Page 139 - Critical Care Notes

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Clinical Presentation
AKI manifests as:
■ Critical illness
■ Lethargy
■ Persistent nausea and vomiting
■ Diarrhea
■ Dry skin and mucous membranes from dehydration
■ Drowsiness
■ Headache
■ Muscle twitching
■ Seizures
■ Heart failure
■ Liver disease
Signs of AKI include:
■ Urine < 400 mL/24 hr; hematuria may or may not be present
■ ↑ serum urea and creatinine
■ Peripheral and systemic edema, JVD, weight gain, ascites
■ ↑ BP → fluid overload → pulmonary and peripheral edema
■ ↓ BP → dehydration and dry mucous membranes, flat JVD
■ Tachycardia, abnormal and irregular pulse → cardiac arrhythmia
■ Kussmaul’s respirations → metabolic acidosis
■ ↑ temperature → infection; sepsis
■ ↓ LOC, lethargy, coma, seizures
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■ Electrolyte imbalance (increased serum BUN, creatinine, K , Na , phos-
phate; decreased serum calcium)
■ High bladder pressures: patients with bladder pressures >25 mm Hg
suspected of having AKI from abdominal compartment syndrome
Diagnostic Tests
■ Serum BUN, creatinine, BUN/Cr ratio, electrolytes, CBC, coagulation studies
(PT/PTT), serum osmolarity, chemistry panel, total protein, albumin, uric acid
■ Fractional excretion of Na (FENa) and urea (FEUrea)
■ Urinalysis with microscopic examination for protein and casts
■ Urine culture and sensitivity
■ Urine electrolytes, urine creatinine, specific gravity, and urine osmolarity
■ 24-hr urine for creatinine clearance
■ ECG
■ Renal ultrasound scanning
■ ABGs and CXR
■ Renal biopsy
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