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Nephrology (Acute Kidney Injury (kidney size (small (Decreased kidney size…
Nephrology
Acute Kidney Injury
definition
increase in 0.3 from baseline, 1.5 X baseline, or oliguria (<0.5 mL/kg) for more than 6 hours
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Evaluation
bedside ultrasound to rule out obstruction (if so - get urology consult)
Calculate FeNa/ or FeUrea if on Lasix - <1% / <35% prerenal and >2%/>50% intrinsic
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kidney size
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perserved
kidney size can be preserved in patients with long-standing diabetic nephropathy, HIV nephropathy, or amyloidosis
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triad of AIN
fever, rash, eosipinophilia
non drug related
connective tissue, legionella
ethylene glycol
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treatment
acidosis, fomepizole, and hemodialysis for severe cases.
Dialysis indications
Absolute indications for dialysis include hyperkalemia, metabolic acidosis, and pulmonary edema refractory to medical therapy; uremic symptoms; uremic pericarditis; and certain drug intoxications.
types of dialysis
IHD is used for stable patients with AKI, and CRRT or PIRRT for critically ill patients with unstable hemodynamics, multiorgan failure, or high catabolic states
Fluids and Electrolytes
Hypernatremia etiology
- loss of sodium and water with water greater than sodium (hypovolemic) - mcc examples include diuresis, vomiting, diahrrea, sweat loss
- net free water loss - DI
- gain of hypertonic solution of sodium bicarbonate
Tx for the most common
- fluid replacement with normal saline
- Free water deficit: MDCALC
how to calculate
Current TBW = Normal TBW (which is 0.6 x kg, or 0.5 in men) x (140/Current Na); free water deficit is Normal - current
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