Wk 5 Acute Kidney Injury Flashcards
Define acute kidney injury.
A rapidly progressive, sudden decline in kidney function that may be reversible
What would a GFR be for someone with AKI?
<90ml/min
What would urine output look like for someone with AKI?
<30 ml/hr
What would BUN look like for someone with AKI?
> 20 mg/dL
What would creatinine look like for someone with AKI?
> 1.2 mg/dL
How fast does AKI occur?
It usually occurs within hours of onset of the problem
What are four labs that we can use to determine if someone is having an AKI?
GFR, urine output, BUN, creatinine
What urine output is normal for 24 hours?
Greater than 400 mLs in 24 hours
What is the medical term for decreased urine output?
oliguria
What is the normal BUN range?
10-20
What is the normal range for creatinine?
0.5-1
AKI encompasses the entire scope of the syndrome, which means…
It can range from slight deterioration in kidney function to severe
What is AKI characterized by?
Rapid loss in kidney function, within hours to days
Does someone with AKI always have decreased urine output?
No, it can be with or without urine output
Although AKI is potentially reversible, it has a very high __ __.
mortality rate
A person who suffers an AKI is typically suffering from other…
life threatening conditions
What are three typical precursors to an AKI?
Severe, prolonged hypotension, hypovolemia, or exposure to a nephrotoxic agent
Why does hypotension and/or hypovolemia result in an AKI?
Decreased perfusion to the kidneys
Where do most AKI occur?
Prerenal
What is a prerenal cause of AKI?
It originates in the intravascular system, before the kidneys, such as decreased cardiac output
What is the most common cause of intrarenal AKI?
Acute tubular necrosis
What is acute tubular necrosis?
Damage to the tubule cells which results in the kidneys not being able to filter the blood, a build up of wastes occurs
What causes acute tubular necrosis?
Ischemia of the kidneys or damage from a toxic substance
Hypokalemia would cause which type of AKI?
Prerenal
What is an example of a post renal cause of AKI?
BPH, a back up of urine causes AKI
What are the three different phases of AKI?
Oliguric, diuretic, and recovery phase
How long does it take for someone to recover from AKI?
It can last 1-3 weeks
Someone with an AKI will develop __ __ excess
Fluid volume excess
Because an AKI can lead to fluid volume excess, what will this result in?
Hyponatremia
A patient whose kidneys are not working build up wastes in the blood which leads to __ __
Metabolic acidosis
What is a neurological sign of AKI?
Altered LOC
Is someone with AKI/CKD hypokalemic or hyperkalemic?
Hyperkalemic
What is the primary treatment in AKI?
Undo what is causing the injury and correct fluid and electrolyte imbalances
What are the manifestations of acute kidney injury?
Hyperkalemia
Hyponatremia (dilutional)
Fluid volume excess
Metabolic acidosis
Altered LOC
Decreased urine output
What are four additional treatments for AKI?
Manage BP
Prevent/Treat infections
Maintain Nutrition
Avoid nephrotoxic drugs
Someone with AKI may have __ restrictions
fluid
What orders might someone with an AKI have?
Fluid restrictions
Daily weights
Diuretics
Dietary restriction of potassium is used for what?
Prevention of recurrent hyperkalemia, not acutre hyperkalemia treatment
What are three GI drugs that can be used to lower serum potassium?
Patiromer (Veltassa)
Sodium zirconium cyclosilicate (Lokelma)
Sodium polystyrene sulfonate (Kayexalate)
Sodium polystyrene sulfonate can be given __ or __
Po or enema
Kayexalate can be given __ or __
PO or enema
What is the brand name of sodium polystyrene sulfonate?
Kayexalate
What is the generic name of Kayexalate?
sodium polystyrene sulfonate
What is the brand name of patiromer?
Veltassa
What is the generic name of Veltassa?
Patiromer
What is the brand name of sodium zirconium cyclosilicate?
Lokelma
What is the generic name of Lokelma?
sodium zirconium cyclosilicate
What type of drug is lokelma, veltassa, and kayexalate?
Potassium binders in the GI tract, cation exchange resins
Kayexalate should not be used for…
emergency, life threatening hyperkalemia
What is a contraindication to GI potassium binders?
Paralytic ileus because we count on peristalsis to move the potassium out of the body
What is an intravenous medication that can be given when someone is hyperkalemic, but it doesn’t actually lower serum potassium?
Calcium gluconate
How does calcium gluconate IV work?
Calcium increases the threshold potential, thus restoring the normal gradient between threshold potential and resting membrane potential, which is abnormally elevated in hyperkalemia.
What is a combination that can be given IV to correct hyperkalemia?
Insulin and glucose
How does insulin and glucose help to correct hyperkalemia?
It temporarily shifts potassium back into the cells and out of the blood
What base can be given IV to correct hyperkalemia?
Sodium bicarbonate
How does sodium bicarbonate correct hyperkalemia?
It corrects acidosis and forces K back into the cells
What is the disadvantage of Calcium gluconate, Insulin, and Bicarb for hyperkalemia correction?
They are all temporary, only buys you some time
Potassium is a major __ __ of the body
intracellular cation
Cations have a __ charge
positive
What is the most effective way to remove potassium from the body?
Hemodialysis
