Renal - AKI

Question 1

Clinical Manifestations of Hyperkalaemia

Answer 1

May be none

Question 2

AKIA and hyperkalaemia - ECG changes

Answer 2

Broad QRS, Peaked T waves, P wave may disappear, may progress to sine wave pattern - ventricular standstill

Question 3

Drugs Implicated with Hyperkalaemia

Answer 3

ACE inhibitors e.g. Ramipril
Angiotensin Receptor Blockers
Spironolactone, Epleronone,
etc (finish card)

Question 4

Treatment for Hyperkalaemia (5)

Answer 4

1) Stop hyperkalaemic medications eg ACEi
2) Stabilise myocardium with ca gluconate/chloride
3) Temporising measure - redistribute potassium (insulin/dextrose, bicarbonate, beta agonists)
4) Reduce absorption from GI tract (Ca resonium, zirconium/patiromer)
5) Remove from body (Dialysis)

Question 5

Management of Hyperkalaemia (>6.4 or ECG changes)

Answer 5

Ensure patient has cardiac monitoring
Review medication chart
IV Calcium Gluconate (10ml of 10% over 10 mins IV) to stabilise myocardium (Can be repeated if ECG changes persist)
IV Insulin (rapid acting preparation) + Dextrose over 20 minutes - Check blood glucose due to hypoglycaemia risk
FINISH CARD

Question 6

Metabolic Acidosis:
... pH (...)
... pCO2 (usually)
... bicarbonate
... base excess (-ve)
... variable

Answer 6

Low pH (<7.35)
Low pCO2 (usually)
Low bicarbonate
Low base excess (-ve)
Po2 variable

Question 7

Metabolic Acidosis and AKI

Answer 7

Kidney failure is associated with acidosis (Retention of metabolic acids) Acidosis may lead to tachypnea - need to differentiate from pulmonary oedema

Question 8

Metabolic Acidosis and AKI - acidosis is exacerbated by other conditions that increase acid load e.g

Answer 8

DKA
Lactic Acidosis
Drug Acidosis - salicylates, ethylene, glycol

Question 9

What causes AKI? … renal, …. renal, … renal

Answer 9

Pre renal, Intrinsic renal, Post renal

Question 10

How is AKI identified?

Answer 10

Bloods/Urine Assessment

Question 11

How is AKI managed?

Answer 11

Depends upon the aetiology - most commonly fluid assessment and medication review. Potassium review and hyperkalaemia management lifesaving