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AKI (Goals (Minimize degree of insult to the kidney, reduce extra-renal…
AKI
Goals
Minimize degree of insult to the kidney, reduce extra-renal complications, and expedite the patient's recovery of kidney function.
Maintain organ function, while sustaining mean arterial pressure.
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Tx
Loop Diuretics
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Equipotent doses of loop diuretics (furosemide, bumetanide, torsemide, and ethacrynic acid) have similar efficacy.
limiting the use of loop diuretics to the management of fluid overload and avoiding their use for the sole purpose of prevention or treatment of AKI
IV-fluids
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Disadvantages include IV administration, hyperosmolality risk, and need for monitoring urine output and serum electrolytes and osmolality because mannitol can contribute to AKI
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there is no definitive therapy for AKI. Supportive care with a focus on managing fluid overload and acid-base/electrolyte imbalances is the mainstay of AKI management regardless of etiology
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Diagnosis
Thorough medical and medication histories, physical examination, assessment of laboratory values, and, if needed, imaging studies are important in the diagnosis of AKI
BUN, Scr, select blood tests, urinary chemistry, and urinary sediment are used to differentiate the cause of AKI and guide pt management
measurements of urine and serum electrolytes and calculation of the fractional excretion of sodium can help determine the etiology of AKI
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Prevention
Non-Pharm
sodium bicarb infusion 154 mEq/L (154 mmol/L) infused at 3 mL/kg/h for 1 hour before the procedure and at 1 mL/kg/h for 6 hours after the procedure.
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Pharm
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control of BG levels of 110 to 149 mg/dL w/ insulin therapy to prevent hyper/hypoglycemia in critically ill pts with AKI
clinical presentation
changes in urinary character, edema, electrolyte disturbances, sudden weight gain, sever abdominal /flank pain.