Question

a.he most common reasons for initiating dialysis in acute kidney injury include which of the following? Select all that apply. Select one or more: a. Volume overload b. Acidosis c. Hyperkalemia d. Hypokalemia

b.The most common cause of acute kidney injury in critically ill patients is:

  

Select one:

a. Medications.  

b. Fluid overload.  

c. Sepsis.  

d. Hemodynamic instability.

Answer 1

1) Volume overload and hyperkalemia

Initiating dialysis may have a beneficial impact on survival of critically ill patients with acute kidney injury. Initiating dialysis in AKI is based on clinical criteria and not on serum creatinine or another serum/urine-based biomarker.

The combination of evaluation of fluid status (overload) and urine output, is one of the most important criteria to start dialysis.Other major criteria include:

- volume overload unresponsive to diuretic therapy;

- electrolyte and acid-base disturbances refractory to medical management, particularly severe hyperkalemia and metabolic acidosis;

- pericarditis and encephalopathy

2) Sepsis

Acute kidney injury (AKI) is an abrupt decrease in glomerular filtration rate (GFR) which results in the retention of metabolic waste products and the dysregulation of fluid, electrolyte and acid-base homeostasis.

- In AKI there is hemodynamic disarrangement that disturb normal renal perfusion and decrease GFR (leading to parenchymal injury obstruction to urine flow; and acute parenchymal injury). The most common causes of AKI in critically ill patients include hemodynamically mediated prerenal dysfunction and acute tubular necrosis (ATN) due to ischemia-reperfusion injury, nephrotoxic exposure, or sepsis

- Sepsis and septic shock remain the most important causes of AKI in critically ill patients and account for more than 50% of cases of AKI in the ICU