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46 - Acute kidney injury and emergent dialysis

from Section 7 - Renal emergencies

Published online by Cambridge University Press:  05 November 2013

Kaushal Shah
Affiliation:
Department of Emergency Medicine, Mount Sinai School of Medicine, New York
Jarone Lee
Affiliation:
Department of Emergency Medicine, Massachusetts General Hospital, Boston
Kamal Medlej
Affiliation:
American University of Beirut
Scott D. Weingart
Affiliation:
Department of Emergency Medicine, Mount Sinai School of Medicine, New York
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Summary

This chapter discusses the diagnosis, evaluation and management of acute kidney injury (AKI). It describes special circumstances for diagnosis and management of acute interstitial nephritis, contrast-induced nephropathy and rhabdomyolysis. A careful patient history frequently reveals etiology of renal failure (e.g., medications or recent administration of contrast dye). A careful patient history and appropriate laboratory testing should reveal the cause of AKI. Once AKI is diagnosed, all drugs that cause renal injury should be discontinued. Volume overload due to AKI can lead to pulmonary edema, which may require respiratory support including noninvasive positive-pressure ventilation or intubation. Patients with AKI who suddenly decompensate should be rapidly evaluated for electrolyte imbalances. Hyperkalemia, which can cause cardiac arrhythmias, is the most concerning. AKI resulting in metabolic acidosis can cause hypotension. Temporary treatment includes volume resuscitation and vasopressors. A sodium bicarbonate infusion can be considered while preparing for dialysis.
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Publisher: Cambridge University Press
Print publication year: 2013

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