AKI

Question 1

Defined as?

Answer 1

Rise in creatinine >26μmol/L in 48hrs
Rise in creatinine >1.5 x baseline
Urine output <0.5ml/kg/h for >6h

Question 2

RF’s

Answer 2

DM, 
new drugs, 
sepsis,
 CKD
, HF,
 PVD, 
liver disease, 
age >75, 
poor fluid intake

Question 3

Nephrotoxic drugs?

Answer 3

Gentamycin,
NSAID’s,
lithium,
ACEi

Question 4

Presentation

Answer 4

Nausea, vomiting, dehydration, fluid overload, confusion, oliguria

either dehydrated or fluid overload

Question 5

Ix?

Answer 5

ABCDE → C, assess volume status
Urine dip +MC&S
Bloods – U&E, creatinine, FBC, LFT, coagulation screen, CK, CRP, VBG

Question 6

Management?

Answer 6

Treat fatal consequences of AKI (↑K+ and pulmonary oedema)
Treat underlying cause!!
Stop nephrotoxic drugs
Supportive care (fluid)

Question 7

Main Causes of Death in AKI

Answer 7

1) Hyperkalaemia
2) Pulmonary oedema 2nd to fluid overload
3) Sepsis

Question 8

If the patient is severely unwell then dialysis may be required. The indications for this are:

Answer 8

Pulmonary oedema
Persistant hyperkalaemia
Severe metabolic acidosis (pH <7.2)
Uraemic complications (encephalopathy, pericarditis)
Drug overdose