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Saturday, May 7, 2022

AKI ED Management

emDOCs - May 06, 2022 - By Anton Helman
Originally published at EM Cases. Reposted with permission
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Take Home Points for AKI ED Management
  • First and foremost, rule out immediate life threats – hyperkalemia and severe acidosis
  • Most patients with AKI simply require “fluids and a foley”, however a more nuanced treatment algorithm should be considered in complex cases
  • Have respect for new severe hypertension in the setting of AKI as these patients may have an intrarenal cause that requires urgent BP control and internal medicine consultation for further workup
  • Get help from ICU for patients with AKI, pulmonary edema and cardiogenic shock as these patients are challenging to manage
  • Not all patients with AKI require imaging; bilateral ureteric obstruction is a rare cause of AKI
  • Avoid nephrotoxins in patients with AKI whenever possible (NSAIDs, ACEi/ARBs, gentamicin, amphotericin)
  • The resuscitation fluid of choice in AKI patients is Ringer’s Lactate in small boluses with frequent assessments of volume status
  • Use AEIOU mnemonic for emergency indications for dialysis; for other AKI patients it is generally safe to delay dialysis for 1-2 days
  • IV bicarb is reasonable in AKI patients with refractory severe metabolic acidosis