AKI/ICU

Question 1

For which med is CVVH first line-therapy for intoxication?

Answer 1

Never; its too slow. HD first, then filter

Question 2

Do you use RRT for tylenol overdose?

Answer 2

Question 3

Dry gas, windshild wiper fluid. What ingestion? What clinical findings?

Answer 3

Methanol
Blindness
HAGMA and OG

Question 4

Antifreeze. What ingestion? What clinical findings?

Answer 4

Ethylene glycol
Renal failure with oxaluria
(cardiovascular collapse)
HAGMA and OG

Question 5

Rubbing alcohol.
What ingestion? What clinical findings?

Answer 5

Isopropranol
OG but no anion gap

Question 6

What are the different metabolites for the alcohols? What is the medicaton for treatment?

Answer 6

Question 7

When do you give fomepizole? Before or after dialysis?

Answer 7

Give after, because it is dialyzable

Question 8

Do you dialyze methanol?
What are the indications?

Answer 8

HD for acidosis

Question 9

Dumbell crystals?

Answer 9

CaOx monohydrate
(M looks like a dumbell)

Question 10

Diamond/envelope crystals?

Answer 10

CaOx dihydrate
(2 pyramids stuck on top of each other)

Question 11

What kind of alcohol ingestion gives you oxalate stones?

Answer 11

Ethylene glycol

Question 12

Do you dialyze ethylene glycol, and if so what are the indications?

Answer 12

Renal failure
MetAc, heart failure, pulm edema, AMS

Question 13

What happens to the gaps?

Answer 13

OG turns into AG with the metabolism process

Question 14

Can you dialyze propylene glycol?
What med do you find this in?
What kind of AB DO?

Answer 14

Can dialyze
Lactic acidosis without a source

Question 15

Why do you treat patients with salicylate poisoning with NABC?

Answer 15

Move the salicylate out the CNS and into the blood (not to treat the MetAc)

Question 16

Indication for HD with salicylate intoxication?

Answer 16

renal failure; non-cardiogenic pulmonary edema, SZ or persistent CNS symptoms, and severe acid-base disorder

If they are tacypneic - then they have CNS involvement (aka if they have a RespAlk, you should HD)

Question 17

When do you dialyze for Li toxicity?

Answer 17

HD for levels > 4 and gfr < 60
AMS, decreased consciousness, SZ or dysrhythmias (regardless of the Li levels)
Use intermittent HD

Rebound Li after HD is good; it means that you are clearing and the Li is moving out of the intracellular space

Question 18

When do you dialyze for metformin?

Answer 18

Lactic acid > 20, pH ≤ 7, shock, failure of standard supportive measures

HD is more important for the acidosis, rather than the removal of the drug

Question 19

Can you HD for dabigitran?

Answer 19

Yes