet – > contain from 20-100 mmol of K daily
Endocrine – >
Aldosteron – > promotes excreation of K //
Insulin  stimulate K uptake by cells
Renal – > acid base blanance – this happen with H ion exchange at cell membrane as one of them reabsopred and the other exceated like in acidosis leads to hyperkalemia and alkalosis leads to hypokalemia

Question 6

Q6: Function of Potassium ?

Answer 6

Important for Nerve impulse function /
muscle function /
cardiac function /
maintain proper fluid balance

Question 6

Q8: Action of k on the cardiac muscle ?

Answer 6

Excess K can lead heart to be dilated/ flaccid and ↓HR and can block conduction of cardiac impulse

Question 7

Q10.Manifestations of Hyperkalemia ?

Answer 7

Anorexia, N, V // cardiac arrythmais, hypotension// ms weakness and flaccid paralysis.
CVS: o Wide QRS o Peaked T wave o Dysrhythmia o Hypotension
o Sudden death
* MSK: o Muscle cramps o Muscle weakness o Flaccid paralysis
* GIT: o Anorexia o Nausea, vomiting o Diarrhea
o Hyperactive bowel sounds o Abdominal pain

Question 7

Q9: Manifestations of Hypokalemia ?

Answer 7

Ms weakness and cramps // Confusion // Arrythmias // Paralytic ileus

Question 8

Q11: Management of hyperkalemia ?

Answer 8

According of CCRISP
Inform consultant and ITU
Transfer Pt to ITU
Stop all K containing IV fluids
CaGluconate 10 ml of 10% over 10 mins IV – OR –
Insulin 5-10 unit over 50 ml of 50% dextrose IV over 30 mins – OR –
Salbutamol IV / Nebulised – OR –
Hemodialysis is an option in case o sever acidosis

Question 9

Q12: if this patient have dementia, how will you consent for dialysis ?

Answer 9

This pt is unable to give consent So we will proceed with dialysis as it’s his best interest after obtaining two consultant signatures
This will also be discussed with family members and special nurse