Provide nutrition with increased carbohydrates to decrease catabolism. T otal caloric intake of 35 to 50 kcal/kg/day should be maintained with most calories provided by carbohydrates (100 g/day).
Correct easy bleeding with DDAVP, estrogen, and cryoprecipitate
Prednisone in acute interstitial nephritis may help
Mannitol - alkaline diuresis in rhabdomyolysis
Goal is to restore BP and intravascular volume
Fluid bolus with 500ml, recheck fluid status, repeat.
Monitor vital signs and electrolytes
Normal or increased fluid status:
CHF: monitor O2 status. Lasix 20-80mg IV.
Monitor diuresis, potassium status, daily weight
Place foley, note residual. If >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
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
Creatinine peaks within 72 hours with slow recovery over 7 to 14 days with appropriate therapy.
higher risk: elderly, volume depletion, >5 days, large doses, preexisting liver disease, and preexisting renal insufficiency.
Correct preexisting volume depletion and monitor drug levels
Treat as determined by cause of acidosis
Watch for co-existing hyperkalemia
Control is aided by restriction of dietary protein
Fluid overload unresponsive to diuretics
Hyperkalemia with K+ >6 to 8
Metabolic acidosis pH <7.20
BUN >35mmol/L with mental status changes, pericarditis or seizure
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.
Elderly more susceptible to ARF (3.5 X more common)