Investigations Flashcards
What would an ECG show for severe hyperkalaemia?
- No discernible P waves - regular rhythm
- Wide QRS complex (>3 small squares)
- Peaked T waves
What investigations would be done for an AKI?
- U+E’s
- ABG’s
- ECG
- In hyperkalaemia it is important to monitor blood sugar
- In hypokalaemia it is important to check serum Mg
What are the pre-renal causes of AKI?
- Dehydration
- Sepsis
- Hypotension
- Hypovolaemia
- Hepatorenal syndrome
- Severe HF
- Renal artery stenosis/clot
- Bleeding
What are the renal causes of AKI?
- NSAIDs
- ACEi
- ARBs
- Gentamicin
- Vasculitis
- Interstitial nephritis
- Myeloma
- Rhabdomyolysis
What are the post renal causes of AKI?
- Prostate enlargement
- Renal stones
- Pelvic cancer
What examinations would be done for a suspected AKI?
- Fluid status
- BP
- JVP
- Loin tenderness
- Palpable bladder
- Rash
- Oedema
- Signs of autoimmune disease
What would blood only on a urine dip indicate?
Trauma, malignancy, stones, rhabdomyolysis
What would blood and protein indicate on a urine dip?
Glomerulonephritis, vasculitis, UTI, malignant hypertension
What would protein on a urine dip indicate?
Glomerulonephritis, amyloid, severe HTN, diabetic nephropathy
What would negative for blood and protein on a urine dip indicate?
Pre or post renal, interstitial nephritis, drugs, myeloma (cast nephropathy)
What observations need to be started when suspected AKI?
- Strict fluid balance chart to monitor input and output
- Use urine catheter if obstructed or unable to monitor urine output with measuring jug
What would other results on a urine dip mean?
- Send MSU if urinalysis shows leucocytes or nitrites
- Send urine protein creatinine ratio if protein >2
What specific renal investigations should be done for an AKI?
- Daily U+E’s
- Autoimmune screen if glomerulonephritis or vasculitis suspected
- Urine sodium if oliguric (<20 = reduced renal perfusion)
- Renal US
- Creatinine
- ABG if EWS >3
What are the high risk criteria for sepsis?
- New altered mental state
- Raised RR (>25)
- New need for O2 to maintain saturation more than 92% (or 88% in COPD)
- BP - systolic < 90mmHg or > 40mmHg below normal
- Raised HR (>130)
- Not passed urine in previous 18 hrs
- Temperature
- Skin: mottled or ashen, cyanosis
What is the measurement for lactate in sepsis?
> 4mmol/l is high risk of circulatory collapse and cardiac arrest so referral to ITU
