AKI in Sepsis - Dr. Gawad
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This document discusses acute kidney injury (AKI) in patients with sepsis. It recommends using isotonic crystalloids for initial volume expansion in at-risk patients and those with AKI. Albumin may have a role in patients requiring substantial crystalloid volumes or those with low serum albumin. Sodium bicarbonate administration has failed to improve hemodynamics in human studies of lactic acidosis and may increase risks. Guidelines are missing data on albumin benefits in low albumin patients and bicarbonate risks.
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AKI in Sepsis - Dr. Gawad
- 1. AKI in Sepsis Mohammed Abdel Gawad Nephrology Consultant - Alexandria - Egypt MD Nephrology - Mansoura University NephroTube Founder/Admin drgawad@gmail.com NephroTube Webinar May 2020
- 2. To download the lecture with full animations contact me drgawad@gmail.com For more Nephrology lectures visit www.NephroTube.com
- 20. 05
- 24. N Engl J Med 2004;350:2247-56. n = 6997 Albumin Saline
- 25. N Engl J Med 2004;350:2247-56. n = 6997 Albumin Saline
- 26. Outcome: Deaths Cochrane Database Syst Rev. 2013 Feb 28;2:CD000567.
- 28. What is KDIGO missing?
- 29. N Engl J Med 2004;350:2247-56. n = 6997
- 30. Crit Care Med. 2011 Feb;39(2):386-91 17 RCT, n=1977 Outcome: Deaths p .047
- 31. Crit Care Med. 2013; 41: 580–637.
- 32. Crit Care Med. 2013; 41: 580–637.
- 33. Crit Care Med. 2013; 41: 580–637. And this is what KDIGO missing
- 34. BMJ. 2006 Nov 18;333(7577):1044. n = 6045 Albumin Saline
- 35. J Chin Med Assoc. 2009 May;72(5):243-50 Albumin ≤ 20 g/L Albumin > 20 g/L A daily minimum of 25 g intravenous human albumin for 3 days during their first 7 days of admission
- 36. Albumin use AKI in critically ill and septic patients • Isotonic crystalloids for initial management for expansion of intravascular volume in patients at risk for AKI or with AKI. • Albumin in severe sepsis and septic shock when patients require substantial amounts of crystalloids. • Albumin as a part of initial volume replacement may have a role in low serum albumin patient (<2-2.5 g/dl).
- 38. NephSAP AKI 2017
- 39. NephSAP AKI 2017
- 40. !
- 42. July 16, 2019 05
- 43. Sodium bicarbonate administration in the setting of lactic acidosis has consistently failed to significantly improve hemodynamic status in humans July 16, 2019 05
- 44. In the bicarbonate group the following increased: All-cause mortality Risk of hypocalcaemia 04
- 45. NephSAP Volume 18, Number 2, May 2019 QUESTIONS
- 46. NephSAP Volume 18, Number 2, May 2019 QUESTIONS
- 47. NephSAP Volume 18, Number 2, May 2019 QUESTIONS ICU patients with a pH less than 7.20, PaCO2 ≤45 mmHg, and serum bicarbonate ≤20 mmol/L received 4.2% sodium bicarbonate (The bicarbonate infusion was titrated to increase the arterial pH to 7.30): • decreased rate of acute kidney injury requiring renal replacement therapy • improved mortality at 28 days • lower rate of hyperkalemia, • higher incidence of metabolic alkalosis, hypernatremia, and hypocalcemia
- 56. NephSAP AKI 2017
- 57. NephSAP AKI 2017
- 68. NephSAP AKI 2017
- 69. NephSAP AKI 2017
- 71. Check RRT in AKI lecture
- 72. Test Yourself
- 73. NephSAP
- 74. NephSAP
- 75. NephSAP
- 76. NephSAP
- 77. NephSAP
- 78. NephSAP
- 79. Thank You
Editor's Notes
- Sodium bicarbonate produces CO2 after buffering plasma protons. This CO2 is then free to diffuse across cell membranes resulting in an intracellular hypercarbic acidemia, while bicarbonate is unable to cross cell membranes to buffer this effect. Nonbicarbonate Buffers. Bicarbonate buffering results in carbon dioxide production and a lowering of free proton concentration. Lower free protons favors disassociation of nonbicarbonate buffers which, in turn, are buffered again by bicarbonate resulting in increasing carbon dioxide production resulting in a cycle of increasing intracellular carbon dioxide so long as exogenous bicarbonate is administered. Acceleration of lactate generation — Acidemia may act as a "brake" on lactic acid generation by inhibiting glycolysis, largely mediated by a reduction in the activity of the enzyme, phosphofructokinase [17].