Critical Care 1 Flashcards
Starting dose of Levophed
0.5 μg/kg/min
Dose range at which dopamine primarily stimulates β1-receptors
7-10 μg/kg/min
Dose range at which dopamine primarily stimulates α1-receptors
> 10 μg/kg/min
What is the main downside of epinephrine?
Increased myocardial oxygen demand
Which vasoactive agents for shock act mainly by increasing cardiac stroke volume?
Dobutamine and milrinone
Which patients should not receive milrinone or dobutamine?
Hypotensive ones
Acid-base disturbance can occur with excessive resuscitation with NS
Hyperchloremic metabolic acidosis
Main drugs used in type-1 hepatorenal syndrome
Albumin, octreotide, and midodrine —> if no response, start norepinephrine
What distinguishes HRS from other causes of AKI in patients with cirrhosis?
Lack of response to crystalloids, benign urine sediment, minimal proteinuria (<5g/day), very low Na excretion, <10 mEq/L, and oliguria.
ICA definition of hepatorenal syndrome (aside from presence of cirrhosis)
- Serum creatinine >1.5 mg/dL
- Cr fails to improve after 48 hrs of diuretic withdrawal and albumin administration
- absence of shock
- no Tx w/ nephrotoxins
- no evidence of parenchymal kidney disease
What counts as evidence of parenchymal kidney disease (for the ICA definition of HRS)?
proteinuria >500 mg/day, microhematuria (>50 RBC/hpf), and/or abnormal renal US
ICA definition of TYPE-1 HRS
doubling of Cr (to >2.5) in <2 wks
Dosing for albumin in type-1 HRS
1 g/kg on day 1
then 20-40 g/day of 25% albumin
Why might CRRT be better than intermittent HD for HRS patients?
corrects Na more gradually and allows for greater CV stability
Dosing of albumin for large volume paracentesis (>5 L) recommended by the EASL
8 g/L removed
