Management

Question 1

What is the management for hyperkalaemia?

Answer 1

• Stabilise the myocardium if there are conduction abnormalities or arrhythmias, using calcium gluconate 10% 10-20ml over 5 mins
• Shift potassium back into cells using 10 units of SA insulin in 50ml 50% dextrose and consider also giving 10-20ml nebulised salbutamol

Question 2

What is the management for hypokalaemia?

Answer 2

• Correct any other underlying electrolyte abnormalities such as hypomagnesaemia
• Administer potassium chloride in sodium chloride at a max rate of 20mmol/hr

Question 3

What drugs need to be stopped for an AKI?

Answer 3

• Stop nephrotoxic drugs (NSAIDs, ACEi, ARBs)

- Stop metformin if eGFR <30

Question 4

When would dialysis be needed for an AKI?

Answer 4

• Hyperkalaemia
• Pulmonary oedema
• Metabolic acidosis
• Uraemic encephalopathy or uraemic pericarditis

Question 5

What is the management of acute tubular necrosis?

Answer 5

It is supportive, there are no specific drug treatments and withdrawal of nephrotoxic agents or of treatment of associated sepsis.

Question 6

What is the sepsis 6?

Answer 6

1. Fluids
2. Antibiotics
3. Oxygen
4. Lactate
5. Urine output
6. Blood cultures

Question 7

When is plasma and dextrose given with fluids?

Answer 7

• Give plasma when need clotting factors e.g. haemorrhage bleeding, coagulopathy
• Dextrose if hyopglycaemic or maintenance

Question 8

What is the criteria for fluid resuscitation?

Answer 8

• Assess volume status
• Systolic BP <100mmHg
• HR >90bpm
• CR >2s or peripheries cold to touch
• RR >20
• NEWS > 5

Question 9

What is the initial treatment for fluid resuscitation?

Answer 9

Fluid bolus of 500ml crystalloid (containing sodium in range of 130-154mmol/l) over less than 15mins

Question 10

What is the maintenance IV fluids?

Answer 10

• 25-30ml/kg/day water
• 1mmol/kg/day Na, K, Cl
• 50-100g/day glucose e.g. glucose 5% contains 5g/100ml

Question 11

How do you prescribe replacement fluids?

Answer 11

Add or subtract from routine maintenance, adjusting for all other sources of fluid and electrolytes.

Question 12

What is the management for an AKI?

Answer 12

• If hyperkalaemia treat immediately
• Consider NEWS and pulmonary oedema for critical care referral
• Treat hypovolaemia (bolus 250-500ml until volume replete)
• Monitor fluid balance, K, lactate + daily creatinine
• Investigations for cause
• Support - treat sepsis, stop nephrotoxic drugs and drugs that may complicate things (metformin, diuretics), consider gastroprotection and nutritional support