Acute Kidney Injury : Management
- Management
- Treatment of precipitating cause
- Fluid restriction (600 mL plus previous 24-hr fluid loss)
- Nutritional therapy
- Adequate protein intake (0.6-2 g/kg/day) depending on degree of catabolism
- Enteral nutrition
- Parenteral nutrition
- Dietary restrictions (potassium, phosphate, sodium)
- Measures to lower potassium (if elevated)
- Therapies for Elevated Potassium levels
- Regular Insulin IV
- Potassium moves into cells when insulin is given.
- IV glucose is given concurrently to prevent hypoglycemia.
- When effects of insulin diminish, potassium shifts back out of cells.
- Sodium Bicarbonate
- Therapy can correct acidosis and cause a shift of potassium into cells.
- Calcium Gluconate IV
- Generally used in advanced cardiac toxicity (with evidence of hyperkalemic ECG changes).
- Calcium raises the threshold for excitation, resulting in dysrhythmias.
- Hemodialysis
- Most effective therapy to remove potassium.
- Works within a short time.
- Sodium Polystyrene Sulfonate (Kayexalate)
- Cation-exchange resin is administered by mouth or retention enema.
- When resin is in the bowel, potassium is exchanged for sodium.
- Therapy removes 1 mEq of potassium per gram of drug.
- It is mixed in water with sorbitol to produce osmotic diarrhea, allowing for evacuation of potassium-rich stool from body.
- Dietary Restriction
- Potassium intake is limited to 40 mEq/day.
- Primarily used to prevent recurrent elevation. Not used for acute elevation.
- Patiromer (Veltassa)
- Oral suspension that binds potassium in GI tract.
- It is used to treat chronic kidney disease.
- It should not be used as an emergency drug for life-threatening hyperkalemia.
- It has a delayed onset of action.
- Calcium supplements or phosphate-binding agents
- Initiation of dialysis (if necessary)
- Continuous renal replacement therapy (if necessary)
