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Acute Kidney Injury - Coggle Diagram
Acute Kidney Injury
Complication
Dose of effluent
IVOIRE
No benefit of ultra high flow rates >70ml/kg/hour vs standard flow rate35mls/kg/hr
Aviod disequilibrium syndrome
reduced urea<30% every 24 hours
Fluid replacement
Pre-filter
reduced the risk fo clotting
Reduced efficiency
Post filter
Improved efficiency
Risk of filter clotting
CVVHD aim for flow rates 200-300ml/minute
Flow rates
CVVHF - flow rates proportional to fluid removal
Anticoagulation
Heparin
Titrateable
Risk of HIT
LMWH
Protacylin
Hypotension
Citrate
Pre-mixed
Loarge sodium load
HYpocalcaemia
Metabolic acidosis - as citrate metabolised to lactate
Classfication
KDIGO
1 = 1.5-2x, UO<0.5 >6hours
2 = >2x UO <0.5 >12 hours
3 = >3x, UO <0.3 >24 hours or anuria for >12 hours
RIFLE
AKIN
Contrast induced nephropathy
Risk factors
age>75
CKD
Nephrotoxic drugs
IV contrast > oral
Treatment
Stop nephrotoxins
REcued dosage
Prehydration
NAC 600mg two days prior
Urinary alkinsation with IV bicarbnoate
RRT
Management
Medical
T = Toxins
O = Obstruction
P = Screen for Primary renal
S = Sepsis and hypopurfusion
RRT
CVVHDF
CONVECTION
HYdrostatic pressure gradient
Middle molecules
CVVHD
DIFFUSION
Countercurrent
Smaller molecules
Slow continuous ultrafiltration
Ultrafiltration only
Only Fluid
Slow low efficiency daily dialysis
Performed overnight
Intermittant