How is UO measured? By shift or by hour? Foley or urinating on
own? Has the patient been sleeping?
What is the trend over last 2-3 hours vs. last 24 hours?
Oliguria = 400ml and discomfort is relieved, leave catheter in
place.
If foley in place, flus with 20-30ml saline
Consider stones or mass obstruction
Daily weights, strict I/O
16. Management: Renal
Hyperkalemia:
Continuous cardiac monitoring
Kayexalate 15 to 30g in 50-100ml 20% sorbitol PO q 3-4 hours or
in 200ml 20% sorbitol PR q 4 hours
Dialysis for failed kidneys: can remove 30-60 mEq/hr
Contrast dye:
Creatinine peaks within 72 hours with slow recovery over 7 to
14 days with appropriate therapy.
Aminoglycosides:
higher risk: elderly, volume depletion, >5 days, large
doses, preexisting liver disease, and preexisting renal
insufficiency.
Correct preexisting volume depletion and monitor drug
levels
17. Management: Renal
Acidosis:
Treat as determined by cause of acidosis
Watch for co-existing hyperkalemia
Control is aided by restriction of dietary protein
Consider dialysis:
Fluid overload unresponsive to diuretics
Hyperkalemia with K+ >6 to 8
Metabolic acidosis pH 35mmol/L with mental status changes,
pericarditis or seizure
18. Complications
Death (50%)
Sepsis infection (leading cause of mortality)
Once ARF stabilizes, fluid replacement should be equal to
insensible losses (500 mL/day) plus urinary or other drainage
losses to avoid hypervolemia
Hypertension exacerbated by fluid overload: Use
antihypertensives that do not decrease renal blood flow
(non-dihydropyridine calcium channel blockers, cardioselective
beta-blockers, and central acting agents).
Anemia is common, caused by increased red blood cell (RBC) loss
and decreased RBC production.
Platelet dysfunction may occur secondary to the uremia and
present as gastrointestinal (GI) bleeding.
19. Special Cases
Elderly:
Elderly more susceptible to ARF (3.5 X more common)