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Year 3 - TCD > Case 13 - AKI > Flashcards

Case 13 - AKI Flashcards

1
Q

What are the risk factor for sepsis?

A
  • Very young or old patients (under 1 or over 75 years)
  • Chronic conditions such as COPD and diabetes
  • Chemotherapy, immunosuppressants or steroids
  • Surgery or recent trauma or burns
  • Pregnancy or peripartum
  • Indwelling medical devices such as catheters or central lines
  • IVDU
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2
Q

What are the symptoms of sepsis?

A
  • Fever, chills and diaphoresis
  • Tachycardia
  • Tachypnoea
  • S: Slurred speech or confusion (often late sign)
  • E: Extreme shivering or muscle pain
  • P: Passing no urine (in a day)
  • S: Severe breathlessness
  • I: It feels like you’re going to die
  • S: Skin mottle or discoloured
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3
Q

What investigations are carried out in sepsis?

A
  • Blood gas: Lactate levels (raised in sepsis), BM, pH
  • Blood culture
  • FBC
  • CRP: raised may be sign of bacterial infection
  • U+E’s: kidneys are often affected early in sepsis
  • Clotting screen: measure severity of sepsis
  • LFT’s: source of infection
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4
Q

What is the treatment for sepsis? Sepsis 6:

A
  • High flow oxygen
  • IV antibiotics: broad spectrum at max dose within 1 hour of identifying high risk pts.
  • IV fluid resuscitation: 500 ml bolus
  • Blood culture and consider source control
  • Check haemoglobin and serial lactate
  • Hourly urine output measurement
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5
Q

What are the symptoms of hyperkalaemia?

A
  • Fast irregular pulse
  • Chest pain
  • Weakness
  • Palpitations
  • Light-headed
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6
Q

What are the ECG changes in hyperkalaemia?

A
  • Small/no P waves
  • Prolonged PR
  • Wide WRS
  • Peaked T waves
  • Slurring into ST (lead V1)
  • VF
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7
Q

What are the causes of hyperkalaemia?

A
  • Renal failure with oliguria/anuria
  • Addison’s disease
  • K-sparing diuretics
  • Rhabdomyolysis
  • Metabolic acidosis (DM)
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8
Q

What are the symptoms of hypernatraemia?

A
  • Lethargy
  • Thirst
  • Weakness
  • Irritability
  • Confusion
  • Signs of dehydration
  • Coma
  • Fits
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9
Q

What are the causes of hypernatraemia?

A
  • Fluid loss > Na loss
  • Diarrhoea
  • Vomiting
  • Burns
  • Diabetes insipidus
  • Primary hyperaldosteronism
  • Excessive fluid resuscitation
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10
Q

What are the symptoms of hypercalcaemia?

A
  • ‘Bones, stones, groans and psychic moans’ – bone pain, stones, abdominal groans (pain, nausea and vomiting) and psychiatric overtone (anxiety, depression, fatigue).
  • Constipation
  • Polyuria, polydipsia
  • Anorexia
  • Weight loss
  • HTN
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11
Q

What are the ECG findings of hypercalcaemia?

A

Short QT interval

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12
Q

What are the causes of hypercalcaemia?

A
  • Malignant - bone mets, PTHrP, myeloma
  • Primary hyperparathyroidism
  • Sarcoidosis
  • Lithium
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13
Q

What are the symptoms of hypokalaemia?

A
  • Muscle weakness
  • Hypotonia
  • Hyporeflexia
  • Cramps
  • Tetany
  • Palpitations/arrhythmias
  • Light-headed
  • Constipation
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14
Q

What are the ECG changes in hypokalaemia?

A
  • Small/inverted T waves
  • Long PR
  • ST depression
  • Prominent U wave
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15
Q

What are the causes of hypokalaemia?

A
  • Diuretics
  • Cushings syndrome/Steroids/ACTH
  • Diarrhoea, vomiting
  • Pyloric stenosis
  • Conn’s syndrome
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16
Q

What are the symptoms of hyponatraemia?

A
  • Anorexia
  • Nausea
  • Malaise
  • Headache
  • Irritability, confusion
  • Weakness
  • Dropping GCS, seizures
  • Oedema
  • Falls
  • HF
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17
Q

What are the symptoms of hypocalcaemia?

A

SPASMODIC’

  • Spasms (Chvosteks sign)
  • Perioral paraesthesia
  • Anxious/irritable/irrational
  • Seizures
  • Increased smooth muscle tone and colic
  • Wheeze
  • Dysphagia
  • Disorientation/confusion
  • Dermatitis/impetigo
  • Cardiomyopathy
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18
Q

What are the ECG findings in hypocalcaemia?

A

Long QT interval

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19
Q

What are the cause of hypocalcaemia?

A
  • CKD
  • Hypoparathyroidism
  • Low Mg
  • Low VitD
20
Q

How to treat hypocalcaemia?

A
  • Mild – give calcium

- Severe – calcium gluconate IV

21
Q

How to treat hypokalaemia?

A
  • If mild (>2.5mmol/L, no symptoms), give oral K supplement. Consider changing thiazide diuretics to K-sparing diuretics.
  • If severe (<2.5mmol/L, dangerous symptoms), give IV potassium cautiously.
22
Q

How to treat hyperkalaemia?

A
  • Treat underlying cause
  • Calcium gluconate or calcium chloride
  • IV Insulin/dextrose infusion
  • Salbutamol
  • Bicarbonate
  • IV NaCl and diuretic
  • Haemodialysis
23
Q

How to treat hyponatremia?

A

Correct underlying cause, never base treatment on NA concentration alone

24
Q

How to treat hypernatremia?

A
  • Give water orally

- IV Glucose 5%

25
Q

What is AKI?

A
  • Defined as decrease in kidney function.

- Rise in creatinine and blood urea nitrogen

26
Q

What are the risk factors of AKI?

A
  • Chronic kidney disease
  • HF + HTN
  • Diabetes
  • Liver disease
  • Older age (above 65 years)
  • Cognitive impairment
  • Nephrotoxic medications
  • Contrast use
  • Sepsis
27
Q

What are the pre-renal causes of AKI?

A
  • Renal artery stenosis
  • Dehydration
  • Hypotensions (hypovolaemia)
  • Sepsis
  • Shock
  • Hepatorenal syndrome
  • Severe HF
  • Intra-abdominal hypertension/compartment syndrome
28
Q

What are the renal causes of AKI?

A
  • Glomerulonephritis
  • Acute tubular nephrosis
  • Interstitial nephritis
  • Vasculitis
  • NSAIDs
  • ACEi
  • ARBs
  • Gentamicin
  • Vancomycin
  • Contrast media
  • Rhabdomyolysis
  • Myeloma
  • Tumour lysis syndrome
29
Q

What are the post-renal causes of AKI?

A
  • Renal stones
  • Pelvic cancer
  • Prostate enlargement: BPH
30
Q

Which medications are considered nephrotoxic?

A
  • NSAIDs
  • ACEi
  • ARBs
  • Gentamicin
  • Vancomycin
  • Contrast media
31
Q

What is stage 1 AKI?

A
  • Serum creatinine >26 μmol/L in 48 hours or 1.5-1.9 x baseline
  • Urine output <0.5ml/kg/hr for >6 consecutive hours
32
Q

What is stage 2 AKI?

A
  • Serum creatinine 2.2-2.9 x baseline

- Urine output <0.5 ml/kg/hr for >12 hours

33
Q

What is stage 3 AKI?

A
  • Serum creatinine >354 μmol/L or >3x baseline or on RRT

- Urine output <0.3 ml/kg/hr for >24 hours or anuric for 12 hours

34
Q

What are the symptoms of AKI?

A
  • Fever
  • Rash
  • Joint pains
35
Q

What are the signs of AKI?

A
  • Rash
  • Uveitis
  • Hydration status
  • Audible abdo bruits
  • Palpable bladder
36
Q

What are the investigations in AKI?

A
  • ABG/VBG: for K+
  • ECG: K+
  • Urine dipstick
37
Q

What do the results of urine dipstick in AKI suggest?

A
  • 3+ proteinuria indicates intrinsic renal disease.

- If blood+ and protein+ then consider glomerulonephritis

38
Q

How to treat AKI?

A
  • IV fluid rehydration 500ml in 15 min in pre-renal AKI
  • Stop nephrotoxic medications
  • Relieve obstruction in a post-renal AKI
39
Q

What does high BP do to the afferent and efferent arterioles?

A

Constricts the afferent, dilates the efferent

40
Q

Why are ACE inhibitors and NSAIDs nephrotoxic?

A
  • ACEi dilate the efferent arteriole
  • NSAIDs block prostaglandins that normally dilate the afferent arteriole (effectively constricting the afferent arteriole)
41
Q

What is the treatment for ATN?

A
  • Supportive management
  • IV fluids
  • Stop nephrotoxic medications
  • Treat complications
42
Q

What does urinalysis of ATN show?

A

Muddy brown casts found on urinalysis is a pathognomonic finding

43
Q

How long does it take for ATN to recover?

A

2-3 weeks

44
Q

What is ATN?

A
  • Damage and death (necrosis) of the epithelial cells of the renal tubules
  • Damage to the kidney cells occurs due to ischaemia or toxins.
45
Q

What are the 3 stages of ATN?

A

1- Oliguric phase: <500ml urine/day
2- Maintenance phase: No longer oliguric, creatinine stable
3- Polyuric recovery phase: large amounts of dilute urine, likely to be hypokalaemia

46
Q

What are the complications of AKI?

A
  • High K+: Hyperkalaemia
  • Pulmonary oedema/fluid overload if low urine output – dark + concentrated urine
  • Metabolic acidosis (kidneys usually excrete H+)
  • High urea: Uraemic encephalopathy and uraemic pericarditis
  • Low Ca, high PO4: lead to parathyroid hormone release which leads to bone breakdown.

Year 3 - TCD (17 decks)

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