Acute Kidney Injury (AKI)
Considerations
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Higher risk of peri-operative morbidity & mortality
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Altered pharmacology
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Dysregulation of volume status, acid-base (metabolic acidosis), & electrolytes
Management
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Consult nephrology
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Avoid further renal insults:
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Maintain euvolemia
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Maintain adequate renal perfusion: MAP > 65
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Avoid nephrotoxins: contrast dye, NSAIDs, aminoglycoside antibiotics
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Identify & treat underlying cause:
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Replace intravascular volume
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Optimize cardiac output & blood pressure
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Correct any outflow obstruction (e.g., BPH)
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Stop nephrotoxic medications
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Know indications for hemodialysis:
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Acidosis
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Electrolyte disturbances (↑ K)
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Intoxication (e.g. methanol, ethylene glycol)
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Volume overload
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Uremia
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Conflicts
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RSI with succinylcholine vs. high K+
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Need for contrast vs. AKI
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Need for surgery vs. AKI