Fluid chart given, what is diagnosis?

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AKI

What is the DD for AKI?

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Pre-renal
Dehydration
Sepsis
Renal
GN
Drugs
Post-renal
Ureteric stones
BPH

Pathophysiology of polyuric phase in AKI?

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Because of inability of kidney to concentrate urine, due to recovery of the glomeruli first with no improvement in distal tubules which will lead to increase in GFR.

Why are uremic patients anaemic?

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Uremic patients may develop a normocytic, normochromic anaemia for a number of reasons
Deficiency of erythropoietin (most important cause)
Bone marrow toxins
Bone marrow fibrosis
Increased red cell fragility

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Hyperkalaemia

ECG findings in hyperkalaemia?

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Flat P wave
Peaked T wave
Prolonged QRS
Arrhythmias

ECG finding in hypokalaemia?

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T wave inversion
Q-T interval Prolongation
S-T depression
U wave.

Function of potassium?

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Fluid balance
Nerve impulse function
Muscle function
Cardiac (heart muscle) function.

Action of K⁺ on the cardiac muscle?

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Excess K⁺ causes the heart to be dilated, flaccid and decreases the heart rate and can block the conduction of cardiac impulse.
i.e. increased K⁺ level will make action potential less negative decreasing the efficacy of cardiac muscle contractility

Homeostasis of potassium in body?

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Gastrointestinal (diet)
Endocrine
-Aldosterone (promotes its excretion)
-Insulin (stimulates K⁺ uptake into cells)
Renal
-Acid base balance (K⁺ and H⁺ are exchanged at the cell membrane)
-Tubular fluid flow rate

Manifestations of hypokalaemia?

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Muscular weakness and cramps
Arrhythmias
Paralytic ileus
Confusion

Manifestations of hyperkalaemia?

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Muscular weakness and cramps
Arrhythmias (can lead to cardiac arrest)
Diarrhoea
Abdominal pain
Hypotension

Management of hyperkalaemia?
Immediate management

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Immediate ABCDE assessment.
Continuous cardiac monitoring » ECG
Stop all potassium-containing intravenous fluids

Correction

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Calcium gluconate (10 ml of 10%) is given IV
Give 5-10 U of insulin in 50 ml of 50% dextrose IV - Sodium bicarbonate (50 mmol IV over 5-10 min)
Haemodialysis
Salbutamol (5-10 g/min by intravenous infusion, or nebulized)
Calcium gluconate

If this patient is confused / has dementia, how will you consent for dialysis ?

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The patient will be unable to give a consent, so I will proceed for dialysis for the patient best interest with two consultant signatures (consent type 4) after discussion with the family members.

Indication of dialysis?

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Uremic encephalopathy
Severe acidosis pH < 7.2
Intractable hyperkalaemia > 6
Pulmonary oedema